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

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2. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
No radial artery punctures if negative


3. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+


4. What is the maintenance for venous access port that isn't being regularly used?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Must be flushed 1x/month with heparin and between treatments.
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
Second right intercostal space


5. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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!
Left sternal border
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+


6. 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.
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 LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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


7. What should you teach someone with arterial insufficiency?

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8. What is the treatment for a pt. with ventricular tachycardia?
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.
Chronic arteriosclerotic disease.
Open up blood vessels
Second Right intercostal space.


9. For which heart sounds should the bell be used?
Chronic arteriosclerotic disease.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Before
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.


10. What should you do to treat pulmonary edema?
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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
0.5-2.0 ng/ml


11. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Air answers (open junctions)


12. What should you do when applying a femoral artery compression device?
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
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.


13. What factors place you at risk for HTN?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
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.
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.


14. How do you prepare a patient for Impedance cardiography monitoring?
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
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
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.


15. What is the treatment for someone in ventricular fibrillation?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Pulse before and after giving.
Right sided heart failure


16. Where should you place your stethescope to find the ERB's Point?
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
(S1 - S2) Third left intercostal space
Steroid treatment or a pregnant woman who is retaining water.
Air answers (open junctions)


17. 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.
Don't interfere!
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.


18. What will be the treatment for an acute episode of life threatening tamponade?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.


19. What should you go when applying nitroglycerin ointment for angina?
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
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.
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.
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


20. What is a major complication of central line placement?
Fifth left intercostal space medial to the midclavicular line.
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


21. What is the antidote for heparin?
Protamine Sulfate
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.
Steroid treatment or a pregnant woman who is retaining water.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


22. What is a therapeutic digoxin level?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
0.5-2.0 ng/ml


23. What is an aortic dissection?

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24. What disease can cause right sided heart failure?
Lung disease
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
D/C the med and call the doctor.


25. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Fourth or fifth intercostal space at or medial to the midclavicular line.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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).


26. Where should you place your stethescope to find the tricuspid valve?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Open up blood vessels
4th left intercostal space lower sternal border
NO because it isn't sterile so keep out.


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

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28. What is the correct way to insert an oropharyngeal airway?
Steroid treatment or a pregnant woman who is retaining water.
Whether the patients ulnar and radial arteries are patent.
Vitamin K (aqua myphiton)
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


29. 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?
D/C the med and call the doctor.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


30. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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-
Only for a few hours


31. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
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.
Maintain BED REST
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


32. What does the device for impedance cardiography consist of?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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 monitor with four dual electrodes that are applied to the patients neck and thorax.
The patient may suffer significant blood loss or femoral nerve compression.


33. In what locations should you not place electrodes?
A nosebleed
Only for a few hours
Vitamin K (aqua myphiton)
In fatty areas or over major muscles - large breasts - or bony prominences.


34. What should you do immediately if you suspect someone of developing a hematoma?
Chronic arteriosclerotic disease.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
Idiopathic


35. What could happen without immediate intervention for a hematoma?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
The patient may suffer significant blood loss or femoral nerve compression.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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).


36. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Poorly controlled hypertension
Maintain BED REST
A monitor with four dual electrodes that are applied to the patients neck and thorax.


37. What is a chemical stress test (persantine stress test)?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
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.
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.


38. What are coumadin and heparin used for?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
To inhibit thrombus and clot formation.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


39. What are the nursing interventions for a pt. with ventricular tachycardia?
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Second right intercostal space


40. How long is contrast media in the body?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
An enlarged space indicates fluid accumulation in the pericardial sac.
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).
Only for a few hours


41. What type of EKG change indicates MI?
ST segment elevation (STEMI)
Air answers (open junctions)
Iodine
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.


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

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43. What needs to be held during the placement of a femoral artery compression device?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
NO NSAIDS or ASA.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


44. What is cardiac tamponade? Common causes?
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Air answers (open junctions)


45. What is cardioversion?

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46. What can result from left sided heart failure if left untreated?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Second right intercostal space
Pulmonary edema
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


47. What are the S&S of aortic dissection?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
NO NSAIDS or ASA.
Nitrates - Beta blockers - and Calcium channel blockers
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.


48. What does plan of care include?
NO NSAIDS or ASA.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Pulse before and after giving.


49. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
Before
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.
0.5-2.0 ng/ml


50. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Fat - Air - DVT - or Amniotic
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.