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 is intermittent claudication?
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.
Second left intercostal space
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.
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.


2. In what locations should you not place electrodes?
Protamine Sulfate
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
In fatty areas or over major muscles - large breasts - or bony prominences.
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.


3. What is the goal of treatment for an MI? Treatment?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Steroid treatment or a pregnant woman who is retaining water.


4. When should you be concerned about premature ventricular contraction?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


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

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6. What disease can cause right sided heart failure?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Pulse before and after giving.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Lung disease


7. What is a assessment finding with DVT?

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8. What are the signs and symptoms of left sided HF?
Nitrates - Beta blockers - and Calcium channel blockers
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Vitamin K (aqua myphiton)
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.


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

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10. What are examples of calcium channel blockers?
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.
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
Second Right intercostal space.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


11. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
D/C the med and call the doctor.
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.
Maintain BED REST
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


12. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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


13. What causes essential/primary hypertension?
Air answers (open junctions)
Idiopathic
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
Vitamin K (aqua myphiton)


14. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
NO because it isn't sterile so keep out.
D/C the med and call the doctor.
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


15. When would a nurse use an external femoral artery compression device?
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
To inhibit thrombus and clot formation.
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).


16. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


17. What are the steps for infant 1&2 rescuer CPR?
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea
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
Maintain BED REST
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.


18. What are the 2 types of pacemakers?
(S1 - S2) Third left intercostal space
Poorly controlled hypertension
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.
Patient who are unable to tolerate exercise stress testing.


19. What landmarks should you be looking for on someone's chest?
Patient who are unable to tolerate exercise stress testing.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


20. How is the Allen's test done?
Iodine
A nosebleed
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
0.5-2.0 ng/ml


21. How should you palpate the carotid arteries?
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.
One at a time to assess the pulse amplitude and contour.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.


22. What should you do to treat pulmonary edema?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


23. What is CVP? Normal?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Right sided heart failure
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.


24. Where do the internal jugular veins lie?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Maintain BED REST
Include rest periods prior to any activity.


25. What should you teach your patient about an electrocardiogram (ECG)?
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
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


26. What should be checked in a patient on a beta blocker?
Open up blood vessels
Second right intercostal space
Pulse before and after giving.
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea


27. What is a major complication of central line placement?
Nitrates - Beta blockers - and Calcium channel blockers
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).


28. What is defibrillation?
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.
One large emboli (smaller=better)
No radial artery punctures if negative
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


29. What is Raynauds disease? Tx?
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.
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
The 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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


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

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


32. What should be done immediately if a pulmonary embolism is suspected?
Iodine
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
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


33. What should you watch for with PICC lines that have been in place for 6 months?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Air answers (open junctions)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+


34. For which heart sounds should the diaphragm be used?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Vascular - artery disease causing fluid to back up into the lungs.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


35. Where should you place your stethescope to find the tricuspid valve?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Fifth left intercostal space medial to the midclavicular line.
4th left intercostal space lower sternal border
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


36. What things should you do to assess cardiovascular status?
The patient may suffer significant blood loss or femoral nerve compression.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.)
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


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

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38. What type of surgery is done for an aortic dissection?
Second right intercostal space
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


39. What should you teach your patient about a cardiac catheterization?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.


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

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41. What condition can cause left sided heart failure?
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.
Pulmonary edema
Vascular - artery disease causing fluid to back up into the lungs.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


42. What are common risk factors for an MI?
BP is elevated or decreased depending on activity.
Patient who are unable to tolerate exercise stress testing.
Second left intercostal space
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


43. What is important to remember when removing a CVC from a patient?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.
Activity intolerance


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


45. What is the treatment for atrial fibrillation?
4th left intercostal space lower sternal border
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
Direct current cardioversion and digoxin/propranolol (inderal).


46. What could happen without immediate intervention for a hematoma?
An enlarged space indicates fluid accumulation in the pericardial sac.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
The patient may suffer significant blood loss or femoral nerve compression.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


47. What is the treatment for someone in ventricular fibrillation?
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Old truck driver or someone on bed rest or with pelvic trauma.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


48. What is labile hypertension?
Include rest periods prior to any activity.
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.
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.
BP is elevated or decreased depending on activity.


49. Where is the tricuspid valve landmark on the chest?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Lower left sternal border
Chronic arteriosclerotic disease.
Must be flushed 1x/month with heparin and between treatments.


50. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
Fat - Air - DVT - or Amniotic