During insertion of a pulmonary artery catheter in a client at 32 weeks with severe preeclampsia and pulmonary edema, what is the priority nursing assessment when the catheter enters the right ventricle?

• A. Assess fetal response
• B. Note sudden chest pain
• C. Monitor for premature ventricular contractions
• D. Observe for maternal blood pressure changes

Answer: (C)

When the catheter tip advances into the right ventricle, the most immediate concern is the heart’s rhythm. The ventricle can be irritated by the catheter, which commonly manifests as premature ventricular contractions. Detecting PVCs quickly signals that the catheter is irritating the ventricular endocardium, so you would pause advancement and assess the catheter’s position, aiming to relocate the tip into the pulmonary artery to avoid ongoing irritation and potential more serious arrhythmias. In a patient with severe preeclampsia and pulmonary edema, maintaining maternal rhythm stability is crucial for overall hemodynamic balance, which in turn supports fetal well-being. While other issues like chest pain or blood pressure changes are important in general, the priority during right-ventricular entry is monitoring for PVCs to prevent progression to larger rhythm disturbances.