Instructions:

• Answer 50 questions in 15 minutes.
• If you are not ready to take this test, you can study here.
• Match each statement with the correct term.
• Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.


2. What should happen if someone converts to asystole/flatline?
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
A nosebleed
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


3. What drugs are most commonly used for angina?
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.
Nitrates - Beta blockers - and Calcium channel blockers
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


4. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.


5. What could happen without immediate intervention for a hematoma?
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the
The patient may suffer significant blood loss or femoral nerve compression.
Poorly controlled hypertension
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


6. Should the tubing for a venous access port be included under the dressing site?

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7. What should you teach your patient about MRI?
MRI is painless - you must remain still inside a small/noisy space. If you are claustrophobic you may need sedation. Remove all jewelry and other metal objects. If you have any shrapnel - a pacemaker - or any surgically implanted joints - pins - clip
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Iodine
Patient who are unable to tolerate exercise stress testing.


8. What are the treatments/ S&S of peripheral venous disease?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Lower HOB - place patient supine - assess LOC - open airway - assess breathing - get ambu bag - put on gloves - connect tubing from O2 source - adjust flow to 10 to 15 liters. First RESCUER: PLACE APEX of MASK OVER BRIDGE of NOSE And BASE BETWEEN LOW
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.


9. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Premature beats that are not preceded by a P- wave - QRS is wide and bizarre - and the T wave of the premature beat is generally large and in the opposite direction of the QRS.


10. Where should you place your stethescope to find the ERB's Point?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.
Fifth left intercostal space medial to the midclavicular line.
(S1 - S2) Third left intercostal space


11. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
NO because it isn't sterile so keep out.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


12. Where should you place your stethescope to find the mitral (apex) valve?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Whether the patients ulnar and radial arteries are patent.
Fifth left intercostal space medial to the midclavicular line.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


13. What is a chemical stress test (persantine stress test)?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Iodine
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the


14. What are all the S&S of pericarditis?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Don't interfere!


15. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Lowers BP and makes heart beat stronger. SE: flushed face.
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
Right atrium - TRICUSPID VALVE (tissue) - right ventricle - PULMONIC VALVE (paper) - lungs - left atrium - MITRAL VALVE (My) - left ventricle - AORTIC VALVE (Assets). Tissue PAPER MY ASSETS!


16. Where is the pulmonic valve landmark on the chest?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Second left intercostal space
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Elderly - hypothyroidism - renal dysfunction - dehydration - HYPOKALEMIA - hypomagnesemia - or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.


17. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).


18. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
Fifth left intercostal space medial to the midclavicular line.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


19. What is a good diagnosis for someone with right sided HF?
To report to her healthcare provider if she feels a large bump in her groin - if she has groin pain unrelieved by acetaminophen - or if she develops numbness - tingling - etc. in the affected leg.
Check for response - activate ERS - open airway head tilt chin lift - check breathing (5-10 sec) - give 2 breaths (1 sec) with visible chest rise - checks brachial pulse (5-10 sec) - locates CPR finger position - deliver 1st cycle of compressions (30
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Activity intolerance


20. What is the goal of treatment for an MI? Treatment?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
If feel more than 3 shocks in a row or develop signs of infection at the site.


21. What will a leg with arterial insufficiency look like?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.


22. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Left sternal border
ST segment elevation (STEMI)
Use sterile gloves and aseptic technique - clean skin over port with alcohol or iodine - insert a 21 or 22 gauge HUBER needle (noncoring - won't break apart) attached to syringe or tubing into the middle of the port until rigid back of port is palpab
Air embolism


23. What should be checked in a patient on a beta blocker?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Pulse before and after giving.
4th left intercostal space lower sternal border
Exercise and use graduated compression devices as directed - don't stand for long period of time - to avoid dislodging blood clots don't rub or massage your legs.


24. What does an Allen's test determine?
Second Right intercostal space.
Whether the patients ulnar and radial arteries are patent.
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


25. What is the correct way to insert an oropharyngeal airway?
Must be flushed 1x/month with heparin and between treatments.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


26. In what locations should you not place electrodes?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
In fatty areas or over major muscles - large breasts - or bony prominences.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


27. What do calcium channel blockers do?
This noninvasive test takes 24 hours and causes no discomfort. Electrodes are applied to your body - you need to log your activities for a 24 hour period (walking - sleeping - urinating - physical symptoms - and medications). Don't tamper with the mo
Open up blood vessels
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.


28. Test ending in Gram=?
Iodine
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Protamine Sulfate


29. Where is the apex/mitral valve landmark on the chest?
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Vitamin K (aqua myphiton)
Fourth or fifth intercostal space at or medial to the midclavicular line.


30. What landmarks should you be looking for on someone's chest?
NO because it isn't sterile so keep out.
When: using anticoagulants - liver disease - decrease in platelets (less than 150 -000) - hemophilia - using thrombolytic meds - DIC - CA - HIV - chemo - bone marrow problems - and ASA/NSAIDS.
Lower left sternal border
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


31. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unu


32. What should you teach someone with arterial insufficiency?

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33. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Lower HOB - place patient supine - assess LOC - open airway - assess breathing - get ambu bag - put on gloves - connect tubing from O2 source - adjust flow to 10 to 15 liters. First RESCUER: PLACE APEX of MASK OVER BRIDGE of NOSE And BASE BETWEEN LOW
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
NO because it isn't sterile so keep out.


34. What is characteristic of ventricular tachycardia?
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
It is noninvasive. You must not eat - smoke - or drink alcohol for 3 hours before the test. WEAR COMFORTABLE SHOES And LOOSE LIGHTWEIGHT SHORTS OR SLACKS - YOU MAY GET AN INJECTION of THAllIUM - after your blood pressure and ECG are monitored for 10-
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


35. What are the nursing interventions for a pt. with ventricular tachycardia?
To inhibit thrombus and clot formation.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Elderly - hypothyroidism - renal dysfunction - dehydration - HYPOKALEMIA - hypomagnesemia - or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.


36. For what disease should you do the Allen's test?

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37. What will be the treatment for an acute episode of life threatening tamponade?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Used in an emergency (Vfib/defib) - used with Vfib or Vtach - NO CARDIAC OUTPUT - client is unconscious - EKG monitor - NO CONSENT NEEDED - begin with 200 Joules and up to 360.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


38. What are the five areas for listening to the heart?

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39. What is pulsus paradoxus?
Close the open catheter lumen with the clamp - and place the pt on their left side in trendelenburg to move the air embolus away from the pulmonic valve. If you hear a churning sound in his chest (a classic sign of air embolus) and the patient starts
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


40. What places someone at risk for an aortic dissection?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Poorly controlled hypertension
Fat - Air - DVT - or Amniotic
An enlarged space indicates fluid accumulation in the pericardial sac.


41. What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
It is a noninvasive test that takes 15 mins. Electrodes are applied to sites on your body. You must lie still - relax - and breathe normally and remain quiet. Talking or moving distorts the images
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


42. What should you do when applying a femoral artery compression device?
No radial artery punctures if negative
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


43. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the
In fatty areas or over major muscles - large breasts - or bony prominences.
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.


44. What type of surgery is done for an aortic dissection?
Feeling warm (fire) or tin can taste is expected and will pass.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
It is a noninvasive test that takes 15 mins. Electrodes are applied to sites on your body. You must lie still - relax - and breathe normally and remain quiet. Talking or moving distorts the images


45. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Only for a few hours


46. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


47. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Cannot
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
The internal jugular veins (external are less reliable).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


48. What is angina? Stable vs. unstable?

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49. What would make someone more at risk for digoxin toxicity?
Right sided heart failure
They may feel a slight stinging under there tongue when they are dissolving - and they should get a HA (if no HA may not be good bc the pills only last for 6 months). Keep with you at all times.
Decrease in weight - diuretics (watch K loss) - aldactone (k sparing but check renal fx) - inderal (do Not give to asthma patients or diabetic patients) - more exercise - no smoking - and decreased Na intake.
Elderly - hypothyroidism - renal dysfunction - dehydration - HYPOKALEMIA - hypomagnesemia - or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.


50. What is the purpose of compression devices?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Protamine Sulfate
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.