MODULE 1

1. A patient with cardiogenic shock is receiving dobutamine, a beta-1 adrenergic agonist, to

increase cardiac output. Which of the following parameters should the nurse monitor closely to

evaluate the effectiveness of this medication?

a) Blood pressure

b) Heart rate

c) Central venous pressure (CVP)

d) Pulmonary capillary wedge pressure (PCWP)*

Rationale: PCWP reflects the left ventricular end-diastolic pressure and is a sensitive indicator

of fluid status and cardiac function. A high PCWP indicates pulmonary congestion and

impaired left ventricular function. Dobutamine aims to improve cardiac contractility and

reduce PCWP. Blood pressure, heart rate and CVP are also important to monitor, but they are

not as specific as PCWP for assessing the response to dobutamine.

2. A patient with septic shock is receiving norepinephrine, a potent vasoconstrictor, to maintain

adequate perfusion pressure. The nurse notices that the patient's urine output has decreased and

the serum creatinine has increased. What is the most likely explanation for this finding?

a) The patient has developed acute kidney injury due to decreased renal blood flow.*

b) The patient has developed a urinary tract infection due to catheterization.

c) The patient has developed fluid overload due to excessive fluid resuscitation.

d) The patient has developed metabolic acidosis due to lactic acid accumulation.

Rationale: Norepinephrine causes vasoconstriction of the peripheral and renal vessels, which

can reduce renal blood flow and cause acute kidney injury. This is manifested by decreased

urine output and increased serum creatinine. A urinary tract infection, fluid overload and

metabolic acidosis are possible complications of septic shock, but they are not directly related

to norepinephrine administration.

3. A patient with pulmonary hypertension is receiving sildenafil, a phosphodiesterase-5

inhibitor, to reduce pulmonary vascular resistance and improve right ventricular function.

Which of the following adverse effects should the nurse monitor for in this patient?

a) Hypotension*

b) Tachycardia

c) Dyspnea

d) Headache

Rationale: Sildenafil causes vasodilation of the systemic and pulmonary vessels, which can

lower blood pressure and increase the risk of hypotension. Tachycardia, dyspnea and headache