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 needs to be held during the placement of a femoral artery compression device?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
NO NSAIDS or ASA.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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 do if you are going to ventilate someone with an ambu bag?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
D/C the med and call the doctor.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


3. What is important to remember when taking care of patients with compression devices?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
(S1 - S2) Third left intercostal space
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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


4. What should be done immediately if a pulmonary embolism is suspected?
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
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.
BP is elevated or decreased depending on activity.
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


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

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6. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
The patient may suffer significant blood loss or femoral nerve compression.


7. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.


8. What is impedance cardiography?
NO NSAIDS or ASA.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


9. How is angina treated?

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10. When would a nurse use an external femoral artery compression device?
Second right intercostal space
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.
Iodine
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


11. How should you palpate the carotid arteries?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
One at a time to assess the pulse amplitude and contour.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


12. What should be immediately done for a patient experiencing digoxin toxicity?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
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


13. What should be done immediately for someone with PE?
One large emboli (smaller=better)
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.


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

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15. Where should you place your stethescope to find the pulmonic valve?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Direct current cardioversion and digoxin/propranolol (inderal).
Second Left intercostal space


16. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Maintain BED REST
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


17. What causes essential/primary hypertension?
Second right intercostal space
Idiopathic
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Only for a few hours


18. What is cardiac tamponade? Common causes?
Activity intolerance
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.
Right sided heart failure
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


19. When should bleeding precautions be implemented?
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Lowers BP and makes heart beat stronger. SE: flushed face.


20. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
Direct current cardioversion and digoxin/propranolol (inderal).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Don't interfere!


21. What is the correct way to insert an oropharyngeal airway?
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.
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
No radial artery punctures if negative
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.


22. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
If feel more than 3 shocks in a row or develop signs of infection at the site.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Chronic arteriosclerotic disease.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).


23. What is cardioversion?

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24. What is a chemical stress test (persantine stress test)?
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
Idiopathic
Poorly controlled hypertension
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


25. What are common risk factors for an MI?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


26. In what locations should you not place electrodes?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Second Right intercostal space.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
In fatty areas or over major muscles - large breasts - or bony prominences.


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

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28. What should you teach your patient about MRI?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Lung disease
Second left intercostal space
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


29. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Fifth left intercostal space medial to the midclavicular line.
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-
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


30. What are the nursing interventions for a patient in atrial fibrillation?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
NO because it isn't sterile so keep out.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.


31. What are coumadin and heparin used for?
4th left intercostal space lower sternal border
Second left intercostal space
To inhibit thrombus and clot formation.
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


32. What will a leg with arterial insufficiency look like?
(S1 - S2) Third left intercostal space
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Vitamin K (aqua myphiton)


33. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


34. Where should you place your stethescope to find the mitral (apex) valve?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
An enlarged space indicates fluid accumulation in the pericardial sac.
Pneumothorax and will end up with chest tube to help reinflate lung.
Fifth left intercostal space medial to the midclavicular line.


35. What is the antidote for coumadin?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Second Right intercostal space.
Second Left intercostal space
Vitamin K (aqua myphiton)


36. What should you teach your patient about an electrocardiogram (ECG)?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


37. What are signs and symptoms of an MI?
Activity intolerance
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
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


38. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
Second Right intercostal space.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


39. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
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
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


40. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Nitrates - Beta blockers - and Calcium channel blockers
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Include rest periods prior to any activity.


41. What is the hallmark clinical finding associated with pericarditis?
No radial artery punctures if negative
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.


42. What are the indications for a chemical stress test (persantine stress test)?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Lung disease
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
Patient who are unable to tolerate exercise stress testing.


43. What is angina? Stable vs. unstable?

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44. Where do the internal jugular veins lie?
Cannot
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.


45. What should you do if the PT value is 45 sec?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
D/C the med and call the doctor.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


46. What condition can cause left sided heart failure?
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Vascular - artery disease causing fluid to back up into the lungs.
One large emboli (smaller=better)


47. What is the treatment for someone with right sided HF? How do you know working?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Lung disease
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.


48. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
The internal jugular veins (external are less reliable).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.


49. What is important to remember when removing a CVC from a patient?
Vitamin K (aqua myphiton)
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.


50. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Air embolism
One large emboli (smaller=better)