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 are the signs and symptoms of left sided HF?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Second Left intercostal space
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


2. What should you observe for in someone on bleeding precautions?
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
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at
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
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).


3. 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?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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!


4. What are the four types of pulmonary emboli?
Include rest periods prior to any activity.
Fat - Air - DVT - or Amniotic
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


5. What are coumadin and heparin used for?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
In the first 72 hours!!!!!
A monitor with four dual electrodes that are applied to the patients neck and thorax.
To inhibit thrombus and clot formation.


6. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Second Right intercostal space.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Right sided heart failure


7. What is an acute peripheral arterial occlusion?
Lower left sternal border
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


8. What landmarks should you be looking for on someone's chest?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Fat - Air - DVT - or Amniotic


9. How is angina treated?

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10. What is an aortic dissection?

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11. What should you explain to the patient about an impedance cardiography test?
Decrease in weight - diuretics (watch K loss) - aldactone (k sparing but check renal fx) - inderal (do Not give to asthma patients or diabetic patients) - more exercise - no smoking - and decreased Na intake.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.


12. What is pericarditis?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
An inflammation of the pericardium. It may result in MI.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
An enlarged space indicates fluid accumulation in the pericardial sac.


13. What is intermittent claudication?
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.


14. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Right sided heart failure
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.


15. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
0.5-2.0 ng/ml
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


16. What is the antidote for heparin?
Protamine Sulfate
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
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
NO NSAIDS or ASA.


17. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
If feel more than 3 shocks in a row or develop signs of infection at the site.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


18. What are the two common complications of 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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.


19. What will a leg with arterial insufficiency look like?
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.


20. What are the 2 types of pacemakers?
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
4th left intercostal space lower sternal border
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


21. What is the antidote for coumadin?
Pulse before and after giving.
Vitamin K (aqua myphiton)
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


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

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23. What is pulsus paradoxus?
Second Left intercostal space
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


24. What do calcium channel blockers do?
Cannot
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Open up blood vessels


25. What is important to remember when removing a CVC from a patient?
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.
Nitrates - Beta blockers - and Calcium channel blockers
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
In fatty areas or over major muscles - large breasts - or bony prominences.


26. Where should you place your stethescope to find the mitral (apex) valve?
Fifth left intercostal space medial to the midclavicular line.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Left sternal border
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


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

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28. 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!
In the first 72 hours!!!!!
Patient who are unable to tolerate exercise stress testing.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


29. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
The internal jugular veins (external are less reliable).


30. How long is contrast media in the body?
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
Only for a few hours
Second Right intercostal space.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.


31. What is Raynauds disease? Tx?
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
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.
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.
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


32. What is the maintenance for venous access port that isn't being regularly used?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Must be flushed 1x/month with heparin and between treatments.


33. What is characteristic of complete heart block?
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


34. What should be done immediately if a pulmonary embolism is suspected?
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.
To inhibit thrombus and clot formation.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


35. What type of surgery is done for an aortic dissection?
Air answers (open junctions)
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.
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


36. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Open up blood vessels
Fat - Air - DVT - or Amniotic
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


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


38. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


39. When should bleeding precautions be implemented?
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.
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
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
Steroid treatment or a pregnant woman who is retaining water.


40. What is the treatments for hypertension?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Decrease in weight - diuretics (watch K loss) - aldactone (k sparing but check renal fx) - inderal (do Not give to asthma patients or diabetic patients) - more exercise - no smoking - and decreased Na intake.
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.
An enlarged space indicates fluid accumulation in the pericardial sac.


41. What is cardioversion?

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42. What usually triggers angina pain?
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 usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
The patient may suffer significant blood loss or femoral nerve compression.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


43. What is the treatment for myocardial infarction?
Fifth left intercostal space medial to the midclavicular line.
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.
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


44. What would make someone more at risk for digoxin toxicity?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.


45. What are the S&S of air embolism?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


46. What are common risk factors for an MI?
Vitamin K (aqua myphiton)
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
One large emboli (smaller=better)
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


47. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
ST segment elevation (STEMI)
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


48. What is the hallmark clinical finding associated with pericarditis?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
(S1 - S2) Third left intercostal space
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.


49. For which heart sounds should the diaphragm be used?
Activity intolerance
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
In the first 72 hours!!!!!
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


50. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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.
File toe nails - if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
Activity intolerance