Test your basic knowledge |

NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

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 the treatment for atrial fibrillation?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.)
Direct current cardioversion and digoxin/propranolol (inderal).
NO NSAIDS or ASA.

2. What would make someone more at risk for digoxin toxicity?
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.
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.
Air answers (open junctions)
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

3. What should you go when applying nitroglycerin ointment for angina?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

4. What are the steps for infant 1&2 rescuer CPR?
One at a time to assess the pulse amplitude and contour.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
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

5. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Include rest periods prior to any activity.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.

6. What is epistaxis?
A nosebleed
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
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

7. What is CVP? Normal?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

8. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
(S1 - S2) Third left intercostal space
If feel more than 3 shocks in a row or develop signs of infection at the site.

9. What is a good diagnosis for someone with right sided HF?
Activity intolerance
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
An inflammation of the pericardium. It may result in MI.
Fat - Air - DVT - or Amniotic

10. What should you teach your patient about a cardiac catheterization?
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
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.)
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.

11. For which heart sounds should the bell be used?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.

12. What is cardiac tamponade? Common causes?
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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

13. What is the antidote for coumadin?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Vitamin K (aqua myphiton)
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

14. What are examples of calcium channel blockers?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

15. What is the purpose of compression devices?
Idiopathic
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Cannot

16. What should be done for someone on bleeding precautions?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Nitrates - Beta blockers - and Calcium channel blockers
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

17. What is the treatment for premature ventricular contractions?
Idiopathic
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Second Left intercostal space
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

18. What landmarks should you be looking for on someone's chest?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

19. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Second Left intercostal space
Fifth left intercostal space medial to the midclavicular line.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

20. What are all the S&S of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
The patient may suffer significant blood loss or femoral nerve compression.
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
Vitamin K (aqua myphiton)

21. What are the four types of pulmonary emboli?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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
Before
Fat - Air - DVT - or Amniotic

22. What does plan of care include?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.

23. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
D/C the med and call the doctor.
NO because it isn't sterile so keep out.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

24. How should you palpate the apical pulse?
D/C the med and call the doctor.
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.

25. What should you not allow if a patient has a negative Allen's test?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
No radial artery punctures if negative
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

26. What are the signs and symptoms of left sided HF?
BP is elevated or decreased depending on activity.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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

27. What should a patient do if they feel chest pain or discomfort?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
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
Before

28. When should you be concerned about premature ventricular contraction?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Right sided heart failure

29. What SE should you look for with calcium channel blocker use?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.
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

30. How long is contrast media in the body?
Must be flushed 1x/month with heparin and between treatments.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Only for a few hours
Second Right intercostal space.

31. What is an acute peripheral arterial occlusion?
D/C the med and call the doctor.
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

32. What makes the symptoms of superior vena cava syndrome better? Worse?
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Poorly controlled hypertension
(S1 - S2) Third left intercostal space

33. What is an aortic dissection?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

34. What is the treatment for a pt. with ventricular tachycardia?
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
Poorly controlled hypertension
Air answers (open junctions)
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.

35. What are the steps for adult/child 1 rescuer CPR?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Pulse before and after giving.
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.
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

36. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Don't interfere!
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

37. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.)
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

38. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.
Open up blood vessels

39. What condition can cause left sided heart failure?
One large emboli (smaller=better)
Second right intercostal space
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
Vascular - artery disease causing fluid to back up into the lungs.

40. What places someone at risk for an aortic dissection?
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.
Poorly controlled hypertension
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
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

41. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

42. What are the nursing interventions for a patient in atrial fibrillation?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

43. What is the maintenance for venous access port that isn't being regularly used?
An enlarged space indicates fluid accumulation in the pericardial sac.
Must be flushed 1x/month with heparin and between treatments.
The internal jugular veins (external are less reliable).
In the first 72 hours!!!!!

44. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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-
The internal jugular veins (external are less reliable).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

45. What does the device for impedance cardiography consist of?
Include rest periods prior to any activity.
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)
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

46. What drugs are most commonly used for angina?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Left sternal border
Nitrates - Beta blockers - and Calcium channel blockers
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

47. What type of surgery is done for an aortic dissection?
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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

48. What do calcium channel blockers do?
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
Open up blood vessels
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.
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.

49. What is intermittent claudication?
4th left intercostal space lower sternal border
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
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.

50. Where should you place your stethescope to find the mitral (apex) valve?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Fifth left intercostal space medial to the midclavicular line.
Feeling warm (fire) or tin can taste is expected and will pass.
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.