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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 should you teach your patient about a holter monitor?

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2. How should you palpate the apical pulse?
In the first 72 hours!!!!!
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
If feel more than 3 shocks in a row or develop signs of infection at the site.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

3. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
4th left intercostal space lower sternal border
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
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.

4. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
Second Left intercostal space
Steroid treatment or a pregnant woman who is retaining water.

5. What should be immediately done for a patient experiencing digoxin toxicity?
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.
Old truck driver or someone on bed rest or with pelvic trauma.
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

6. What is pulsus paradoxus?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Fourth or fifth intercostal space at or medial to the midclavicular line.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
An enlarged space indicates fluid accumulation in the pericardial sac.

7. What are the nursing interventions for a patient in complete heart block?
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Include rest periods prior to any activity.
Second Left intercostal space

8. What are the 2 types of pacemakers?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
Protamine Sulfate
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.

9. What landmarks should you be looking for on someone's chest?
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va
Pulmonary edema
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

10. Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Poorly controlled hypertension

11. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

12. What are the nursing interventions for a patient in atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
BP is elevated or decreased depending on activity.

13. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
BP is elevated or decreased depending on activity.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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

14. What should you do if you are going to ventilate someone with an ambu bag?
Maintain BED REST
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
Lower left sternal border
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

15. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Vascular - artery disease causing fluid to back up into the lungs.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

16. What is labile hypertension?
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
BP is elevated or decreased depending on activity.
Pulse before and after giving.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

17. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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
The patient may suffer significant blood loss or femoral nerve compression.
Air embolism
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

18. What is more harmful a lot of little emboli or one large emboli?
4th left intercostal space lower sternal border
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Lowers BP and makes heart beat stronger. SE: flushed face.
One large emboli (smaller=better)

19. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Chronic arteriosclerotic disease.
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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.

20. What does a swan ganz measure?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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!
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

21. What are the proper steps to changing a central venous catheter dressing?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Before
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.
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

22. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
Air answers (open junctions)
Must be flushed 1x/month with heparin and between treatments.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

23. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
D/C the med and call the doctor.
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.
Steroid treatment or a pregnant woman who is retaining water.

24. Which type of patient shouldn't take nitrates?
Vitamin K (aqua myphiton)
A nosebleed
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

25. What should you remember while taking care of someone with a peripheral arterial occlusion?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.
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

26. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
No radial artery punctures if negative
If feel more than 3 shocks in a row or develop signs of infection at the site.
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

27. What is the treatment for myocardial infarction?
Left sternal border
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

28. What are the indications for a chemical stress test (persantine stress test)?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Right sided heart failure
Patient who are unable to tolerate exercise stress testing.
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.

29. Where should you place your stethescope to find the ERB's Point?
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
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
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.
(S1 - S2) Third left intercostal space

30. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.

31. What makes the symptoms of superior vena cava syndrome better? Worse?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

32. What condition can cause left sided heart failure?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Vascular - artery disease causing fluid to back up into the lungs.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

33. What is the correct way to insert an oropharyngeal airway?
Idiopathic
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
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

34. What will be the treatment for an acute episode of life threatening tamponade?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Must be flushed 1x/month with heparin and between treatments.
Pulse before and after giving.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

35. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
No radial artery punctures if negative
Protamine Sulfate
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

36. What places someone at risk for an aortic dissection?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
Poorly controlled hypertension
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

37. What is INR?
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

38. In What time period is the greatest risk of sudden death from an MI?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
In the first 72 hours!!!!!
Fat - Air - DVT - or Amniotic
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

39. What is characteristic of ventricular tachycardia?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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

40. What SE should you look for with calcium channel blocker use?
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-
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Before

41. What are the steps to perform the heimlich maneuver?
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.
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
NO because it isn't sterile so keep out.

42. What is the nursing care associated with chemical stress tests (persantine stress test)?
Include rest periods prior to any activity.
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va
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.
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

43. What is Raynauds disease? Tx?
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.
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.
To inhibit thrombus and clot formation.
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.

44. What is the treatment for someone in ventricular fibrillation?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

45. What is an air embolism?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Only for a few hours
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

46. What are the S&S of pulmonary embolism?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Fat - Air - DVT - or Amniotic

47. What should a patient do if they feel chest pain or discomfort?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Vitamin K (aqua myphiton)
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 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.

48. What should be checked in a patient on a beta blocker?
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
Pulse before and after giving.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.

49. 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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

50. What will a leg with arterial insufficiency look like?
Chronic arteriosclerotic disease.
The patient may suffer significant blood loss or femoral nerve compression.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.