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 should you observe for in someone on bleeding precautions?
Hematuria (tea or coca cola colored) - nosebleeds - gingival bleeding (no medicated mouth wash - flossing - or lemon glycerin swabs) - and bruising (assess for abuse w/o caregiver).
Air embolism
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


2. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Air embolism
4th left intercostal space lower sternal border
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


3. What is superior vena cava syndrome?
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.
Whether the patients ulnar and radial arteries are patent.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.


4. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
D/C the med and call the doctor.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.


5. Where is the right ventricle landmark on the chest?
Left sternal border
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
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.


6. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
D/C the med and call the doctor.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Include rest periods prior to any activity.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


7. What are the S&S of air embolism?
Lowers BP and makes heart beat stronger. SE: flushed face.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


8. What is angina? Stable vs. unstable?

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9. What should be done immediately if a pulmonary embolism is suspected?
Protamine Sulfate
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


10. What is an acute peripheral arterial occlusion?
NO NSAIDS or ASA.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!


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

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12. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
BP is elevated or decreased depending on activity.
An enlarged space indicates fluid accumulation in the pericardial sac.
Right sided heart failure
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


13. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
In the first 72 hours!!!!!


14. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
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


15. What is the antidote for heparin?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Protamine Sulfate
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.


16. What are the nursing interventions for a patient in atrial fibrillation?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Steroid treatment or a pregnant woman who is retaining water.
Include rest periods prior to any activity.


17. What is a assessment finding with DVT?

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18. What should you teach your patient about a cardiac catheterization?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
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
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.


19. What should you teach your patient about an abdominal ultrasonography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
One at a time to assess the pulse amplitude and contour.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


20. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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.
Right sided heart failure
The internal jugular veins (external are less reliable).
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.


21. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer - hurts more - etc.)
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


22. What drugs are most commonly used for angina?
D/C the med and call the doctor.
Nitrates - Beta blockers - and Calcium channel blockers
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


23. What should you teach your patient about an electrocardiogram (ECG)?
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.
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
Include rest periods prior to any activity.
Poorly controlled hypertension


24. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Lowers BP and makes heart beat stronger. SE: flushed face.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


25. What are the four types of pulmonary emboli?
Cannot
Fat - Air - DVT - or Amniotic
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


26. Who would most likely have peripheral venous disease?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Old truck driver or someone on bed rest or with pelvic trauma.
Second Left intercostal space
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.


27. What should you do immediately if you suspect someone of developing a hematoma?
Using both gloved hands - apply firm pressure just above the skin puncture site and over the hematoma to compress the area. Wait at least 15 mins before removing pressure and reassessing the site. Then notify the health care provider.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.


28. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
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
Fifth left intercostal space medial to the midclavicular line.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


29. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
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.
NO because it isn't sterile so keep out.


30. What is the treatment for premature ventricular contractions?
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.
NO because it isn't sterile so keep out.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.


31. What are the S&S of superior vena cava syndrome?
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
Second left intercostal space
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
Iodine


32. What is cardioversion?

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33. What is intermittent claudication?
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Second right intercostal space
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


34. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Cannot


35. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
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.
BP is elevated or decreased depending on activity.
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


36. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
Second right intercostal space


37. What should you teach someone about iodine?
Hematuria (tea or coca cola colored) - nosebleeds - gingival bleeding (no medicated mouth wash - flossing - or lemon glycerin swabs) - and bruising (assess for abuse w/o caregiver).
Feeling warm (fire) or tin can taste is expected and will pass.
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
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


38. What should you remember while taking care of someone with a peripheral arterial occlusion?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
Include rest periods prior to any activity.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


39. What should you go when applying nitroglycerin ointment for angina?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.


40. What are examples of calcium channel blockers?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
To inhibit thrombus and clot formation.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
An enlarged space indicates fluid accumulation in the pericardial sac.


41. What lab value is used to evaluate a patient on coumadin? What is the normal value?
One large emboli (smaller=better)
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.
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


42. What is the treatment for someone in ventricular fibrillation?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


43. 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?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Include rest periods prior to any activity.


44. What is a major complication of central line placement?
Pneumothorax and will end up with chest tube to help reinflate lung.
Activity intolerance
Fifth left intercostal space medial to the midclavicular line.
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.


45. Where do the internal jugular veins lie?
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
Must be flushed 1x/month with heparin and between treatments.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


46. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
One at a time to assess the pulse amplitude and contour.
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.
Steroid treatment or a pregnant woman who is retaining water.


47. What should you teach your patient about a holter monitor?

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48. What are coumadin and heparin used for?
Old truck driver or someone on bed rest or with pelvic trauma.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
To inhibit thrombus and clot formation.


49. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
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
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
Patient who are unable to tolerate exercise stress testing.


50. What type of EKG change indicates MI?
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
ST segment elevation (STEMI)
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Include rest periods prior to any activity.