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 should be done for someone on bleeding precautions?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.


2. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
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.
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.


3. What is pulsus paradoxus?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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).
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


4. What should you teach your patient about a holter monitor?

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

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6. What is the purpose of compression devices?
D/C the med and call the doctor.
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.)
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


7. What should you teach your patient about MRI?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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


8. What should you teach your patient about angiography (arteriography)?
D/C the med and call the doctor.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
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


9. What does vasotec (Enalapril Maleate) do/SE?
Right sided heart failure
BP is elevated or decreased depending on activity.
Lowers BP and makes heart beat stronger. SE: flushed face.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.


10. What are the S&S of superior vena cava syndrome?
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Feeling warm (fire) or tin can taste is expected and will pass.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


11. What should be done immediately for someone with PE?
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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


12. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
The patient may suffer significant blood loss or femoral nerve compression.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


13. What are the two common complications of pericarditis?
Idiopathic
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


14. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Include rest periods prior to any activity.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.


15. What does a swan ganz measure?
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.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


16. What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Pulse before and after giving.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


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

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18. What should you teach your patient about an abdominal ultrasonography?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.


19. How is the Allen's test done?
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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


20. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.


21. What condition can cause left sided heart failure?
Second left intercostal space
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
Vascular - artery disease causing fluid to back up into the lungs.
Air answers (open junctions)


22. What should happen if someone converts to asystole/flatline?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
To inhibit thrombus and clot formation.
Whether the patients ulnar and radial arteries are patent.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


23. What is cardiac tamponade? Common causes?
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Direct current cardioversion and digoxin/propranolol (inderal).
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


24. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.


25. What will be the treatment for an acute episode of life threatening tamponade?
Lung disease
No radial artery punctures if negative
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Vascular - artery disease causing fluid to back up into the lungs.


26. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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!
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Second right intercostal space


27. What are coumadin and heparin used for?
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.
To inhibit thrombus and clot formation.


28. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!


29. What would make someone more at risk for digoxin toxicity?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.


30. What is a therapeutic digoxin level?
Fat - Air - DVT - or Amniotic
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
0.5-2.0 ng/ml
4th left intercostal space lower sternal border


31. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
In the first 72 hours!!!!!


32. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.


33. What SE should you look for with calcium channel blocker use?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


34. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
0.5-2.0 ng/ml
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


35. What should you do to treat pulmonary edema?
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.
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
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


36. 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?
Feeling warm (fire) or tin can taste is expected and will pass.
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.
Open up blood vessels
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


37. What are examples of calcium channel blockers?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Second left intercostal space
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Whether the patients ulnar and radial arteries are patent.


38. What is the most common cause of arterial insufficiency?
Vitamin K (aqua myphiton)
Chronic arteriosclerotic disease.
Old truck driver or someone on bed rest or with pelvic trauma.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


39. How should you palpate the carotid arteries?
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.
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
One at a time to assess the pulse amplitude and contour.


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

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41. What type of EKG change indicates MI?
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Must be flushed 1x/month with heparin and between treatments.
ST segment elevation (STEMI)


42. What are the S&S of cardiac tamponade?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Vitamin K (aqua myphiton)


43. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
Direct current cardioversion and digoxin/propranolol (inderal).
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).
Fifth left intercostal space medial to the midclavicular line.


44. What should you teach someone with arterial insufficiency?

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45. What is the antidote for heparin?
Nitrates - Beta blockers - and Calcium channel blockers
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Protamine Sulfate


46. What is characteristic of atrial fibrillation?
Poorly controlled hypertension
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Cannot


47. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Nitrates - Beta blockers - and Calcium channel blockers
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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


48. What are the four types of pulmonary emboli?
Iodine
Fat - Air - DVT - or Amniotic
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


49. What should you teach your patient about an electrocardiogram (ECG)?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
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
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.


50. What is important to remember when taking care of patients with compression devices?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Only for a few hours
To inhibit thrombus and clot formation.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.