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. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Right sided heart failure
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 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


2. What is an air embolism?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Lowers BP and makes heart beat stronger. SE: flushed face.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


3. 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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


4. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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!
In fatty areas or over major muscles - large breasts - or bony prominences.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


5. What is characteristic of complete heart block?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


6. How should you palpate the apical pulse?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
0.5-2.0 ng/ml
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
One large emboli (smaller=better)


7. 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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Only for a few hours


8. What drugs are most commonly used for angina?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
Nitrates - Beta blockers - and Calcium channel blockers
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


9. Where is the apex/mitral valve landmark on the chest?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
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.


10. What is cardioversion?

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11. What does the device for impedance cardiography consist of?
Pulse before and after giving.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


12. What are the nursing interventions for a patient in complete heart block?
To inhibit thrombus and clot formation.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


13. What is the most common cause of arterial insufficiency?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
Chronic arteriosclerotic disease.
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


14. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
In fatty areas or over major muscles - large breasts - or bony prominences.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
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


15. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


16. What is CVP? Normal?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Iodine
No radial artery punctures if negative


17. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Idiopathic
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).


18. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Cannot
Maintain BED REST
Lower left sternal border
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


19. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
One large emboli (smaller=better)
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.
Pulmonary edema


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

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21. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
D/C the med and call the doctor.
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.
BP is elevated or decreased depending on activity.


22. What should you watch for with PICC lines that have been in place for 6 months?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Air answers (open junctions)


23. What can result from left sided heart failure if left untreated?
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
Pulmonary edema
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.)


24. What is an aortic dissection?

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25. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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
Include rest periods prior to any activity.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.


26. What are the four types of pulmonary emboli?
Poorly controlled hypertension
Chronic arteriosclerotic disease.
Fat - Air - DVT - or Amniotic
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


27. What are the S&S of air embolism?
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
D/C the med and call the doctor.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


28. What are the S&S of aortic dissection?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
BP is elevated or decreased depending on activity.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.


29. What should you teach your patient about an abdominal ultrasonography?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


30. What is defibrillation?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
4th left intercostal space lower sternal border
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


31. What is characteristic of ventricular fibrillation?
Idiopathic
Feeling warm (fire) or tin can taste is expected and will pass.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


32. What things should you do to assess cardiovascular status?
A nosebleed
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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


33. For what disease should you do the Allen's test?

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34. What is Raynauds disease? Tx?
Must be flushed 1x/month with heparin and between treatments.
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 monitor with four dual electrodes that are applied to the patients neck and thorax.
In the first 72 hours!!!!!


35. What is important to remember when removing a CVC from a patient?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


36. What should you do when applying a femoral artery compression device?
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.
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
Pulse before and after giving.


37. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Iodine
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


38. Where should you place your stethescope to find the ERB's Point?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
(S1 - S2) Third left intercostal space
Don't interfere!


39. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
0.5-2.0 ng/ml
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Lower left sternal border
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


40. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
To report to her healthcare provider if she feels a large bump in her groin - if she has groin pain unrelieved by acetaminophen - or if she develops numbness - tingling - etc. in the affected leg.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Air answers (open junctions)
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


41. What are the S&S associated with right sided heart failure?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


42. What should you tell someone about taking nitroglycerin tablets (SE)?
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
They may feel a slight stinging under there tongue when they are dissolving - and they should get a HA (if no HA may not be good bc the pills only last for 6 months). Keep with you at all times.


43. What should you not allow if a patient has a negative Allen's test?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
No radial artery punctures if negative
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


44. Where should you place your stethescope to find the mitral (apex) valve?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Fifth left intercostal space medial to the midclavicular line.


45. What should you teach someone with arterial insufficiency?

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46. What are the steps for adult 2 rescuer CPR?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Air embolism
(S1 - S2) Third left intercostal space
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


47. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Pulmonary edema
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.


48. What makes the symptoms of superior vena cava syndrome better? Worse?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
ST segment elevation (STEMI)
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


49. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(S1 - S2) Third left intercostal space
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


50. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
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
Air answers (open junctions)
If feel more than 3 shocks in a row or develop signs of infection at the site.