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 is the aortic valve landmark on the chest?
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.
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.
The internal jugular veins (external are less reliable).
Second right intercostal space


2. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
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!
0.5-2.0 ng/ml
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


3. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
Whether the patients ulnar and radial arteries are patent.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


4. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Fifth left intercostal space medial to the midclavicular line.
BP is elevated or decreased depending on activity.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


5. What should you not allow if a patient has a negative Allen's test?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
No radial artery punctures if negative


6. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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.
Air embolism
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


7. Where should you place your stethescope to find the pulmonic valve?
NO NSAIDS or ASA.
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
Second Left intercostal space
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


8. How is angina treated?

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9. What makes the symptoms of superior vena cava syndrome better? Worse?
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).
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
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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


10. What is the treatment for a patient in complete heart block?
Lung disease
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
It is a 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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


11. What are the nursing interventions for a patient in complete heart block?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
Pneumothorax and will end up with chest tube to help reinflate lung.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


12. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
A nosebleed
Steroid treatment or a pregnant woman who is retaining water.


13. What is angina? Stable vs. unstable?

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14. What are the nursing interventions for a patient in atrial fibrillation?
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Fat - Air - DVT - or Amniotic


15. What is the treatment for someone with right sided HF? How do you know working?
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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


16. What would make someone more at risk for digoxin toxicity?
Must be flushed 1x/month with heparin and between treatments.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.


17. What should you teach your patient about an electrocardiogram (ECG)?
Pneumothorax and will end up with chest tube to help reinflate lung.
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
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 central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.


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

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19. What will be the treatment for an acute episode of life threatening tamponade?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Before


20. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Air embolism
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Pneumothorax and will end up with chest tube to help reinflate lung.
To inhibit thrombus and clot formation.


21. What is a chemical stress test (persantine stress test)?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Second Left intercostal space


22. What is characteristic of ventricular tachycardia?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


23. What are the nursing interventions for a patient with premature ventricular contractions?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
In the first 72 hours!!!!!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


24. What is an air embolism?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
Chronic arteriosclerotic disease.
One large emboli (smaller=better)


25. What should be done immediately for someone with PE?
Lung disease
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
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.


26. What should you do if the PT value is 45 sec?
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
D/C the med and call the doctor.
Idiopathic
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


27. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Patient who are unable to tolerate exercise stress testing.
Second Right intercostal space.
Open up blood vessels


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

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29. How does the blood flow through the heart? (valves?)
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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!
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


30. What is epistaxis?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
A nosebleed
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Poorly controlled hypertension


31. Which type of patient shouldn't take nitrates?
D/C the med and call the doctor.
Protamine Sulfate
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.


32. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


33. When should you be concerned about premature ventricular contraction?
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
4th left intercostal space lower sternal border


34. What are the steps for infant 1&2 rescuer CPR?
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
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
In the first 72 hours!!!!!


35. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.


36. What is INR?
If feel more than 3 shocks in a row or develop signs of infection at the site.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Before


37. What is a assessment finding with DVT?

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38. What are the S&S of air embolism?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


39. What are common risk factors for an MI?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Open up blood vessels
Chronic arteriosclerotic disease.


40. What should you do if you are going to ventilate someone with an ambu bag?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Open up blood vessels
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


41. Where is the tricuspid valve landmark on the chest?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Lower left sternal border
Old truck driver or someone on bed rest or with pelvic trauma.


42. For which heart sounds should the bell be used?
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Second Left intercostal space
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


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

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44. What do calcium channel blockers do?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
In fatty areas or over major muscles - large breasts - or bony prominences.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Open up blood vessels


45. What should you teach your patient about an abdominal ultrasonography?
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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
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


46. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
Air embolism
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


47. What is superior vena cava syndrome?
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.
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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


48. What should you do when applying a femoral artery compression device?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
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
NO NSAIDS or ASA.


49. What are coumadin and heparin used for?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
To inhibit thrombus and clot formation.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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


50. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
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-
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.