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. Where do the internal jugular veins lie?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
D/C the med and call the doctor.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


2. What is important to remember when removing a CVC from a patient?
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
Whether the patients ulnar and radial arteries are patent.


3. During an Allen's test don't compress one artery _____ the other.
Before
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
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.
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.


4. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.


5. What is a major complication of central line placement?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pneumothorax and will end up with chest tube to help reinflate lung.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


6. What can result from left sided heart failure if left untreated?
One large emboli (smaller=better)
Activity intolerance
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Pulmonary edema


7. What should you watch for with PICC lines that have been in place for 6 months?
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.
Direct current cardioversion and digoxin/propranolol (inderal).
Air answers (open junctions)
In fatty areas or over major muscles - large breasts - or bony prominences.


8. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
NO because it isn't sterile so keep out.
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.


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

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10. When should bleeding precautions be implemented?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
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
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.


11. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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


12. What landmarks should you be looking for on someone's chest?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
D/C the med and call the doctor.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


13. How long is contrast media in the body?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Only for a few hours
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
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


14. What is an acute peripheral arterial occlusion?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


15. What is the treatment for a patient in complete heart block?
Second right intercostal space
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
Must be flushed 1x/month with heparin and between treatments.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


16. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
If feel more than 3 shocks in a row or develop signs of infection at the site.
One at a time to assess the pulse amplitude and contour.


17. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
Left sternal border
Chronic arteriosclerotic disease.
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


18. What will be the treatment for an acute episode of life threatening tamponade?
Second right intercostal space
Whether the patients ulnar and radial arteries are patent.
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.


19. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.


20. What are the nursing interventions for a patient with premature ventricular contractions?
Don't interfere!
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.)


21. Where is the tricuspid valve landmark on the chest?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Lower left sternal border


22. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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
Feeling warm (fire) or tin can taste is expected and will pass.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
BP is elevated or decreased depending on activity.


23. What is important to remember when taking care of patients with compression devices?
Left sternal border
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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


24. Where is the right ventricle landmark on the chest?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Left sternal border
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


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

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26. Where is the aortic valve landmark on the chest?
Second right intercostal space
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
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-
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


27. What are the steps for adult 2 rescuer CPR?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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
To report to her healthcare provider if she feels a large bump in her groin - if she has groin pain unrelieved by acetaminophen - or if she develops numbness - tingling - etc. in the affected leg.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


28. What are signs and symptoms of an MI?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
In the first 72 hours!!!!!


29. What should you do to treat pulmonary edema?
Iodine
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
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
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


30. What is pulsus paradoxus?
ST segment elevation (STEMI)
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Protamine Sulfate


31. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
In fatty areas or over major muscles - large breasts - or bony prominences.


32. Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Direct current cardioversion and digoxin/propranolol (inderal).
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.
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


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

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34. What are examples of calcium channel blockers?
In the first 72 hours!!!!!
Air answers (open junctions)
Poorly controlled hypertension
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


35. What is the treatment for myocardial infarction?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Left sternal border
If feel more than 3 shocks in a row or develop signs of infection at the site.


36. What is intermittent claudication?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
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


37. What should you teach your patient about an electrocardiogram (ECG)?
Second right intercostal space
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 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
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.


38. What should you do if you are going to ventilate someone with an ambu bag?
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
ST segment elevation (STEMI)
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


39. What is cardioversion?

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40. What is more harmful a lot of little emboli or one large emboli?
Activity intolerance
Left sternal border
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
One large emboli (smaller=better)


41. What is the maintenance for venous access port that isn't being regularly used?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
To inhibit thrombus and clot formation.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Must be flushed 1x/month with heparin and between treatments.


42. What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
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.
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


43. When should you be concerned about premature ventricular contraction?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


44. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


45. How is the Allen's test done?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


46. What are the steps for adult/child 1 rescuer CPR?
Fat - Air - DVT - or Amniotic
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
Pneumothorax and will end up with chest tube to help reinflate lung.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


47. What are the two common complications of pericarditis?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Air embolism
Maintain BED REST


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

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49. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
Second right intercostal space
In fatty areas or over major muscles - large breasts - or bony prominences.


50. What is characteristic of complete heart block?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Maintain BED REST
Fat - Air - DVT - or Amniotic
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.