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 causes essential/primary hypertension?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
D/C the med and call the doctor.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Idiopathic


2. What are the proper steps to changing a central venous catheter dressing?
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
It is a sterile procedure so both nurse and patient should wear a mask - arrange sterile field - remove dressing - assess the catheter insertion site for infection - put on sterile gloves - clean the site moving outwardly in a circular motion - apply
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.


3. What should you do immediately if you suspect someone of developing a hematoma?
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


4. What are the nursing interventions for a patient with premature ventricular contractions?
In the first 72 hours!!!!!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Idiopathic


5. For which heart sounds should the diaphragm be used?
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


6. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Include rest periods prior to any activity.
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


7. What is Deep Vein Thrombosis (DVT)?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Lowers BP and makes heart beat stronger. SE: flushed face.


8. What are the steps for adult/child 1 rescuer CPR?
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
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Pneumothorax and will end up with chest tube to help reinflate lung.


9. What is the antidote for coumadin?
Lung disease
One large emboli (smaller=better)
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Vitamin K (aqua myphiton)


10. When should you be concerned about premature ventricular contraction?
Poorly controlled hypertension
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Don't interfere!
The patient may suffer significant blood loss or femoral nerve compression.


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

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12. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Only for a few hours
NO NSAIDS or ASA.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


13. What is the correct way to insert an oropharyngeal airway?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.)
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
If feel more than 3 shocks in a row or develop signs of infection at the site.


14. What is characteristic of premature ventricular contractions?
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.
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
Pulmonary edema
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


15. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


16. What body systems are affected by digoxin toxicity? S&S?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


17. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
Cannot
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


18. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Direct current cardioversion and digoxin/propranolol (inderal).
Pulse before and after giving.
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


19. What should you teach someone with arterial insufficiency?

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20. What is the treatment for atrial fibrillation?
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.
Direct current cardioversion and digoxin/propranolol (inderal).
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).


21. What is a chemical stress test (persantine stress test)?
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
Lowers BP and makes heart beat stronger. SE: flushed face.


22. Where should you place your stethescope to find the aortic valve?
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Second Right intercostal space.


23. What should you teach your patient about an electrocardiogram (ECG)?
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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 internal jugular veins (external are less reliable).


24. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Cannot
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


25. What is CVP? Normal?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.


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

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27. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
The internal jugular veins (external are less reliable).
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.
Cannot


28. What are the nursing interventions for a patient in atrial fibrillation?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.


29. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Pulmonary edema
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.)
Left sternal border
Include rest periods prior to any activity.


30. What should you explain to the patient about an impedance cardiography test?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Before
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


31. What should be checked in a patient on a beta blocker?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Pulse before and after giving.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


32. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.


33. What could happen without immediate intervention for a hematoma?
Air embolism
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Protamine Sulfate
The patient may suffer significant blood loss or femoral nerve compression.


34. What are the S&S of pulmonary embolism?
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


35. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Don't interfere!
The internal jugular veins (external are less reliable).
Right sided heart failure
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.


36. What is characteristic of atrial fibrillation?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Nitrates - Beta blockers - and Calcium channel blockers


37. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
In fatty areas or over major muscles - large breasts - or bony prominences.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Old truck driver or someone on bed rest or with pelvic trauma.
Whether the patients ulnar and radial arteries are patent.


38. 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.
Pulmonary edema
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.


39. What should a patient do if they feel chest pain or discomfort?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


40. What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


41. What makes the symptoms of superior vena cava syndrome better? Worse?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


42. What is labile hypertension?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
BP is elevated or decreased depending on activity.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


43. What is angina? Stable vs. unstable?

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44. What are the steps for adult 2 rescuer CPR?
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
Vitamin K (aqua myphiton)
No radial artery punctures if negative
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


45. What is the purpose of compression devices?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Poorly controlled hypertension


46. What is a assessment finding with DVT?

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47. What will a leg with arterial insufficiency look like?
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.


48. For which heart sounds should the bell be used?
The patient may suffer significant blood loss or femoral nerve compression.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.


49. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


50. What is a transthoracic echocardiograph (TTE)?
0.5-2.0 ng/ml
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
NO because it isn't sterile so keep out.
(S1 - S2) Third left intercostal space