The nurse is caring for a patient who has central venous pressure (CVP) monitoring in place. The nurse's most recent assessment reveals that CVP is 7 mm Hg. What is the nurse's most appropriate action?
A) Arrange for continuous cardiac monitoring and reposition the patient.
B) Remove the CVP catheter and apply an occlusive dressing.
C) Assess the patient for fluid overload and inform the physician.
D) Raise the head of the patient's bed and have the patient perform deep breathing exercise, if possible.
Ans: C
Feedback:
The normal CVP is 2 to 6 mm Hg. Many problems can cause an elevated CVP, but the most common is due to hypervolemia. Assessing the patient and informing the physician are the most prudent actions. Repositioning the patient is ineffective and removing the device is inappropriate.
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