CCRN Hemodynamic Monitoring 2 — Questions and Answers
Question 1: A patient's pulmonary capillary wedge pressure (PCWP) is 4 mmHg with a CVP of 2 mmHg and tachycardia. What does this most likely indicate?
- Hypovolemia (Correct answer)
- Left ventricular failure
- Cardiac tamponade
- Pulmonary hypertension
Correct answer: Hypovolemia
Low PCWP and low CVP with compensatory tachycardia indicate reduced preload from hypovolemia.
Question 2: Which waveform component on a central venous pressure (CVP) tracing corresponds to atrial contraction?
- a wave (Correct answer)
- c wave
- x descent
- v wave
Correct answer: a wave
The a wave reflects atrial contraction at end-diastole.
Question 3: To obtain accurate hemodynamic readings, where should the air-fluid interface (transducer) be leveled?
- Phlebostatic axis (Correct answer)
- Sternal notch
- Xiphoid process
- Midclavicular line
Correct answer: Phlebostatic axis
The phlebostatic axis, at the 4th intercostal space midaxillary line, approximates the level of the atria.
Question 4: A large v wave on the PCWP tracing is most characteristic of which condition?
- Acute mitral regurgitation (Correct answer)
- Tricuspid stenosis
- Hypovolemia
- Aortic stenosis
Correct answer: Acute mitral regurgitation
Regurgitant flow into the left atrium during systole produces a prominent v wave.
Question 5: Normal mixed venous oxygen saturation (SvO2) measured from the distal port of a PA catheter is approximately:
- 60-80% (Correct answer)
- 30-45%
- 85-95%
- 45-55%
Correct answer: 60-80%
Normal SvO2 is 60-80%, reflecting balance between oxygen delivery and consumption.
Question 6: When should the pulmonary artery occlusion (wedge) pressure be read during the respiratory cycle?
- End-expiration (Correct answer)
- Peak inspiration
- Mid-inspiration
- During a cough
Correct answer: End-expiration
End-expiration minimizes intrathoracic pressure influence on the reading.
Question 7: A patient develops a sudden dampened arterial line waveform with a falsely low blood pressure. The FIRST action is to:
- Check for kinks, air, or clot and verify the system (Correct answer)
- Administer a fluid bolus
- Start a vasopressor
- Remove the catheter immediately
Correct answer: Check for kinks, air, or clot and verify the system
Troubleshoot the system for mechanical causes before treating a presumed clinical change.
CCRN Hemodynamic Monitoring 2
A patient's pulmonary capillary wedge pressure (PCWP) is 4 mmHg with a CVP of 2 mmHg and tachycardia.
What does this most likely indicate?