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. During an Allen's test don't compress one artery _____ the other.
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.
Before
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Right sided heart failure


2. In What time period is the greatest risk of sudden death from an MI?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
ST segment elevation (STEMI)
In the first 72 hours!!!!!


3. What are the S&S of aortic dissection?
Whether the patients ulnar and radial arteries are patent.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


4. What is the correct way to insert an oropharyngeal airway?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
ST segment elevation (STEMI)
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


5. What should you do immediately if you suspect someone of developing a hematoma?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Pneumothorax and will end up with chest tube to help reinflate lung.


6. What is important to remember when removing a CVC from a patient?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
Protamine Sulfate


7. What should you not allow if a patient has a negative Allen's test?
Protamine Sulfate
No radial artery punctures if negative
Second right intercostal space
4th left intercostal space lower sternal border


8. What should you observe for in someone on bleeding precautions?
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).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
NO because it isn't sterile so keep out.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


9. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Fifth left intercostal space medial to the midclavicular line.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.


10. What should you teach someone with arterial insufficiency?

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11. What is a assessment finding with DVT?

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12. What will a leg with arterial insufficiency look like?
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.


13. What are the nursing interventions for a patient in atrial fibrillation?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.


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

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15. What are the 2 types of pacemakers?
Second left intercostal space
Pulmonary edema
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.


16. 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.
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
Activity intolerance


17. What is an acute peripheral arterial occlusion?
Second Right intercostal space.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
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


18. What is characteristic of complete heart block?
Protamine Sulfate
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
One large emboli (smaller=better)


19. What is cardioversion?

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

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21. What should be done for someone on bleeding precautions?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Don't interfere!
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


22. How long is contrast media in the body?
0.5-2.0 ng/ml
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.)
Only for a few 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


23. What are the steps to perform the heimlich maneuver?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Pulse before and after giving.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.


24. What should you watch for with PICC lines that have been in place for 6 months?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Only for a few hours
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Air answers (open junctions)


25. What is the hallmark clinical finding associated with pericarditis?
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.
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!
Nitrates - Beta blockers - and Calcium channel blockers


26. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Patient who are unable to tolerate exercise stress testing.
One at a time to assess the pulse amplitude and contour.
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.


27. What should you teach your patient about MRI?
Open up blood vessels
The internal jugular veins (external are less reliable).
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
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.


28. When should you be concerned about premature ventricular contraction?
Nitrates - Beta blockers - and Calcium channel blockers
Cannot
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


29. How is the Allen's test done?
Right sided heart failure
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.
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
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.


30. What needs to be held during the placement of a femoral artery compression device?
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).
Fourth or fifth intercostal space at or medial to the midclavicular line.
NO NSAIDS or ASA.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


31. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


32. What are the S&S of pulmonary embolism?
Open up blood vessels
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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


33. What is defibrillation?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.
Don't interfere!


34. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
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
Right sided heart failure


35. What should you do to treat pulmonary edema?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
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
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


36. What are common risk factors for an MI?
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


37. What should you remember while taking care of someone with a peripheral arterial occlusion?
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.
The patient may suffer significant blood loss or femoral nerve compression.
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


38. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Include rest periods prior to any activity.
Air embolism


39. What is epistaxis?
Iodine
Poorly controlled hypertension
In fatty areas or over major muscles - large breasts - or bony prominences.
A nosebleed


40. 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).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Pneumothorax and will end up with chest tube to help reinflate lung.
Whether the patients ulnar and radial arteries are patent.


41. What is superior vena cava syndrome?
The internal jugular veins (external are less reliable).
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Include rest periods prior to any activity.


42. What is angina? Stable vs. unstable?

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43. What is important to remember when taking care of patients with compression devices?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Fat - Air - DVT - or Amniotic
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


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

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45. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
An enlarged space indicates fluid accumulation in the pericardial sac.
No radial artery punctures if negative
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.


46. What are the S&S of superior vena cava syndrome?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
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
An enlarged space indicates fluid accumulation in the pericardial sac.


47. What does plan of care include?
Lower left sternal border
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


48. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.


49. What is characteristic of premature ventricular contractions?
(S1 - S2) Third left intercostal space
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


50. Where should you place your stethescope to find the ERB's Point?
Direct current cardioversion and digoxin/propranolol (inderal).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
(S1 - S2) Third left intercostal space
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).