Pulmonary Artery Catheter Questionnaire


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Pulmonary Artery Catheter Questionnaire

  1. 1. 1 <ul><li>Which of the following attempts at pulmonary artery catheter (PAC) placement should be discontinued? (check one) </li></ul><ul><ul><li>Blood aspirated from the PAC introducer from the left internal jugular puncture site reveals a pH 7.29, PO2, 60 torr, hemoglobin saturation 90% </li></ul></ul><ul><ul><li>Five-beat ventricular tachycardia occurs while passing through the right ventricle. </li></ul></ul><ul><ul><li>While attempting catheterization, the nurse pints out that the patient had a left bundle branch block (LBBB) on the admission EKG. </li></ul></ul><ul><ul><li>Patient complains o pain at the insertion site. </li></ul></ul><ul><ul><li>Large-v-waves are seen on the monitor </li></ul></ul>
  2. 2. 2 <ul><li>During a right subclavian vein catheterization attempt, a 35-yar-old female patient becomes tachypneic, tachycardia, hypotensive and hemiplegic. Auscultation of the chest revealed breath sounds to be present and symmetrical in all areas. Heart sounds were obscured by a crunching murmur that had not been present previously. Which one of the following is the MOST appropriate initial maneuver? (check one) </li></ul><ul><ul><li>Immediate pericardiocentesis </li></ul></ul><ul><ul><li>Left lateral decubitus and Trendelenburg positioning </li></ul></ul><ul><ul><li>Immediate systemic heparinization </li></ul></ul><ul><ul><li>Needle decompression of the right chest </li></ul></ul><ul><ul><li>Chest radiograph </li></ul></ul>
  3. 3. 3 <ul><li>If the PAC balloon rup0tuers and 1./5 ml o air is inadvertently injected, which one of the following is MOST LIKELY to occur to the patient? (check one) </li></ul><ul><ul><li>No detectable change </li></ul></ul><ul><ul><li>Transient dyspnea </li></ul></ul><ul><ul><li>Ventricular arrhythmia </li></ul></ul><ul><ul><li>Infiltrate on STAT chest radiograph </li></ul></ul><ul><ul><li>None of the above </li></ul></ul>
  4. 4. 4 <ul><li>After uneventful PAC insertion, the tracing appears quite damped. The catheter was inserted via the right subclavian approach. A possible cause of this problem is: (check one) </li></ul><ul><ul><li>Kinking of the catheter as it passes through the introducer </li></ul></ul><ul><ul><li>Air in the transducer chamber </li></ul></ul><ul><ul><li>A decrease in the pressure in the fluid monitoring system </li></ul></ul><ul><ul><li>The venous pressure line is calibrated for arterial pressures </li></ul></ul><ul><ul><li>All of the above </li></ul></ul>
  5. 5. 5 <ul><li>During insertion, as the PAC passes from the right ventricle into the pulmonary artery, which one of the following pressures being recorded from the catheter changes the MOST? (check one) </li></ul><ul><ul><li>Diastolic pressure </li></ul></ul><ul><ul><li>Systolic pressure </li></ul></ul><ul><ul><li>Mean pressure </li></ul></ul><ul><ul><li>Central venous pressure </li></ul></ul><ul><ul><li>All change equally </li></ul></ul>
  6. 6. 6 <ul><li>Several hours after an uneventful catheter insertion, it is noted that the volume of air needed to inflate the balloon to obtain a wedge tracing is less than previously required. The MOST LIKELY cause is: (check one) </li></ul><ul><ul><li>Air in the pressure tubing </li></ul></ul><ul><ul><li>The catheter tip is occluded by the vessel wall </li></ul></ul><ul><ul><li>Balloon rupture </li></ul></ul><ul><ul><li>Distal migration of the catheter </li></ul></ul><ul><ul><li>Calibration error </li></ul></ul>
  7. 7. 7 <ul><li>In a supine patient, the PAC generally flows to: (check one) </li></ul><ul><ul><li>Posterior dependent lung zones </li></ul></ul><ul><ul><li>Superior lung zones </li></ul></ul><ul><ul><li>Inferior lung zones </li></ul></ul><ul><ul><li>Anterior lung zones </li></ul></ul><ul><ul><li>Areas with high ventilation-to-perfusion ratios </li></ul></ul>
  8. 8. 8 <ul><li>Systemic vascular resistance (check one) </li></ul><ul><ul><li>Is a measurement obtained directly from the PAC </li></ul></ul><ul><ul><li>Can be calculated as (MAP-PAOP/CO)*80 </li></ul></ul><ul><ul><li>Can be calculated as (SAP-PAOP/CO)*80 </li></ul></ul><ul><ul><li>Can be calculated as (SAP-PAOP/MAP)*80 </li></ul></ul><ul><ul><li>Can be calculated as (MAP-CVP/CO)*80 </li></ul></ul>
  9. 9. 9 <ul><li>The pulmonary artery wedge pressure gives an accurate measure of: </li></ul><ul><ul><li>Left ventricular compliance </li></ul></ul><ul><ul><li>Intravascular volume </li></ul></ul><ul><ul><li>Left ventricular volume </li></ul></ul><ul><ul><li>Ventricular interdependence </li></ul></ul><ul><ul><li>None of the above </li></ul></ul>
  10. 10. 10 <ul><li>Large v-waves on the wedge pressure tracing may indicate all of the following EXCEPT: (check one) </li></ul><ul><ul><li>Papillary muscle rupture </li></ul></ul><ul><ul><li>Ruptured chordae tendineae </li></ul></ul><ul><ul><li>Dilated mitral annulus </li></ul></ul><ul><ul><li>2:1 A-V block </li></ul></ul><ul><ul><li>Papillary muscle ischemia </li></ul></ul>
  11. 11. 11 <ul><li>Which one of the following disorders is MOST likely to increase the CVP and simultaneously decrease the PAOP? (check one) </li></ul><ul><ul><li>Left ventricular myocardial infarction </li></ul></ul><ul><ul><li>Excessive administration of IV fluids </li></ul></ul><ul><ul><li>Rupture of the mitral valve papillary muscle </li></ul></ul><ul><ul><li>Acute pulmonary embolus </li></ul></ul><ul><ul><li>Acute dissecting aneurysm with aortic regurgitation </li></ul></ul>
  12. 12. 12 <ul><li>A patient with adult respiratory distress syndrome is on a FIO2 of 0.6, positive end-expiratory pressure (PEEP) of 17 cm H2O with an ABG of pH 7.3, PCO2 40 torr and PO2 55 torr. When estimating the PAOP the current recommendation is: (check one) </li></ul><ul><ul><li>Temporarily disconnect the patient from the ventilator and measure the PAOP at end-expiration </li></ul></ul><ul><ul><li>Determine the pressure at end-expiration and follow the trend </li></ul></ul><ul><ul><li>Determine the pressure at end-expiration </li></ul></ul><ul><ul><li>Do not follow the PAOP, at best it will be misleading </li></ul></ul><ul><ul><li>A and B </li></ul></ul>
  13. 13. 13 <ul><li>Aspirated blood from the distal port of the PAC has a PO2 of 83 torr (saturation 90%). Which one of the following is the MOST likely cause? (check one) </li></ul><ul><ul><li>High levels of supplemental O2 </li></ul></ul><ul><ul><li>The PaO2 is > 100 torr </li></ul></ul><ul><ul><li>The catheter is coiled in the right ventricle </li></ul></ul><ul><ul><li>The catheter is in the wedge position </li></ul></ul><ul><ul><li>The patient is septic with a high cardiac output </li></ul></ul>
  14. 14. 14 <ul><li>In an 18 year old woman who is 4 ft 6 in. in height, a PAC is inserted via the right internal jugular vein and reaches a satisfactory wedge position at 35 cm. Repeated cardiac output determinations vary from 2-10 L/min. All of the equipment is checked and found to be in good working order. Which one of the following is the problem? (check one) </li></ul><ul><ul><li>The cardiac output is so high that it cannot be accurately measured </li></ul></ul><ul><ul><li>The proximal port is not in the right heart </li></ul></ul><ul><ul><li>There is a large change in the cardiac output with respiration </li></ul></ul><ul><ul><li>The body surface area is underestimated </li></ul></ul><ul><ul><li>None of the above </li></ul></ul>
  15. 15. 15 <ul><li>A 74-year old patient with a history of CHF and COPD is admitted to the ICU with BP 70/40 mm Hg, RR 35 breaths/min, rales one third of the way up both lung fields, and an ABG on FIO2 0.4 of pH 7.01, PCO2 58 torr, and PO2 50 torr. The CBC, Na, K, glucose and BUN are all within normal limits. The EKG reveals the patient to be in atrial fibrillation with a ventricular response of 135 beats/min. A chest radiograph has been ordered. Your first maneuver should be: (check one) </li></ul><ul><ul><li>Insert a PAC from the nonsubclavian site to avoid a pneumothorax </li></ul></ul><ul><ul><li>Insert a PAC with the patient in the sitting position </li></ul></ul><ul><ul><li>Give 1 ampule of sodium bicarbonate and insert the PAC </li></ul></ul><ul><ul><li>Insert the PAC from any site as soon as possible prior to initiating any therapy </li></ul></ul><ul><ul><li>None of the above </li></ul></ul>
  16. 16. 16 <ul><li>An 18 year-old male is injured in a head-on collision in which he was the driver of the vehicle. At surgery he had repair of a liver laceration and resection of his pancreas and spleen. On admission to the ICU his BP is 60/40 mm Hg, HR 120 beats/min and he is mechanically ventilated. He is given 500 ml of fluid without response and a PAC is inserted revealing cardiac index (CI) 2.0 L/min/M2, CVP 2 mm Hg, PAOP 1 mm Hg, and PAP 15/5 mm Hg. The MOST LIKELY diagnosis is: (check one) </li></ul><ul><ul><li>Cardiac contusion </li></ul></ul><ul><ul><li>Hypovolemia </li></ul></ul><ul><ul><li>Over ventilation </li></ul></ul><ul><ul><li>Cardiac tamponade </li></ul></ul><ul><ul><li>Pneumothorax </li></ul></ul>
  17. 17. 17 <ul><li>PAC data on a 68-yar old cirrhotic patient reveal an elevated cardiac index, decreased systemic vascular resistance, normal pulmonary vascular resistance, elevated PO2, increased oxygen delivery, and decreased arterial-venous oxygen content difference. These calculations may suggest all of the following EXCEPT: (check one) </li></ul><ul><ul><li>Hyperdynamic picture of sepsis </li></ul></ul><ul><ul><li>Hyperdynamic picture of cirrhosis </li></ul></ul><ul><ul><li>Pulmonary embolus </li></ul></ul><ul><ul><li>Previously placed arterio-venous fistula </li></ul></ul><ul><ul><li>None of the above </li></ul></ul>
  18. 18. 18 <ul><li>Which one of the following interventions will cause oxygen delivery to increase the MOST? (check one) </li></ul><ul><ul><li>Increase the PO2 from 75 torr to 100 torr </li></ul></ul><ul><ul><li>Increase the cardiac output by 10% </li></ul></ul><ul><ul><li>Increase the hematocrit from 20% to 25% </li></ul></ul><ul><ul><li>Interventions a,b,c will all have an equal effect </li></ul></ul><ul><ul><li>None of the above will raise the delivery of oxygen </li></ul></ul>
  19. 19. 19 <ul><li>Which one of the following statements is TRUE? (check one) </li></ul><ul><ul><li>In a critically ill patient, changes in the central venous pressure parallel changes in the pulmonary wedge pressure </li></ul></ul><ul><ul><li>Positive end-expiratory pressure increases the PAOP by 1 mm Hg for every 1 cm in water pressure </li></ul></ul><ul><ul><li>Insertion of the catheter in a patient with a left bundle branch block is contraindicated </li></ul></ul><ul><ul><li>Prophylactic lidocaine should be administered prior to the insertion of PA catheters </li></ul></ul><ul><ul><li>None of the above </li></ul></ul>
  20. 20. 20 <ul><li>In a 180-cm (5 ft 11 in) tall, 70-kg patient with normal anatomy, at what cm length should a PAC reach the wedge position if inserted via the right internal jugular approach (check one) </li></ul><ul><ul><li>25-25 cm </li></ul></ul><ul><ul><li>35-44 cm </li></ul></ul><ul><ul><li>45-59 cm </li></ul></ul><ul><ul><li>60-75 cm </li></ul></ul><ul><ul><li>More than 75 cm </li></ul></ul>
  21. 21. 21 <ul><li>Questions 43, 44,45 pertain to the following data: </li></ul><ul><li>The following data are obtained from an ICU patient: height 60 in (162 cm), weight 140 pounds (64 kg), body surface area 1.50 M2, temp 37.5C, HR 114 beats/min, MAP 60 mm Hg, PAP 40/20 mm Hg, PAOP 18 mm Hg, CVP 10 mm Hg, CO 4 L/min; Hgb 10.0 gm%, FIO2, pH 7.39, PCO2 40 torr, PO2 70 torr, art Hgb sat 95%, SvO2 sat 75%, PvO2 28 torr. Assume 1.34 ml of O2 per gm Hgb at 100% saturation. </li></ul><ul><li>The cardiac index (L/min/M2) is: (check one) </li></ul><ul><ul><li>1.8 </li></ul></ul><ul><ul><li>2.3 </li></ul></ul><ul><ul><li>2.7 </li></ul></ul><ul><ul><li>3.4 </li></ul></ul><ul><ul><li>6.8 </li></ul></ul>
  22. 22. 22 <ul><li>The systemic vascular resistance (dynes.sec.cm5) is: (check one) </li></ul><ul><ul><li>840 </li></ul></ul><ul><ul><li>1000 </li></ul></ul><ul><ul><li>1300 </li></ul></ul><ul><ul><li>1000 </li></ul></ul><ul><ul><li>2200 </li></ul></ul>
  23. 23. 23 <ul><li>The arterial oxygen content (ml O2/100 ml blood) is: (check one) </li></ul><ul><ul><li>5.1 </li></ul></ul><ul><ul><li>8.3 </li></ul></ul><ul><ul><li>10.1 </li></ul></ul><ul><ul><li>12.9 </li></ul></ul><ul><ul><li>16.8 </li></ul></ul>
  24. 24. 24 <ul><li>A 76-year old patient with a history of coronary artery disease who is clinically stable and has a normal physical exam undergoes elective PAC. The following data are obtained: HR 90 beats/min, BP 150/75 mm g, CO 4.5 L/min, PAOP 6 mm Hg. Suddenly the patient complains of severe chest pain and a 12-lead EKG shows lateral wall ischemia. New pulmonary artery catheter daa reveal: HR 125 beats/min, BP 10/80 mm Hg, CO 5.0 L/min, PAOP 17 mm Hg. He chang in the PAOP MOST LIKELY represents: (check one) </li></ul><ul><ul><li>A change in total body volume </li></ul></ul><ul><ul><li>An increase in the left ventricular volume </li></ul></ul><ul><ul><li>Intravascular volume overload </li></ul></ul><ul><ul><li>A change in the ejection fraction </li></ul></ul><ul><ul><li>A decrease in the left ventricular compliance </li></ul></ul>
  25. 25. 25 <ul><li>When determining the cardiac output, injection of less than the correct amount of volume (i.e., 9 ml instead of 10 ml) will lead to: (check one) </li></ul><ul><ul><li>An underestimation of the cardiac output </li></ul></ul><ul><ul><li>An overestimation of the cardiac output </li></ul></ul><ul><ul><li>No change in the determined cardiac output </li></ul></ul><ul><ul><li>An unpredictable change in the cardiac output </li></ul></ul><ul><ul><li>The cardiac computer will read “error” </li></ul></ul>
  26. 26. 26 <ul><li>Which of the following are needed to calculate oxygen delivery from APC data? (check one) </li></ul><ul><ul><li>Cardiac output, hemoglobin, arterial O2, saturation PaO2 </li></ul></ul><ul><ul><li>Stroke volume, hemoglobin, pulmonary artery PO2, arterial saturation </li></ul></ul><ul><ul><li>PaO2, pulmonary artery PO2 arterial saturation, cardiac output </li></ul></ul><ul><ul><li>Pulmonary artery saturation, arterial saturation, cardiac output, oxygen consumption </li></ul></ul><ul><ul><li>None of the above </li></ul></ul>
  27. 27. 27 <ul><li>All of the following may raise the PO2 of the blood drawn from the distal port of a PAC in a patient with no cardiorespiratory pathology EXCEPT: (check one) </li></ul><ul><ul><li>Early sepsis </li></ul></ul><ul><ul><li>Increased cardiac output </li></ul></ul><ul><ul><li>Arterio-venous fistula </li></ul></ul><ul><ul><li>Malignant hyperthermia </li></ul></ul><ul><ul><li>Inotropic agents </li></ul></ul>
  28. 28. 28 <ul><li>The pulmonary artery wedge pressure must be determined: (check one) </li></ul><ul><ul><li>As the mean of the diastolic pressure </li></ul></ul><ul><ul><li>At end-expiration </li></ul></ul><ul><ul><li>With the patient holding his/her breath </li></ul></ul><ul><ul><li>Following inflation of the balloon for at least 30 sec </li></ul></ul><ul><ul><li>As the mean pressure given by the bedside monitor </li></ul></ul>
  29. 29. 29 <ul><li>Which one of the following may cause an abnormal elevation in the oxygen saturation of blood drawn from the distal port? (check one) </li></ul><ul><ul><li>Ventricular septal defect </li></ul></ul><ul><ul><li>Catheter in the wedge position </li></ul></ul><ul><ul><li>Peripheral arterio-venous fistula </li></ul></ul><ul><ul><li>Severe mitral regurgitation </li></ul></ul><ul><ul><li>All of the above </li></ul></ul>