Hemodynamics for the CCRN
Updated October 30, 2026
Hemodynamics shows up across the CCRN (Adult) exam: in cardiovascular questions, in shock and sepsis questions under Multisystem, and in respiratory questions about the ventilated patient. You rarely need to recite a normal range. You need to look at a set of numbers and say which way each one has moved, what kind of shock that pattern means, and what the patient needs.
This page gives approximate normal values, the shock profiles by direction of change, the bedside technique points that come up, and 8 original practice questions. It is independent practice, not official AACN material.
Approximate normal values
Normal ranges differ a little between references, so treat these as approximate. Exam questions that depend on a value usually give it in the stem or use numbers that are clearly abnormal.
| Measure | Approximate normal | What it reflects |
|---|---|---|
| MAP | 70 to 105 mm Hg; a common treatment target is 65 or higher | Perfusion pressure to the organs |
| CVP or right atrial pressure | About 2 to 6 mm Hg (some references 0 to 8) | Right-sided filling pressure, right ventricular preload |
| PA pressure | About 15 to 30 systolic, 8 to 15 diastolic | Pulmonary circulation and left-sided pressures |
| PAOP (wedge) | About 8 to 12 mm Hg (some references 4 to 12) | Left-sided filling pressure, left ventricular preload |
| Cardiac output | About 4 to 8 L/min | Blood pumped per minute |
| Cardiac index | About 2.5 to 4.0 L/min/m2 (some references from 2.2) | Cardiac output adjusted for body size |
| SVR | About 800 to 1,200 dynes/sec/cm5 (references vary widely) | Afterload of the left ventricle |
| SvO2 | About 60% to 80% | Balance of oxygen delivery and use |
MAP is about (systolic + 2 × diastolic) / 3. Cardiac output is heart rate × stroke volume, and stroke volume depends on preload, afterload and contractility.
Shock profiles by direction of change
Every reference agrees on the direction each value moves, even where the exact ranges differ. This is how the exam tests shock.
| Shock state | CVP | PAOP | CO / CI | SVR | Other clues |
|---|---|---|---|---|---|
| Hypovolemic | Low | Low | Low | High | Low SvO2, cool skin, tachycardia |
| Cardiogenic (left ventricle) | Normal or high | High | Low | High | Low SvO2, crackles, S3 |
| Septic, after fluids | Low or normal | Low or normal | Normal or high early | Low | SvO2 may be normal or high, warm skin early |
| Neurogenic | Low | Low | Low or normal | Low | Bradycardia, warm dry skin |
| Anaphylactic | Low | Low | Low or normal | Low | Hives, stridor, wheeze |
| Obstructive: pulmonary embolism | High | Low or normal | Low | High | High PA pressures, right ventricular strain |
| Obstructive: tamponade | High | High | Low | High | CVP, PA diastolic and PAOP near equal, narrow pulse pressure |
| Obstructive: tension pneumothorax | High | Variable | Low | High | Absent breath sounds, high airway pressures |
A simple way to remember it: the problem shows up first in the value closest to it. Losing volume drops the filling pressures; a failing pump backs pressure up behind it and drops output; a dilated vascular bed drops SVR; and an obstruction raises pressures upstream and drops output downstream.
Bedside technique that gets tested
- Level and zero at the phlebostatic axis, the fourth intercostal space at the midpoint of the chest’s front-to-back diameter. A transducer below that level reads falsely high, and one above it reads falsely low.
- Read pressures at end-expiration, when intrathoracic pressure is closest to zero, whether the patient is breathing on their own or on a ventilator.
- Fluid responsiveness is better judged by dynamic tests, such as the change in stroke volume with a passive leg raise, than by a single CVP number.
- A wedge pressure needs the balloon deflated afterward. A PA catheter that stays wedged, with a wedge waveform showing when the balloon is down, can cause pulmonary infarction.
Treatment follows the profile
| Pattern | Usual direction of treatment |
|---|---|
| Low filling pressures, low output | Volume |
| High filling pressures, low output, adequate BP | Diuresis, afterload reduction, inotropes |
| High filling pressures, low output, low BP | Vasopressor support, inotropes, mechanical support |
| Low SVR after adequate fluids | Vasopressor, such as norepinephrine in septic shock |
| Obstruction | Relieve it: decompression, pericardiocentesis, reperfusion |
Hemodynamics practice questions
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A trauma patient has BP 82/56 mm Hg, HR 134, cool clammy skin, CVP 1 mm Hg, PAOP 3 mm Hg, cardiac index 1.8 L/min/m2 and SVR 1,850 dynes/sec/cm5. Which type of shock does this profile MOST LIKELY show?Answer: ALow filling pressures on both sides, low output and a high SVR from compensatory vasoconstriction are the pattern of volume loss. Cardiogenic shock would raise the PAOP, and neurogenic and septic shock lower the SVR.
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A patient 2 days after a large anterior MI has BP 84/60 mm Hg, HR 116, crackles to the mid lung fields, PAOP 28 mm Hg, cardiac index 1.6 L/min/m2, SVR 1,900 dynes/sec/cm5 and SvO2 48%. Which type of shock is MOST LIKELY?Answer: CA high wedge pressure with a low cardiac index shows a failing left ventricle backing pressure into the lungs. The high SVR and low SvO2 reflect compensation and poor delivery. Hypovolemia would lower the wedge, and septic and anaphylactic shock lower the SVR.
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After 3 L of balanced crystalloid, a patient with a urinary tract infection has BP 80/40 mm Hg, HR 122, warm flushed skin, PAOP 9 mm Hg, cardiac output 9.4 L/min and SVR 420 dynes/sec/cm5. Which finding BEST explains the hypotension?Answer: BCardiac output is high and the wedge pressure is adequate after fluids, so the problem is a very low SVR from widespread vasodilation, the hallmark of septic shock. This points toward a vasopressor rather than more fluid or an inotrope.
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A patient with a massive pulmonary embolism has a PA catheter in place. Which hemodynamic pattern is MOST LIKELY?Answer: DA large clot blocks flow through the pulmonary arteries, so pressure rises behind it in the PA and right heart, while less blood reaches the left side, leaving the wedge low or normal and the output low.
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A patient's arterial line shows a BP of 96/42 mm Hg. What is the MAP, rounded to the nearest whole number?Answer: AMAP is about the diastolic pressure doubled plus the systolic, divided by 3: 42 × 2 = 84, plus 96 is 180, and 180 / 3 = 60. A wide pulse pressure can make the systolic number look reassuring while the MAP is low.
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A patient with heart failure has BP 112/70 mm Hg (MAP 84), PAOP 26 mm Hg, cardiac index 1.7 L/min/m2, SVR 1,700 dynes/sec/cm5 and cool extremities. Which medication should the nurse anticipate?Answer: CThe patient has a low output with high filling pressures and an adequate blood pressure, so an inotrope such as dobutamine is used to improve contractility. A pure vasoconstrictor would raise an already high SVR, and fluid would add to the congestion.
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The nurse finds that a patient's PA catheter transducer is mounted 10 cm below the phlebostatic axis after the bed was raised. How will this affect the readings?Answer: BA transducer below the phlebostatic axis adds the weight of the fluid column above it to the reading, so pressures appear higher than they are. It must be releveled to the axis, the fourth intercostal space at the midpoint of the chest's front-to-back diameter, and rezeroed.
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A hypotensive patient on a stroke volume monitor has a passive leg raise. Stroke volume rises from 52 mL to 63 mL within a minute. What does this MOST LIKELY indicate?Answer: DA passive leg raise shifts blood from the legs into the chest, acting as a reversible fluid challenge. A rise in stroke volume of about 20% shows the heart is on the steep part of its preload curve and is likely to respond to fluid.
Keep practicing
Shock and hemodynamics questions are spread through the exam, so practice them in context with the cardiovascular questions and the multisystem questions. The full practice exams on the home page mix all six areas into 125 scored questions with 83 to pass. For the exam itself, see the CCRN exam guide.
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