Instructions:

• Answer 50 questions in 15 minutes.
• If you are not ready to take this test, you can study here.
• Match each statement with the correct term.
• Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
Vascular - artery disease causing fluid to back up into the lungs.


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

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3. What is characteristic of complete heart block?
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.
An enlarged space indicates fluid accumulation in the pericardial sac.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


4. What is an air embolism?
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Left sternal border
ST segment elevation (STEMI)


5. How should you palpate the apical pulse?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


6. How is the Allen's test done?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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


7. What should you always assume with a patient who has a central line placed and is experiencing SOB?
In fatty areas or over major muscles - large breasts - or bony prominences.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Air embolism
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.


8. How long is contrast media in the body?
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
Only for a few hours
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


9. What is the treatment for a patient in complete heart block?
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.
Chronic arteriosclerotic disease.
Fifth left intercostal space medial to the midclavicular line.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


10. What is the hallmark clinical finding associated with pericarditis?
To inhibit thrombus and clot formation.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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
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.


11. What is Raynauds disease? Tx?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
Nitrates - Beta blockers - and Calcium channel blockers
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


12. What is more harmful a lot of little emboli or one large emboli?
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.
One large emboli (smaller=better)
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


13. What factors place you at risk for HTN?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


14. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Fat - Air - DVT - or Amniotic
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Feeling warm (fire) or tin can taste is expected and will pass.


15. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


16. What does plan of care include?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


17. What is the treatment for a pt. with ventricular tachycardia?
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.
NO because it isn't sterile so keep out.
Feeling warm (fire) or tin can taste is expected and will pass.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


18. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Cannot
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


19. What should you go when applying nitroglycerin ointment for angina?
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
Pulmonary edema
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.


20. What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


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


22. What are the S&S of cardiac tamponade?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
0.5-2.0 ng/ml
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.


23. During an Allen's test don't compress one artery _____ the other.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
An enlarged space indicates fluid accumulation in the pericardial sac.
Before


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

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25. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
Include rest periods prior to any activity.
Pulmonary edema


26. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
Poorly controlled hypertension
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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


27. What should you observe for in someone on bleeding precautions?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Pneumothorax and will end up with chest tube to help reinflate lung.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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).


28. Where should you place your stethescope to find the mitral (apex) valve?
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.
Fifth left intercostal space medial to the midclavicular line.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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


29. What is a assessment finding with DVT?

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30. What does the device for impedance cardiography consist of?
Iodine
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


31. What is cardiac tamponade? Common causes?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.


32. Who would most likely have peripheral venous disease?
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Direct current cardioversion and digoxin/propranolol (inderal).
Old truck driver or someone on bed rest or with pelvic trauma.


33. What can result from left sided heart failure if left untreated?
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
Pulmonary edema
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


34. What are the S&S of superior vena cava syndrome?
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.


35. What will be the treatment for an acute episode of life threatening tamponade?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Patient who are unable to tolerate exercise stress testing.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.


36. What do calcium channel blockers do?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Open up blood vessels
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
Nitrates - Beta blockers - and Calcium channel blockers


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

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38. How is angina treated?

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39. What should you remember while taking care of someone with a peripheral arterial occlusion?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
If feel more than 3 shocks in a row or develop signs of infection at the site.
Fourth or fifth intercostal space at or medial to the midclavicular line.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


40. What is a major complication of central line placement?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Pneumothorax and will end up with chest tube to help reinflate lung.
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
Pulse before and after giving.


41. A femoral artery compression device ______be assigned to an NA?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Cannot
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


42. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
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.
Right sided heart failure


43. What is pulsus paradoxus?
BP is elevated or decreased depending on activity.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.


44. What should be checked in a patient on a beta blocker?
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.
Pulse before and after giving.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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-


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

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46. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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


47. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Left sternal border
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.)
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


48. What should you teach your patient about an abdominal ultrasonography?
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


49. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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


50. What are the five areas for listening to the heart?

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