Wagner
Module 12 – Determinants and Assessment of Cardiac Output
Learning Objectives
12-1. Define and state adult normal values for cardiac output, cardiac index, heart rate,
and stroke volume.
12-2. Discuss how preload, contractility, and afterload impact stroke volume.
12-3. Describe the relationship of stroke volume and preload in terms of the Frank–
Starling law.
12-4. Describe the relationship among pressure, flow, and resistance and how these
impact cardiac output.
12-5. Discuss factors that influence myocardial contractility.
12-6. State some of the conditions that affect heart rate, preload, contractility, and
afterload.
12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
12-8. Describe various cardiovascular diagnostic procedures used to evaluate the
components of cardiac output.
12-9. Discuss nursing responsibilities in caring for a patient receiving cardiovascular
diagnostic procedures.
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-1. Define and state adult normal values for cardiac output, cardiac index, heart
rate, and stroke volume.
1. The nurse is going to calculate the normal cardiac output for an adult patient. Which
of the following will be needed to make this calculation?
1. age
2. height
3. body surface area
4. weight
Answer: 3
Rationale: Cardiac output is most affected by body size. Age alone does not necessarily
influence cardiac output. The most accurate influence for cardiac output is not height
independently, nor weight independently, but together proportionately height and weight
have an impact on cardiac output. Therefore, the correct answer is body surface area
because this considers both height and weight in combination for a patient.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-1. Define and state adult normal values for cardiac output, cardiac index, heart
rate, and stroke volume.
2. The nurse is concerned about a patient’s cardiac output. Which of the following will
help the nurse determine this patient’s cardiac output?
1. as stroke volume decreases and heart rate increases
2. as stroke volume decreases and heart rate decreases
3. as stroke volume increases and heart rate increases
4. as stroke volume maintains and heart rate maintains
Answer: 1
Rationale: Stroke volume and heart rate form an interrelationship to keep cardiac output
at the level needed by the body. This is a compensatory mechanism that is an inverse
relationship. If the stroke volume decreases, the heart rate increases to compensate. If the
heart rate decreases, the stroke volume increases to compensate.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-2. Discuss how preload, contractility, and afterload impact stroke volume.
1. A patient is having an echocardiogram with measurement of ejection fraction. The
nurse realizes this diagnostic test will evaluate which of the following cardiac
characteristics?
1. preload
2. afterload
3. contractility
4. cardiac output
Answer: 3
Rationale: Contractility is defined as the force of myocardial contraction and reflects the
ability of the heart muscle to work independently of preload and afterload; the ability to
function as a pump. Ejection fraction is a measure of the percent of blood ejected with
each stroke volume and is used as an index of myocardial function. The ejection fraction
is the stroke volume divided by end diastolic volume. A normal ejection fraction is 60
percent. The ejection fraction does not evaluate preload, afterload, or cardiac output.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-2. Discuss how preload, contractility, and afterload impact stroke volume.
2. It has been determined that a patient has a high preload. Which of the following will
occur with this patient?
1. stroke volume will be low
2. stroke volume will be high
3. stroke volume will be unchanged
4. afterload will increase
Answer: 2
Rationale: The greater the volume of blood in the ventricle, the greater the amount of
stretch that the fibers experience. Preload is greatly affected by the volume of blood
delivered to the heart from the venous system. If a large volume of blood returns from the
venous system to the ventricle, the myocardial fibers will be stretched so that they are far
apart. This represents a high preload. High preload corresponds to high volume; low
preload corresponds to low volume. If afterload increases, stroke volume decreases.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-3. Describe the relationship of stroke volume and preload in terms of the Frank–
Starling law.
1. The nurse is caring for a patient with an increasing preload. The nurse realizes that
which of the following will occur with this increase in preload?
1. stroke volume will decrease
2. stroke volume will not be affected
3. stroke volume will increase only if the heart rate increases
4. stroke volume will increase
Answer: 4
Rationale: Within limits, the heart pumps the amount of blood it receives with each beat.
This is known as the Frank–Starling Law of the heart. In other words, as preload
increases, so will stroke volume, and as preload decreases, stroke volume falls. The
patient with an increasing preload will have an increase in stroke volume. The other
choices are incorrect.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-3. Describe the relationship of stroke volume and preload in terms of the Frank–
Starling law.
2. A patient, with a steadily increasing preload was experiencing a corresponding
increase in stroke volume but it has now begun to decrease. The nurse realizes that
which of the following is occurring in this patient?
1. maximum preload has yet to be reached
2. there is something else going on with the patient that is effecting the stroke
volume
3. the heart rate is increasing which is causing the drop in stroke volume
4. preload has reached the critical point and now stroke volume will decrease
Answer: 4
Rationale: Until a critical point is reached, as preload increases, so does stroke volume.
An optimal preload leads to an optimal stroke volume. Once past this point, an increase
in preload results in a decrease in stroke volume. If the heart receives too much preload, it
cannot effectively pump out that volume and stroke volume decreases. Stroke volume
decreases because too much volume causes excessive stretching of the myocardial fibers
and the ventricles cannot effectively contract. There is not something else going on with
the patient that is affecting the stroke volume. There is no evidence to suggest that the
patient’s heart rate is increasing.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-4. Describe the relationship among pressure, flow, and resistance and how these
impact cardiac output.
1. A patient is admitted to the intensive care unit with a diagnosis of hypertension. The
nurse realizes that which of the following is occurring with this patient’s cardiac
afterload?
1. afterload is increased, cardiac output decreases, and blood pressure increases
2. afterload is decreased, cardiac output decreases, and blood pressure increases
3. afterload is increased, cardiac output increases, and blood pressure increases
4. afterload is decreased, cardiac output increases, and blood pressure stays the
same.
Answer: 1
Rationale: Afterload is increased, cardiac output decreases, and blood pressure increases
is the correct answer. Afterload is the resistance against which the ventricle must pump
blood. If afterload increases, stroke volume must decrease. Therefore, this causes the
blood pressure to increase. The flow and resistance compensate to maintain the pressure,
just as the stroke volume and the heart rate compensate to maintain the cardiac output.
Afterload is decreased, cardiac output decreases, and blood pressure increases is an
incorrect choice because if the afterload is decreased, the cardiac output must increase.
Afterload is increased, cardiac output increases, and blood pressure increases is an
incorrect choice because the cardiac output would decrease if afterload is increased.
Afterload is decreased, cardiac output increases, and blood pressure stays the same is an
incorrect choice because the blood pressure would increase if afterload is decreased and
cardiac output increases.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-4. Describe the relationship among pressure, flow, and resistance and how these
impact cardiac output.
2. A patient is diagnosed with septic shock and has a decrease in afterload. The nurse
realizes that which of the following is occurring with this patient?
1. increase in cardiac output and decrease in blood pressure
2. decrease in cardiac output and increase in blood pressure
3. increase in cardiac output and increase in blood pressure
4. decrease in cardiac output and decrease in blood pressure
Answer: 1
Rationale: Blood pressure is the product of cardiac output and afterload. When afterload
decreases, cardiac output increases and blood pressure decreases. This is what happens to
patients diagnosed with septic shock. When afterload increases, cardiac output decreases
and blood pressure increases. This is what happens to patients with hypertension. The
other two choices do not correlate with the diagnosis of septic shock.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-5. Discuss factors that influence myocardial contractility.
1. The patient with congestive heart failure has oxygen prescribed as needed. In which of
the following situations would oxygen be needed to prevent hypoxemia in the patient?
1. conducting passive range of motion on the patient
2. having a quiet conversation with a clergy member
3. assisting the patient with self-care activities
4. while taking a midday nap.
Answer: 3
Rationale: The patient needs additional oxygen when doing any activity that increases the
work of the heart. Hypoxemia is a negative inotrope and will reduce the contractility of
the heart. When the patient is at rest, the load on the heart would decrease and, therefore,
the need for oxygen would decrease. Having a quiet conversation with a clergy member
and having passive range of motion will also not increase the oxygen demands on the
heart or cause hypoxemia.
Cognitive Level: Analyzing
Nursing Process: Implementation
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-5. Discuss factors that influence myocardial contractility.
2. It is determined that a patient has poor cardiac contractility. The nurse realizes that
which of the following medications would help this patient?
1. hydralazine
2. digoxin
3. hydrochlorothiazide
4. Aldomet
Answer: 2
Rationale: Factors that increase myocardial contractility have a positive inotropic effect.
Positive inotropes include sympathetic nervous system stimulation, increased calcium
release, and the administration of inotropic drugs, such as digoxin and dobutamine. The
other medication choices are not considered positive inotropes.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-6. State some of the conditions that affect heart rate, preload, contractility, and
afterload.
1. A patient is prescribed a beta-blocker. The nurse realizes that which of the following
will occur in this patient?
1. increased blood pressure
2. decreased preload
3. increased contractility
4. decreased heart rate
Answer: 4
Rationale: Heart rate may be slowed by administration of drugs that block sympathetic
activity such as beta-blockers. Medications that block sympathetic activity will decrease
the blood pressure. Decreased preload is seen in hemorrhage, dehydration, diuretic use,
atrioventricular valve malfunction, vasodilation of the venous system, and a rapid heart
rate. Parasympathetic nerve stimulation will cause decreased contractility and not
increased contractility.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-6. State some of the conditions that affect heart rate, preload, contractility, and
afterload.
2. A patient is diagnosed with aortic valve stenosis. Which of the following will this
valve disorder effect?
1. afterload
2. heart rate
3. preload
4. contractility
Answer: 1
Rationale: The major determinant of afterload is the resistance to flow caused by the
arterial system. Resistance to flow can be caused by failure of the pulmonic or aortic
valve to allow free flow of blood from the ventricle to the artery. In this case, the
stenosed valve causes an increase in afterload. The stenosis will not affect heart rate,
preload, or contractility.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
1. A patient is admitted with the complaint of chest pain. Which of the following must
the nurse assess to discriminate between pain of cardiac origin and that of pulmonary
origin?
1. sensations of loss, timing, and diet
2. precipitating factors, quality, and location
3. home remedies, bedrest, and diet
4. dietary habits, smoking, and cough history
Answer: 2
Rationale: The pain assessment will include the following factors: quality, radiation and
region (location), associated symptoms, and timing and treatment strategies. Precipitating
factors, quality, and location includes those characteristics, whereas the other choices
include diet, extraneous factors, and risk factors which are not included when
discriminating between pain of cardiac origin from that of a pulmonary origin.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
2. The nurse will use which of the following physical assessment techniques when
assessing a patient for cardiac output?
1. inspection, percussion, auscultation
2. inspection, palpation, percussion
3. inspection, palpation, diaphragmatic excursion
4. inspection, auscultation, palpation
Answer: 4
Rationale: The techniques for physical assessment of cardiac output include inspection,
palpation, and auscultation. Percussion is incorrect because it measures heart size very
crudely but not output. Inspection, palpation, diaphragmatic excursion is incorrect
because diaphragmatic excursion measures lung expansion.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
3. A patient has been admitted with chest pain and generalized discomfort. Which of the
following assessment data will assist the nurse in setting realistic goals for patient
therapy and education?
1. demographic data including age, sex, race, and weight of patient
2. knowledge of the patient’s functional status prior to illness
3. cardiovascular risk factors, such as history of smoking and stress level
4. family history of disease, diet history, and prior medical history
Answer: 2
Rationale: Knowledge of the patient’s functional status prior to illness assists the nurse in
setting goals that are realistic for the patient. The other data to be collected such as
demographic data, risk factors, and family conditions are all data that should be obtained
during the history but do not assist the nurse in setting realistic goals.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
4. The nurse is conducting a detailed patient history on a patient admitted with a cardiac
disorder. Which of the following assessment data will help identify the patient’s
cardiovascular risk factors?
1. patient eats a vegetarian diet
2. patient is 6 feet 4 inches tall and weighs 185 pounds
3. patient quit smoking 5 years ago
4. patient has no previous health problems
Correct Answers: 3
Rationale: Cardiovascular risk factors, such as exercise pattern, obesity, smoking history,
and stress level, must be assessed. Quitting smoking identifies a smoking history, and
therefore is the correct response. Patient is 6 feet 4 inches tall and weighs 185 pounds
does not identify an obese patient; patient eats a vegetarian diet only gives information
about the patient’s diet, not a risk associated with high cholesterol or other factors; and
patient has no previous health problems does not indicate any other health problems.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
5. After auscultating a patient’s heart sounds and measuring vital signs, the nurse
determines that which of the following assessment findings needs additional
assessment?
1. split of S2
2. bounding, vigorous pulse
3. pulse pressure of 30 to 40 mm hg
4. apical pulse of 60 to 80
Answer: 1
Rationale: The split of S2 indicates that one ventricle is emptying earlier or later than
another and that contractility may, therefore, be diminished. This would indicate the need
for further assessment and is the correct answer. Pulse pressure is defined as the
difference between diastolic and systolic blood pressure. The pulse pressure reflects how
much the heart is able to raise the pressure in the arterial system with each beat. Pulse
pressure of 30 to 40 mm Hg does not indicate cause for concern because it is within the
normal pulse pressure range. Apical pulse of 60 to 80 is within normal limits also.
Increased contractility is recognized in a bounding, vigorous pulse and, therefore, not
cause for alarm.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
6. A patient is admitted with a decrease in cardiac output. Which of the following
assessment findings are consistent with this diagnosis?
1.
2.
3.
4.
increased urine output
warm skin temperature
changes in skin color
localized edema in the calf
Correct Answers: 3
Rationale: Changes in skin color can be a sign of hemodynamic compromise and a
decrease in cardiac output. Warm skin temperature is a normal finding, whereas cool
distal extremities would be an indicator of decreased cardiac output. A decrease in
cardiac output generally results in a decrease in urine output. Localized edema in the calf
is indicative of obstruction of venous blood flow from a clot in a leg vein. Generalized
edema is associated with congestive heart failure.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
7. A patient is being assessed for myocardial damage. Which of the following diagnostic
tests will provide the most information about the patient’s heart?
1. creatine kinase level
2. BNP level
3. electrolytes
4. troponin level
Answer: 4
Rationale: Troponin is a protein found in cardiac muscle and can appear in the blood as
early as 3 to 4 hours after myocardial damage. Troponin has a higher sensitivity and
specificity for identifying even minor necrosis than CK-MB. The higher the troponin
level and/or the longer the troponin levels remain elevated, the greater the size of
myocardial damage and the severity of injury. BNP level is assessed for the presence of
heart failure. Electrolytes are important to assess but will not provide the most
information about the patient’s heart damage.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-7. Identify the common clinical assessments that evaluate heart rate, preload,
contractility, and afterload.
8. A patient is at risk for decreased right heart preload. The nurse realizes that which of
the following findings would impact the patient’s safety?
1. patient experiences dry flaky skin
2. patient experiences dry mucous membranes
3. patient experiences dizziness on rising to a sitting position
4. patient has no peripheral edema
Answer: 3
Rationale: The signs of decreased right heart preload are poor skin turgor, dry mucous
membranes, orthostatic hypotension, and flat jugular veins. Dizziness, dry skin, and dry
mucous membranes are all correct assessments for the condition. However, the patient
experiencing dizziness on rising to a sitting position indicates orthostatic hypotension,
which puts the patient at risk for falls and fainting and, therefore, is the choice that
impacts the patient’s safety.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-8. Describe various cardiovascular diagnostic procedures used to evaluate the
components of cardiac output.
1. The nurse is instructing a patient who is scheduled for a cardiac catheterization.
Which of the following comments made by the patient would indicate the need for
additional education?
1. “I will place a warm pack at the puncture site for pain relief.”
2. “I will bring someone with me to drive me home following the procedure.”
3. “I will not be able to go upstairs to my bedroom for 72 hours.”
4. “I will not be able to take a bath for 7 days.”
Answer: 1
Rationale: Cardiac catheterization is performed to determine the patency of the coronary
vessels and to observe the blood flow through the chambers and the valves. This
procedure is conducted via the arterial system and the most common insertion site is the
femoral artery. Complications of this procedure can include hematoma, bleeding, and
pseudoaneurysm. Driving, bathing, and climbing stairs should be avoided for 72 hours to
reduce the chance of rupture at the insertion site. The puncture site should not be
submerged for 7 days to reduce the chances of infection. The vasodilatory effect of a
warm pack would cause vessel rupture and, therefore, is the choice that indicates a need
for further education.
Cognitive Level: Analyzing
Nursing Process: Evaluation
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-8. Describe various cardiovascular diagnostic procedures used to evaluate the
components of cardiac output.
2. A patient is admitted with a cardiac arrhythmia. Which of the following diagnostic
tests will help in the diagnosis of this patient’s cardiac disorder?
1. cardiac catheterization
2. electrophysiology study
3. echocardiogram
4. exercise electrocardiogram
Answer: 2
Rationale: The electrophysiology study is an invasive procedure that evaluates the
cardiac conduction system and helps classify cardiac arrhythmias. The findings from this
study help to determine if the patient would benefit from further interventions such as a
pacemaker, implantable cardiodefibrillator, and radiofrequency ablation or medication
therapy. Cardiac catheterization is performed to determine the presence and extent of
coronary artery disease, evaluate left ventricular function, and to evaluate valvular or
myocardial disorders. Echocardiograms are used to visualize blood, cardiac valves, the
myocardium, and the pericardium. Exercise electrocardiograms evaluate heart muscle
and its blood supply during physical stress.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-9. Discuss nursing responsibilities in caring for a patient receiving cardiovascular
diagnostic procedures.
1. A patient is scheduled for an exercise electrocardiogram. Which of the following will
the nurse ensure is present in the room while the test is being conducted?
1. external pacemaker
2. portable chest x-ray machine
3. oral fluids
4. emergency medications and a defibrillator
Answer: 4
Rationale: Emergency medications and a defibrillator should be present in the room
during an exercise electrocardiogram test. External pacemakers, portable chest x-ray
machines, and oral fluids are not indicated to be present in the room during an exercise
electrocardiogram.
Cognitive Level: Applying
Nursing Process: Planning
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition
LO: 12-9. Discuss nursing responsibilities in caring for a patient receiving cardiovascular
diagnostic procedures.
2. The nurse is caring for a patient having a TEE. Which of the following is an
appropriate nursing intervention for the care of this patient?
1. monitor for bradycardia and hypotension after the procedure
2. dim the lights in the room
3. apply pressure to the puncture site
4. assess pedal pulses bilaterally
Answer: 1
Rationale: The TEE is done under conscious sedation. After the procedure, the nurse
needs to assess for bradycardia and hypotension because of possible stimulation of the
patient’s vagus nerve. Dimming the lights in the room would be appropriate for a
transthoracic echocardiogram. Applying pressure to the puncture site and assessing pedal
pulses would be appropriate after a cardiac catheterization.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
©2010 by Pearson Education, Inc.
Wagner/Johnson/Hardin-Pierce, Test Item File for HighAcuity Nursing, 5th Edition