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 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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


2. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
Fifth left intercostal space medial to the midclavicular line.


3. What is the treatment for someone with right sided HF? How do you know working?
NO NSAIDS or ASA.
In the first 72 hours!!!!!
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


4. What landmarks should you be looking for on someone's chest?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


5. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


6. 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!
BP is elevated or decreased depending on activity.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.


7. What should you watch for with PICC lines that have been in place for 6 months?
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.
Air answers (open junctions)
Second right intercostal space
Right sided heart failure


8. What should be done for someone on bleeding precautions?
Lung disease
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


9. What should be checked in a patient on a beta blocker?
BP is elevated or decreased depending on activity.
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.
Pulse before and after giving.
The patient may suffer significant blood loss or femoral nerve compression.


10. For which heart sounds should the bell be used?
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.
Protamine Sulfate
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


11. What are the S&S associated with right sided heart failure?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


12. What is the treatments for hypertension?
Patient who are unable to tolerate exercise stress testing.
Vascular - artery disease causing fluid to back up into the lungs.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.


13. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
To inhibit thrombus and clot formation.
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.
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.


14. What is an acute peripheral arterial occlusion?
No radial artery punctures if negative
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


15. What are the nursing interventions for a patient with premature ventricular contractions?
Fifth left intercostal space medial to the midclavicular line.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
ST segment elevation (STEMI)


16. What are the S&S of cardiac tamponade?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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 is the goal of treatment for an MI? Treatment?
Poorly controlled hypertension
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.


18. What should you teach your patient about an exercise ECG (stress test)?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Lowers BP and makes heart beat stronger. SE: flushed face.
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-
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.


19. What are examples of calcium channel blockers?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


20. How is angina treated?

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21. For which heart sounds should the diaphragm be used?
Lung disease
One at a time to assess the pulse amplitude and contour.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
NO because it isn't sterile so keep out.


22. Where do the internal jugular veins lie?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


23. What is a good diagnosis for someone with right sided HF?
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
Activity intolerance
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.


24. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
An enlarged space indicates fluid accumulation in the pericardial sac.


25. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Only for a few hours
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.


26. What should happen if someone converts to asystole/flatline?
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.
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
An inflammation of the pericardium. It may result in MI.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


27. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).


28. What is angina? Stable vs. unstable?

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29. How should you palpate the carotid arteries?
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.
4th left intercostal space lower sternal border
One at a time to assess the pulse amplitude and contour.
Fat - Air - DVT - or Amniotic


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

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31. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


32. What are the steps to perform the heimlich maneuver?
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.
Feeling warm (fire) or tin can taste is expected and will pass.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


33. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
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
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


34. What could happen without immediate intervention for a hematoma?
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
The patient may suffer significant blood loss or femoral nerve compression.
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
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.


35. Where should you place your stethescope to find the pulmonic valve?
NO NSAIDS or ASA.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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
Second Left intercostal space


36. What condition can cause left sided heart failure?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Vascular - artery disease causing fluid to back up into the lungs.
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.


37. What is INR?
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
NO because it isn't sterile so keep out.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.


38. What is more harmful a lot of little emboli or one large emboli?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
NO because it isn't sterile so keep out.
One large emboli (smaller=better)


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

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

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41. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Maintain BED REST
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


42. Where is the right ventricle landmark on the chest?
Left sternal border
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
Iodine
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


43. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.


44. What should you teach your patient about MRI?
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.
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
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


45. What is defibrillation?
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
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.
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.
NO NSAIDS or ASA.


46. What type of surgery is done for an aortic dissection?
Steroid treatment or a pregnant woman who is retaining water.
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


47. What are the two common complications of pericarditis?
One large emboli (smaller=better)
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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 S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
The internal jugular veins (external are less reliable).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Poorly controlled hypertension


49. What will be the treatment for an acute episode of life threatening tamponade?
Right sided heart failure
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.


50. What disease can cause right sided heart failure?
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).
Lung disease
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.