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. Where should you place your stethescope to find the mitral (apex) valve?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Fifth left intercostal space medial to the midclavicular line.


2. What should be checked in a patient on a beta blocker?
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
Used to 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
Pulse before and after giving.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


3. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
The internal jugular veins (external are less reliable).
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


4. What could happen without immediate intervention for a hematoma?
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
The patient may suffer significant blood loss or femoral nerve compression.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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. Should the tubing for a venous access port be included under the dressing site?

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6. What should you watch for with PICC lines that have been in place for 6 months?
Maintain BED REST
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Air answers (open junctions)
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


7. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
Right sided heart failure
A nosebleed
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


8. What are the indications for a chemical stress test (persantine stress test)?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Steroid treatment or a pregnant woman who is retaining water.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Patient who are unable to tolerate exercise stress testing.


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

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10. What should be done immediately if a pulmonary embolism is suspected?
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.
The internal jugular veins (external are less reliable).
Only for a few hours
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


11. When would a nurse use an external femoral artery compression device?
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


12. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
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.
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


13. What should you teach your patient about an electrocardiogram (ECG)?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
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.)
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.


14. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
Fat - Air - DVT - or Amniotic
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


15. What would make someone more at risk for digoxin toxicity?
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
Pulmonary edema
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


16. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


17. What can result from left sided heart failure if left untreated?
BP is elevated or decreased depending on activity.
Pulmonary edema
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


18. What should you teach someone about iodine?
Lower left sternal border
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Lung disease
Feeling warm (fire) or tin can taste is expected and will pass.


19. What should a patient do if they feel chest pain or discomfort?
Chronic arteriosclerotic disease.
Cannot
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
NO NSAIDS or ASA.


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

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21. What is cardioversion?

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22. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
BP is elevated or decreased depending on activity.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.


23. What disease can cause right sided heart failure?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Lung disease


24. What is labile hypertension?
BP is elevated or decreased depending on activity.
Pulse before and after giving.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.


25. Who would most likely have peripheral venous disease?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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).
Old truck driver or someone on bed rest or with pelvic trauma.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


26. What type of EKG change indicates MI?
ST segment elevation (STEMI)
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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


27. What are the S&S of aortic dissection?
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Pneumothorax and will end up with chest tube to help reinflate lung.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


28. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
Lung disease
Feeling warm (fire) or tin can taste is expected and will pass.


29. 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.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Fifth left intercostal space medial to the midclavicular line.


30. What is characteristic of ventricular fibrillation?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
0.5-2.0 ng/ml
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


31. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Air embolism
Right sided heart failure
In fatty areas or over major muscles - large breasts - or bony prominences.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).


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

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33. What are signs and symptoms of an MI?
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


34. What is defibrillation?
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.
Iodine
Activity intolerance
Steroid treatment or a pregnant woman who is retaining water.


35. What is the goal of treatment for an MI? Treatment?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
4th left intercostal space lower sternal border


36. What is cardiac tamponade? Common causes?
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.)
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
Second right 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


37. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Exercise and use graduated compression devices as directed - don't stand for long period of time - to avoid dislodging blood clots don't rub or massage your legs.
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


38. How long is contrast media in the body?
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
Only for a few hours
Left sternal border
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


39. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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 they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


40. What is the treatment for someone in ventricular fibrillation?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Before


41. How should you palpate the carotid arteries?
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.
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.
One at a time to assess the pulse amplitude and contour.
The patient may suffer significant blood loss or femoral nerve compression.


42. What landmarks should you be looking for on someone's chest?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Poorly controlled hypertension
If feel more than 3 shocks in a row or develop signs of infection at the site.
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


43. What is a transthoracic echocardiograph (TTE)?
Lower left sternal border
ST segment elevation (STEMI)
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


44. Where do the internal jugular veins lie?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Chronic arteriosclerotic disease.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Cannot


45. What is characteristic of atrial fibrillation?
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


46. How is the Allen's test done?
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
Right sided heart failure
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Idiopathic


47. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
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).


48. What is the treatment for a pt. with ventricular tachycardia?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
D/C the med and call the doctor.


49. Where is the right ventricle landmark on the chest?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Left sternal border
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


50. Where is the tricuspid valve landmark on the chest?
Lower left sternal border
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
In fatty areas or over major muscles - large breasts - or bony prominences.
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