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 checked in a patient on a beta blocker?
Pulse before and after giving.
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
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.
No radial artery punctures if negative


2. What is important to remember when taking care of patients with compression devices?
Patient who are unable to tolerate exercise stress testing.
In fatty areas or over major muscles - large breasts - or bony prominences.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


3. What places someone at risk for an aortic dissection?
Pulse before and after giving.
Poorly controlled hypertension
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


4. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).


5. Where do the internal jugular veins lie?
A nosebleed
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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


6. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Include rest periods prior to any activity.


7. What SE should you look for with calcium channel blocker use?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Vascular - artery disease causing fluid to back up into the lungs.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.


8. What does an Allen's test determine?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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
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.
Whether the patients ulnar and radial arteries are patent.


9. What is the treatment for myocardial infarction?
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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


10. What are the S&S of pulmonary embolism?
Iodine
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


11. What is labile hypertension?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
BP is elevated or decreased depending on activity.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.


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

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13. Test ending in Gram=?
Iodine
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.
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


14. What is a good diagnosis for someone with right sided HF?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
One large emboli (smaller=better)
Activity intolerance
Before


15. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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


16. What will a leg with arterial insufficiency look like?
Poorly controlled hypertension
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


17. What is cardiac tamponade? Common causes?
To inhibit thrombus and clot formation.
D/C the med and call the doctor.
Right sided heart failure
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


18. What is characteristic of ventricular fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


19. What are the 2 types of pacemakers?
Second right intercostal space
NO because it isn't sterile so keep out.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.


20. Where is the right ventricle landmark on the chest?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Left sternal border
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.
Only for a few hours


21. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.
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
D/C the med and call the doctor.


22. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
Right sided heart failure
Activity intolerance
An inflammation of the pericardium. It may result in MI.


23. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Maintain BED REST


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

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

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26. What should you teach someone with arterial insufficiency?

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27. What should you do immediately if you suspect someone of developing a hematoma?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Include rest periods prior to any activity.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.


28. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
The patient may suffer significant blood loss or femoral nerve compression.
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.


29. What is the treatment for a patient in complete heart block?
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
Air answers (open junctions)
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


30. What is more harmful a lot of little emboli or one large emboli?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
One large emboli (smaller=better)
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).


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

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32. What is Deep Vein Thrombosis (DVT)?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Include rest periods prior to any activity.
An inflammation of the pericardium. It may result in MI.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


33. Where is the pulmonic valve landmark on the chest?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Second left intercostal space
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


34. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


35. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Air embolism
Fifth left intercostal space medial to the midclavicular line.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


36. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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
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.
Pulse before and after giving.
If feel more than 3 shocks in a row or develop signs of infection at the site.


37. What is the antidote for coumadin?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Vitamin K (aqua myphiton)
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
Iodine


38. What is the treatment for someone in ventricular fibrillation?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
D/C the med and call the doctor.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


39. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
The internal jugular veins (external are less reliable).
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


40. In what locations should you not place electrodes?
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Lowers BP and makes heart beat stronger. SE: flushed face.
In fatty areas or over major muscles - large breasts - or bony prominences.


41. For which heart sounds should the diaphragm be used?
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.


42. Where should you place your stethescope to find the mitral (apex) valve?
Fifth left intercostal space medial to the midclavicular line.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Direct current cardioversion and digoxin/propranolol (inderal).


43. What is the maintenance for venous access port that isn't being regularly used?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Must be flushed 1x/month with heparin and between treatments.


44. What is a therapeutic digoxin level?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
D/C the med and call the doctor.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
0.5-2.0 ng/ml


45. What are the nursing interventions for a patient in complete heart block?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Chronic arteriosclerotic disease.
To inhibit thrombus and clot formation.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


46. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A nosebleed


47. What are the proper steps to changing a central venous catheter dressing?
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.
Maintain BED REST
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


48. What are examples of calcium channel blockers?
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
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


49. What needs to be held during the placement of a femoral artery compression device?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
NO NSAIDS or ASA.


50. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Before
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.
One at a time to assess the pulse amplitude and contour.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.