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 disease can cause right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Lung disease
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


2. What is the treatment for premature ventricular contractions?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Right sided heart failure
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
Pneumothorax and will end up with chest tube to help reinflate lung.


3. Where should you place your stethescope to find the ERB's Point?
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.
(S1 - S2) Third left intercostal space
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


4. What does the device for impedance cardiography consist of?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Lung disease
A monitor with four dual electrodes that are applied to the patients neck and thorax.


5. What is intermittent claudication?
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
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.


6. What should you teach your patient about an abdominal ultrasonography?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
Poorly controlled hypertension
Maintain BED REST


7. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


8. What is the maintenance for venous access port that isn't being regularly used?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Pneumothorax and will end up with chest tube to help reinflate lung.
Must be flushed 1x/month with heparin and between treatments.


9. What is the nursing care associated with chemical stress tests (persantine stress test)?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Don't interfere!
Lower left sternal border
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


10. When should you be concerned about premature ventricular contraction?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Don't interfere!
D/C the med and call the doctor.


11. What is the goal of treatment for an MI? Treatment?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


12. What factors place you at risk for HTN?
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.
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.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


13. A femoral artery compression device ______be assigned to an NA?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Cannot


14. Where do the internal jugular veins lie?
Second right intercostal space
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.


15. What is an aortic dissection?

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16. What should you teach someone with arterial insufficiency?

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17. What should you observe for in someone on bleeding precautions?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Poorly controlled hypertension
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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 are signs and symptoms of an MI?
Pneumothorax and will end up with chest tube to help reinflate lung.
Direct current cardioversion and digoxin/propranolol (inderal).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Iodine


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

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20. What is a major complication of central line placement?
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
Pneumothorax and will end up with chest tube to help reinflate lung.
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


21. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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-
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


22. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Lung disease
An enlarged space indicates fluid accumulation in the pericardial sac.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


23. Where is the tricuspid valve landmark on the chest?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Lower left sternal border
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


24. What should be done for someone on bleeding precautions?
Left sternal border
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


25. Who would most likely have peripheral venous disease?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
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!
Old truck driver or someone on bed rest or with pelvic trauma.


26. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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 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
Iodine


27. Where should you place your stethescope to find the pulmonic valve?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Idiopathic
Second Left intercostal space
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


28. What is characteristic of complete heart block?
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
A nosebleed
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


29. What should you not allow if a patient has a negative Allen's test?
Steroid treatment or a pregnant woman who is retaining water.
No radial artery punctures if negative
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 at a time to assess the pulse amplitude and contour.


30. What should be done immediately for someone with PE?
Lowers BP and makes heart beat stronger. SE: flushed face.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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
An inflammation of the pericardium. It may result in MI.


31. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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
Air embolism
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.)
Protamine Sulfate


32. If a victim is choking but can cough - speak - or breath what should you do?

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33. What places someone at risk for an aortic dissection?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Poorly controlled hypertension


34. What should you do when applying a femoral artery compression device?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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


35. What causes secondary hypertension?
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.
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
Steroid treatment or a pregnant woman who is retaining water.
BP is elevated or decreased depending on activity.


36. What should be checked in a patient on a beta blocker?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
BP is elevated or decreased depending on activity.
Pulse before and after giving.


37. What is characteristic of ventricular fibrillation?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Steroid treatment or a pregnant woman who is retaining water.
An enlarged space indicates fluid accumulation in the pericardial sac.


38. What condition can cause left sided heart failure?
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Vascular - artery disease causing fluid to back up into the lungs.


39. What can result from left sided heart failure if left untreated?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
Pulmonary edema


40. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Whether the patients ulnar and radial arteries are patent.


41. What are the steps to perform the heimlich maneuver?
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
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.


42. What are coumadin and heparin used for?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
To inhibit thrombus and clot formation.
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
0.5-2.0 ng/ml


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

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44. What is the most common cause of arterial insufficiency?
Check for response - activate ERS and AED - open airway with head tilt chin lift - checking breathing (5-10 sec) - give 2 breaths (1 sec each) - check carotid pulse (5-10 sec) - locate CPR hand position - deliver first cycle of compressions (30 compr
Chronic arteriosclerotic disease.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


45. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
It is a sterile procedure so both nurse and patient should wear a mask - arrange sterile field - remove dressing - assess the catheter insertion site for infection - put on sterile gloves - clean the site moving outwardly in a circular motion - apply
BP is elevated or decreased depending on activity.
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


46. What is the correct way to insert an oropharyngeal airway?
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
Only for a few hours
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Pulmonary edema


47. What is pulsus paradoxus?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
The patient may suffer significant blood loss or femoral nerve compression.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


48. What is Raynauds disease? Tx?
One at a time to assess the pulse amplitude and contour.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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!
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.


49. What is epistaxis?
A nosebleed
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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).


50. What is the antidote for heparin?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
Protamine Sulfate