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 the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
In the first 72 hours!!!!!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Include rest periods prior to any activity.
Cannot


2. What is characteristic of atrial fibrillation?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


3. What should you teach your patient about MRI?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Idiopathic
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


4. What are examples of calcium channel blockers?
Right sided heart failure
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
ST segment elevation (STEMI)
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


5. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Feeling warm (fire) or tin can taste is expected and will pass.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Old truck driver or someone on bed rest or with pelvic trauma.


6. If a victim is choking but can cough - speak - or breath what should you do?

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7. What are the nursing interventions for a patient in complete heart block?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


8. 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
Air answers (open junctions)
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


9. What is the treatment for atrial fibrillation?
Air answers (open junctions)
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Direct current cardioversion and digoxin/propranolol (inderal).


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

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11. What is an aortic dissection?

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12. Where should you place your stethescope to find the aortic valve?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
NO because it isn't sterile so keep out.
Second Right intercostal space.


13. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
Pulse before and after giving.
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.


14. What is a therapeutic digoxin level?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
0.5-2.0 ng/ml
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.


15. Where should you place your stethescope to find the pulmonic valve?
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
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.
BP is elevated or decreased depending on activity.
Second Left intercostal space


16. What should a patient do if they feel chest pain or discomfort?
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


17. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Second Right intercostal space.
To inhibit thrombus and clot formation.


18. What body systems are affected by digoxin toxicity? S&S?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
NO because it isn't sterile so keep out.
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


19. How should you palpate the carotid arteries?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
One at a time to assess the pulse amplitude and contour.
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.
Only for a few hours


20. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
If feel more than 3 shocks in a row or develop signs of infection at the site.


21. What is the treatment for someone with right sided HF? How do you know working?
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
No radial artery punctures if negative
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


22. What should you do when applying a femoral artery compression device?
Before
Second right intercostal space
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


23. What should you observe for in someone on bleeding precautions?
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).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Patient who are unable to tolerate exercise stress testing.


24. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
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.
0.5-2.0 ng/ml
Lung disease


25. 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.
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.
Open up blood vessels
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.


26. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
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
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 monitor with four dual electrodes that are applied to the patients neck and thorax.


27. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
Pulmonary edema
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.
Pulse before and after giving.


28. When should bleeding precautions be implemented?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
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.
Pneumothorax and will end up with chest tube to help reinflate lung.


29. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Feeling warm (fire) or tin can taste is expected and will pass.
Lung disease
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. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
D/C the med and call the doctor.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


31. What should you do to treat pulmonary edema?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
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


32. What SE should you look for with calcium channel blocker use?
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.
D/C the med and call the doctor.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


33. How is angina treated?

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34. What disease can cause right sided heart failure?
Lung disease
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


35. What is the correct way to insert an oropharyngeal airway?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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


36. What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Open up blood vessels
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


37. What is cardioversion?

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38. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Before
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


39. What makes the symptoms of superior vena cava syndrome better? Worse?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


40. What should be immediately done for a patient experiencing digoxin toxicity?
Whether the patients ulnar and radial arteries are patent.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Don't interfere!
Must be flushed 1x/month with heparin and between treatments.


41. Where is the right ventricle landmark on the chest?
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.
Left sternal border
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.
A nosebleed


42. What are all the S&S of pericarditis?
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.


43. What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
Right atrium - TRICUSPID VALVE (tissue) - right ventricle - PULMONIC VALVE (paper) - lungs - left atrium - MITRAL VALVE (My) - left ventricle - AORTIC VALVE (Assets). Tissue PAPER MY ASSETS!
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.


44. What are the nursing interventions for a patient in atrial fibrillation?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
NO because it isn't sterile so keep out.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


45. What is Raynauds disease? Tx?
Lowers BP and makes heart beat stronger. SE: flushed face.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.
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


46. What is the treatment for premature ventricular contractions?
An inflammation of the pericardium. It may result in MI.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Pulmonary edema


47. What are signs and symptoms of an MI?
Cannot
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


48. What are the steps for infant 1&2 rescuer CPR?
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Only for a few hours


49. Test ending in Gram=?
Fourth or fifth intercostal space at or medial to the midclavicular line.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Don't interfere!
Iodine


50. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Cannot
ST segment elevation (STEMI)
An enlarged space indicates fluid accumulation in the pericardial sac.