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 are the nursing interventions for a patient with premature ventricular contractions?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
4th left intercostal space lower sternal border
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table


2. What should you teach someone with arterial insufficiency?

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3. What are the steps to perform the heimlich maneuver?
Stand behind the victim - wrap arms around waist (IF PREGNANT WRAP ABOVE The BABy) - make a fist with one had and place thumb against abdomen midline - grasp fist with other hand - press into victims abdomen with quick upward thrusts.
Left sternal border
An inflammation of the pericardium. It may result in MI.
Old truck driver or someone on bed rest or with pelvic trauma.


4. What should you tell someone about taking nitroglycerin tablets (SE)?
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
BP is elevated or decreased depending on activity.
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.


5. What should you explain to the patient about an impedance cardiography test?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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 arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


6. What should you teach your patient about an exercise ECG (stress test)?
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.
Cannot
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-
Second left intercostal space


7. What is Deep Vein Thrombosis (DVT)?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A nosebleed
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


8. What is intermittent claudication?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Clip hair if necessary - abrade the skin (use abrader pads or fine sandpaper and lightly rub skin using 2 or 3 brisk strokes - improves tracings) - dry skin if necessary - and attach the lead wires to the electrodes before you apply them to the patie
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


9. How is angina treated?

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10. When should you be concerned about premature ventricular contraction?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
One at a time to assess the pulse amplitude and contour.


11. What signals an elevated venous pressure based on the internal jugular veins?
Identify the highest point of pulsation and measure from this point to the sternal angle. A measurement of greater than 3 cm= an elevated venous pressure.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.
NO NSAIDS or ASA.


12. What needs to be held during the placement of a femoral artery compression device?
Identify the highest point of pulsation and measure from this point to the sternal angle. A measurement of greater than 3 cm= an elevated venous pressure.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
NO NSAIDS or ASA.
Before


13. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Include rest periods prior to any activity.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Protamine Sulfate
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


14. What body systems are affected by digoxin toxicity? S&S?
Air embolism
Pulse before and after giving.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


15. What should you do when applying a femoral artery compression device?
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.
NO because it isn't sterile so keep out.
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
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-


16. What are the signs and symptoms of left sided HF?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


17. What are common risk factors for an MI?
Pulse before and after giving.
Vitamin K (aqua myphiton)
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


18. What is the goal of treatment for an MI? Treatment?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Second left intercostal space
Check for response - activate ERS and AED - open airway with head tilt chin lift - checking breathing (5-10 sec) - give 2 breaths (1 sec each) - check carotid pulse (5-10 sec) - locate CPR hand position - deliver first cycle of compressions (30 compr
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


19. What are the treatments/ S&S of peripheral venous disease?
An enlarged space indicates fluid accumulation in the pericardial sac.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Fat - Air - DVT - or Amniotic
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


20. What is a nursing diagnosis for arterial occlusion? Tx
A complication from a venous access device or port. It is a blockage of the superior vena cava preventing superior blood flow from reaching the heart.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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


21. What usually triggers angina pain?
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Feeling warm (fire) or tin can taste is expected and will pass.
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea


22. What does an Allen's test determine?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Idiopathic
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.
Whether the patients ulnar and radial arteries are patent.


23. What are the nursing interventions for a patient in complete heart block?
Old truck driver or someone on bed rest or with pelvic trauma.
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


24. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Right sided heart failure
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna


25. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
Activity intolerance
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.


26. What is epistaxis?
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A nosebleed
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.


27. What makes the symptoms of superior vena cava syndrome better? Worse?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


28. How do you prepare a patient for Impedance cardiography monitoring?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea


29. What are the steps for adult/child 1 rescuer CPR?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Check for response - activate ERS and AED - open airway with head tilt chin lift - checking breathing (5-10 sec) - give 2 breaths (1 sec each) - check carotid pulse (5-10 sec) - locate CPR hand position - deliver first cycle of compressions (30 compr
A nosebleed
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits - leans forward - and breaths out.


30. Where should you place your stethescope to find the mitral (apex) valve?
Second Right intercostal space.
Fifth left intercostal space medial to the midclavicular line.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


31. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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32. What drugs are most commonly used for angina?
Left sternal border
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
Nitrates - Beta blockers - and Calcium channel blockers
Iodine


33. What should you teach someone after they have had a pacemaker placed?

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34. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Before
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


35. What should you teach a patient regarding discharge after a DVT?

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36. What are the proper steps to changing a central venous catheter dressing?
Demand: Works PRN (when HR goes below predetermined rate) or Fixed: beats constantly at predetermined rate so no matter what heart does still beats at same rate.
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
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.
It is a sterile procedure so both nurse and patient should wear a mask - arrange sterile field - remove dressing - assess the catheter insertion site for infection - put on sterile gloves - clean the site moving outwardly in a circular motion - apply


37. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
An inflammation of the pericardium. It may result in MI.


38. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Only for a few hours
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


39. What does the device for impedance cardiography consist of?
Second Right intercostal space.
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


40. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Feeling warm (fire) or tin can taste is expected and will pass.
Poorly controlled hypertension
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.


41. In What time period is the greatest risk of sudden death from an MI?
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Fourth or fifth intercostal space at or medial to the midclavicular line.
In the first 72 hours!!!!!


42. What type of EKG change indicates MI?
Rescuer arrives with AED - turn AED on - select proper pads and apply - clear victim to analyze - clear victim to shock/press shock - resume chest compressions after 1 shock - delivers cycle of compressions at correct rate - pause to allow other resc
ST segment elevation (STEMI)
Don't interfere!
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


43. What is defibrillation?
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


44. What should you teach your patient about an abdominal ultrasonography?
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
To inhibit thrombus and clot formation.


45. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Iodine
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


46. When should bleeding precautions be implemented?
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
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.
BP is elevated or decreased depending on activity.
Vitamin K (aqua myphiton)


47. What should you teach your patient about a cardiac catheterization?
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
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
Awake and alert: IV lidocaine bolus and drip Unconscious - hypotensive - or S&S of angina/CHF: Direct current cardioversion and IV Lidocaine bolus and drip.
Protamine Sulfate


48. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
File toe nails - if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


49. In what locations should you not place electrodes?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
D/C the med and call the doctor.
One large emboli (smaller=better)
In fatty areas or over major muscles - large breasts - or bony prominences.


50. What factors place you at risk for HTN?
A nosebleed
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.
Fifth left intercostal space medial to the midclavicular line.