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

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2. What is pulsus paradoxus?
Steroid treatment or a pregnant woman who is retaining water.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


3. What lab value is used to evaluate a patient on coumadin? What is the normal value?
D/C the med and call the doctor.
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).
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
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.


4. How long is contrast media in the body?
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Only for a few hours
No radial artery punctures if negative


5. What is the treatment for someone in ventricular fibrillation?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
If feel more than 3 shocks in a row or develop signs of infection at the site.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


6. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Include rest periods prior to any activity.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
No radial artery punctures if negative


7. What are all the S&S of pericarditis?
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


8. What should you teach someone with arterial insufficiency?

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9. What landmarks should you be looking for on someone's chest?
Old truck driver or someone on bed rest or with pelvic trauma.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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!


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

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11. Where should you place your stethescope to find the pulmonic valve?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Second Left intercostal space
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


12. In What time period is the greatest risk of sudden death from an MI?
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
In the first 72 hours!!!!!
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


13. What should you watch for with PICC lines that have been in place for 6 months?
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.
Fat - Air - DVT - or Amniotic
Lower left sternal border
Air answers (open junctions)


14. What type of EKG change indicates MI?
ST segment elevation (STEMI)
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


15. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


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

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17. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Maintain BED REST
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.


18. How should you palpate the carotid arteries?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
One at a time to assess the pulse amplitude and contour.


19. What do calcium channel blockers do?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Pulse before and after giving.
Open up blood vessels
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


20. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Right sided heart failure
Before
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


21. What should you do to treat pulmonary edema?
Chronic arteriosclerotic disease.
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.
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
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


22. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
Include rest periods prior to any activity.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


23. What is the treatment for a pt. with ventricular tachycardia?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
Lower left sternal border


24. What are the S&S of aortic dissection?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.


25. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Chronic arteriosclerotic disease.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


26. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Fat - Air - DVT - or Amniotic
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.
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.


27. What is the goal of treatment for an MI? Treatment?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


28. What drugs are most commonly used for angina?
An enlarged space indicates fluid accumulation in the pericardial sac.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Only for a few hours
Nitrates - Beta blockers - and Calcium channel blockers


29. What are the 2 types of pacemakers?
Pneumothorax and will end up with chest tube to help reinflate lung.
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
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


30. 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!
In the first 72 hours!!!!!
Left sternal border
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.


31. What is cardioversion?

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32. What is the treatment for atrial fibrillation?
In fatty areas or over major muscles - large breasts - or bony prominences.
Direct current cardioversion and digoxin/propranolol (inderal).
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
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.


33. Test ending in Gram=?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
Iodine


34. When should bleeding precautions be implemented?
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.


35. What should you remember while taking care of someone with a peripheral arterial occlusion?
Include rest periods prior to any activity.
A nosebleed
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.)


36. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
Nitrates - Beta blockers - and Calcium channel blockers
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.


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

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

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39. What are coumadin and heparin used for?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Air answers (open junctions)
To inhibit thrombus and clot formation.
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


40. What should you do immediately if you suspect someone of developing a hematoma?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


41. What are the nursing interventions for a pt. with ventricular tachycardia?
(S1 - S2) Third left intercostal space
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.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


42. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Nitrates - Beta blockers - and Calcium channel blockers
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Left sternal border


43. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Fourth or fifth intercostal space at or medial to the midclavicular line.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Left sternal border


44. 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?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.


45. What is INR?
Steroid treatment or a pregnant woman who is retaining water.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
D/C the med and call the doctor.


46. What is angina? Stable vs. unstable?

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47. What is the treatment for myocardial infarction?
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Fat - Air - DVT - or Amniotic
A monitor with four dual electrodes that are applied to the patients neck and thorax.


48. A femoral artery compression device ______be assigned to an NA?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
Cannot
Before


49. What should you do if the PT value is 45 sec?
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
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
D/C the med and call the doctor.


50. What is the treatment for premature ventricular contractions?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
0.5-2.0 ng/ml