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 will a leg with arterial insufficiency look like?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Open up blood vessels
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.


2. 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).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Whether the patients ulnar and radial arteries are patent.


3. What are the four types of pulmonary emboli?
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
Nitrates - Beta blockers - and Calcium channel blockers
Fat - Air - DVT - or Amniotic
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.


4. What factors place you at risk for HTN?
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
(S1 - S2) Third left intercostal space
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.


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

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

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7. What is the most common cause of arterial insufficiency?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
4th left intercostal space lower sternal border
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Chronic arteriosclerotic disease.


8. What is an air embolism?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


9. For which heart sounds should the bell be used?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
An enlarged space indicates fluid accumulation in the pericardial sac.
Iodine


10. What is a therapeutic digoxin level?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.
Activity intolerance
0.5-2.0 ng/ml


11. Where should you place your stethescope to find the ERB's Point?
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.
Poorly controlled hypertension
(S1 - S2) Third left intercostal space


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

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13. What are signs and symptoms of an MI?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


14. What is an aortic dissection?

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15. What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Pulse before and after giving.
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.
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


16. What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
Fat - Air - DVT - or Amniotic
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.
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


17. For which heart sounds should the diaphragm be used?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Left sternal border
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


18. What is Deep Vein Thrombosis (DVT)?
Second Left intercostal space
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


19. What should you teach your patient about an abdominal ultrasonography?
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
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


20. What should you remember while taking care of someone with a peripheral arterial occlusion?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.


21. What is an acute peripheral arterial occlusion?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


22. What drugs are most commonly used for angina?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Nitrates - Beta blockers - and Calcium channel blockers


23. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
ST segment elevation (STEMI)


24. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Chronic arteriosclerotic disease.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


25. Which type of patient shouldn't take nitrates?
Right sided heart failure
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.


26. What is important to remember when removing a CVC from a patient?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Second left intercostal space
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


27. Where should you place your stethescope to find the mitral (apex) 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
Steroid treatment or a pregnant woman who is retaining water.
No radial artery punctures if negative
Fifth left intercostal space medial to the midclavicular line.


28. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Vascular - artery disease causing fluid to back up into the lungs.
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


29. Where do the internal jugular veins lie?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
In fatty areas or over major muscles - large breasts - or bony prominences.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Lung disease


30. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Poorly controlled hypertension
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.


31. What is characteristic of ventricular tachycardia?
Maintain BED REST
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


32. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Right sided heart failure


33. What are examples of calcium channel blockers?
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.
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
A nosebleed


34. Who would most likely have peripheral venous disease?
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Old truck driver or someone on bed rest or with pelvic trauma.


35. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


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

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37. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
Left sternal border
BP is elevated or decreased depending on activity.
Air answers (open junctions)


38. What condition can cause left sided heart failure?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Vascular - artery disease causing fluid to back up into the lungs.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


39. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


40. 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?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


41. What causes essential/primary hypertension?
Idiopathic
Steroid treatment or a pregnant woman who is retaining water.
Lung disease
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


42. What are the S&S of superior vena cava syndrome?
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.
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


43. What should you do if you are going to ventilate someone with an ambu bag?
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
NO NSAIDS or ASA.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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


44. What are the two common complications of pericarditis?
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.
(S1 - S2) Third left intercostal space
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


45. What is the treatment for someone in ventricular fibrillation?
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
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


46. What does a swan ganz measure?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
Whether the patients ulnar and radial arteries are patent.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


47. What should be done for someone on bleeding precautions?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


48. What are all the S&S of pericarditis?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Idiopathic
A monitor with four dual electrodes that are applied to the patients neck and thorax.


49. What is the treatment for atrial fibrillation?
0.5-2.0 ng/ml
Direct current cardioversion and digoxin/propranolol (inderal).
An enlarged space indicates fluid accumulation in the pericardial sac.
4th left intercostal space lower sternal border


50. How is the Allen's test done?
An inflammation of the pericardium. It may result in MI.
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
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