A nurse is assessing a client's pulmonary artery wedge pressure (PAWP). The nurse should recognize that an elevated PAWP indicates which of the following complications?
Hypovolemia
Hypotension
Left ventricular failure
Cardiogenic shock
The Correct Answer is C
Rationale:
A. Hypovolemia: Hypovolemia causes a decrease in PAWP due to reduced circulating blood volume and inadequate venous return to the heart. A low PAWP reflects decreased left ventricular preload, not an elevated value.
B. Hypotension: Hypotension alone does not directly increase PAWP. In fact, low blood pressure often accompanies decreased cardiac filling pressures. Elevated PAWP typically occurs with fluid overload or impaired ventricular function rather than simple hypotension.
C. Left ventricular failure: An elevated PAWP indicates increased left-sided heart pressures due to ineffective left ventricular pumping. Blood backs up into the pulmonary circulation, leading to pulmonary congestion and edema.
D. Cardiogenic shock: In cardiogenic shock, PAWP can be elevated due to impaired contractility, but it is accompanied by low cardiac output and hypotension. While related, the elevated PAWP in cardiogenic shock results from the underlying left ventricular failure, which is the primary cause of the pressure increase.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. A health care surrogate makes health care decisions when the client is no longer able: A health care surrogate, also called a health care proxy, is designated by the client to make medical decisions on their behalf if they become incapacitated.
B. Advance directives cannot be changed once implemented: Advance directives are legally binding but can be revised or revoked by the client at any time while they are competent. Flexibility allows clients to update their preferences as their health status or values change.
C. Assigning a health care surrogate requires legal consultation: While consulting an attorney can be helpful, it is not required to designate a health care surrogate. Most states allow clients to assign a surrogate using standardized forms provided by healthcare facilities or state agencies.
D. A client must create a do-not-resuscitate order when completing advance directives: Creating a DNR order is optional and only applicable if the client wishes to limit resuscitation. Advance directives encompass broader healthcare decisions beyond resuscitation preferences.
Correct Answer is D
Explanation
Rationale:
A. Select a vein on the back of the hand: Veins on the dorsum of the hand are more fragile in older adults and have less subcutaneous tissue, increasing the risk of infiltration or phlebitis. Larger veins on the forearm are preferred for safer and more stable IV access.
B. Apply a tourniquet firmly above the insertion site: Excessive tourniquet pressure can damage fragile veins and impair circulation in older adults. The tourniquet should be applied gently enough to distend the vein without causing bruising or discomfort.
C. Clean the site using vigorous friction: Vigorous scrubbing can irritate or damage delicate skin in older adults. The site should be cleansed using gentle, circular motions with appropriate antiseptic solution to reduce infection risk without causing trauma.
D. Use a 22-gauge catheter for insertion: A 22-gauge catheter provides an appropriate balance between ease of insertion and adequate flow rate for older adult clients. Smaller-gauge catheters minimize trauma to fragile veins while still allowing effective IV therapy.
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