NCLEX Cardiac

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. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Feeling warm (fire) or tin can taste is expected and will pass.
One at a time to assess the pulse amplitude and contour.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


2. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
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.
4th left intercostal space lower sternal border


3. What is the treatment for someone in ventricular fibrillation?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.)


4. What are the two common complications of pericarditis?
One at a time to assess the pulse amplitude and contour.
An inflammation of the pericardium. It may result in MI.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


5. What landmarks should you be looking for on someone's chest?
In the first 72 hours!!!!!
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


6. What signals an elevated venous pressure based on the internal jugular veins?
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.
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.


7. What is an air embolism?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Must be flushed 1x/month with heparin and between treatments.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.


8. What should happen if someone converts to asystole/flatline?
D/C the med and call the doctor.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


9. What type of surgery is done for an aortic dissection?
Protamine Sulfate
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.)
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


10. What are examples of calcium channel blockers?
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).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
0.5-2.0 ng/ml


11. What can result from left sided heart failure if left untreated?
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.
Pulmonary edema
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Fat - Air - DVT - or Amniotic


12. What is the treatment for myocardial infarction?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
4th left intercostal space lower sternal border
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


13. What is characteristic of ventricular tachycardia?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Iodine
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


14. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Must be flushed 1x/month with heparin and between treatments.
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


15. What causes secondary hypertension?
ST segment elevation (STEMI)
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Steroid treatment or a pregnant woman who is retaining water.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


16. What is impedance cardiography?
D/C the med and call the doctor.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Second Right intercostal space.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


17. What is angina? Stable vs. unstable?

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18. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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.
Maintain BED REST
Pneumothorax and will end up with chest tube to help reinflate lung.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


19. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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


20. What is a assessment finding with DVT?

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21. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
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
Lowers BP and makes heart beat stronger. SE: flushed face.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


22. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Old truck driver or someone on bed rest or with pelvic trauma.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Iodine


23. What should you do if you are going to ventilate someone with an ambu bag?
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
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
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


24. What is characteristic of atrial fibrillation?
Lower left sternal border
Second right intercostal space
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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


25. Which type of patient shouldn't take nitrates?
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


26. What is an aortic dissection?

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27. Where is the apex/mitral valve landmark on the chest?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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!
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Fourth or fifth intercostal space at or medial to the midclavicular line.


28. What should you teach your patient about MRI?
(S1 - S2) Third left intercostal space
Air embolism
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


29. Where should you place your stethescope to find the pulmonic valve?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
Second Left intercostal space
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.


30. What is Deep Vein Thrombosis (DVT)?
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


31. What is intermittent claudication?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.


32. What should you explain to the patient about an impedance cardiography test?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Old truck driver or someone on bed rest or with pelvic trauma.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.


33. What is characteristic of premature ventricular contractions?
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.
Maintain BED REST
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


34. 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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
The internal jugular veins (external are less reliable).
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!


35. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


36. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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37. What needs to be held during the placement of a femoral artery compression device?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
4th left intercostal space lower sternal border
NO NSAIDS or ASA.


38. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
Iodine


39. What does a swan ganz measure?
Steroid treatment or a pregnant woman who is retaining water.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Pneumothorax and will end up with chest tube to help reinflate lung.
4th left intercostal space lower sternal border


40. What are the proper steps to changing a central venous catheter dressing?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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


41. What should you watch for with PICC lines that have been in place for 6 months?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Air answers (open junctions)
(S1 - S2) Third left intercostal space


42. What does the device for impedance cardiography consist of?
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
Second Right intercostal space.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Before


43. What are the steps to perform the heimlich maneuver?
Air embolism
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.
ST segment elevation (STEMI)
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


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

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45. What would make someone more at risk for digoxin toxicity?
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.
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
Old truck driver or someone on bed rest or with pelvic trauma.
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.


46. What are the treatments/ S&S of peripheral venous disease?
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
Fat - Air - DVT - or Amniotic
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
NO NSAIDS or ASA.


47. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
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
ST segment elevation (STEMI)
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 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?
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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).
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.


49. What should you do immediately if you suspect someone of developing a hematoma?
A nosebleed
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Second Right intercostal space.
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.


50. What is an acute peripheral arterial occlusion?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
NO because it isn't sterile so keep out.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Only for a few hours