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 characteristic of premature ventricular contractions?
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
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.
Feeling warm (fire) or tin can taste is expected and will pass.
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.


2. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
Steroid treatment or a pregnant woman who is retaining water.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Second Right intercostal space.


3. What places someone at risk for an aortic dissection?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
Protamine Sulfate
Poorly controlled hypertension


4. What are the steps for adult 2 rescuer CPR?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.
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
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.


5. What is INR?
Poorly controlled hypertension
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
Second Left intercostal space


6. How is angina treated?

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7. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


8. What are the S&S of superior vena cava syndrome?
Chronic arteriosclerotic disease.
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
Vitamin K (aqua myphiton)
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


9. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Vitamin K (aqua myphiton)
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


10. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
ST segment elevation (STEMI)


11. 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.
Whether the patients ulnar and radial arteries are patent.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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


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

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13. What is characteristic of atrial fibrillation?
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.
Second Right intercostal space.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


14. What are the S&S associated with right sided heart failure?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


15. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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!
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
In fatty areas or over major muscles - large breasts - or bony prominences.


16. What are the S&S of air embolism?
4th left intercostal space lower sternal border
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


17. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Second Left intercostal space
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
Must be flushed 1x/month with heparin and between treatments.


18. What causes essential/primary hypertension?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Idiopathic
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


19. What will a leg with arterial insufficiency look like?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
In fatty areas or over major muscles - large breasts - or bony prominences.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


20. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
No radial artery punctures if negative
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


21. What is CVP? Normal?
Feeling warm (fire) or tin can taste is expected and will pass.
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


22. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the
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.


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


24. What should you teach your patient about MRI?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


25. What are the steps to perform the heimlich maneuver?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


26. 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 atrium - TRICUSPID VALVE (tissue) - right ventricle - PULMONIC VALVE (paper) - lungs - left atrium - MITRAL VALVE (My) - left ventricle - AORTIC VALVE (Assets). Tissue PAPER MY ASSETS!
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


27. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
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!


28. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
Before
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
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


29. What is characteristic of ventricular fibrillation?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Chronic arteriosclerotic disease.
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


30. What disease can cause right sided heart failure?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Lung disease
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 should you teach your patient about angiography (arteriography)?
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
Air answers (open junctions)
In the first 72 hours!!!!!
Second Left intercostal space


32. What type of surgery is done for an aortic dissection?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


33. What type of EKG change indicates MI?
ST segment elevation (STEMI)
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
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.


34. What is cardioversion?

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35. What is epistaxis?
Fifth left intercostal space medial to the midclavicular line.
A nosebleed
Old truck driver or someone on bed rest or with pelvic trauma.
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


36. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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-
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


37. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
One large emboli (smaller=better)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


38. What do calcium channel blockers do?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Air answers (open junctions)
Direct current cardioversion and digoxin/propranolol (inderal).
Open up blood vessels


39. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Poorly controlled hypertension
Must be flushed 1x/month with heparin and between treatments.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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


40. What will be the treatment for an acute episode of life threatening tamponade?
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
Must be flushed 1x/month with heparin and between treatments.
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.


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

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42. What is angina? Stable vs. unstable?

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43. What does vasotec (Enalapril Maleate) do/SE?
One at a time to assess the pulse amplitude and contour.
Lowers BP and makes heart beat stronger. SE: flushed face.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


44. What should you teach your patient about a cardiac catheterization?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
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
Don't interfere!


45. When should bleeding precautions be implemented?
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.
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
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


46. What should be immediately done for a patient experiencing digoxin toxicity?
Don't interfere!
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
ST segment elevation (STEMI)
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


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

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48. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Vitamin K (aqua myphiton)
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


49. What should be done immediately for someone with PE?
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
Iodine
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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


50. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Lowers BP and makes heart beat stronger. SE: flushed face.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.
Only for a few hours