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 two common complications of pericarditis?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


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

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3. What signals an elevated venous pressure based on the internal jugular veins?
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
Don't interfere!


4. What are the S&S of air embolism?
Include rest periods prior to any activity.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


5. What does a swan ganz measure?
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Fifth left intercostal space medial to the midclavicular line.


6. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
An enlarged space indicates fluid accumulation in the pericardial sac.
Second right intercostal space


7. What places someone at risk for an aortic dissection?
Second right intercostal space
Poorly controlled hypertension
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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).


8. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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
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
Include rest periods prior to any activity.
If feel more than 3 shocks in a row or develop signs of infection at the site.


9. What is a nursing diagnosis for arterial occlusion? Tx
Lower left sternal border
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
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.)


10. What should you teach your patient about angiography (arteriography)?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


11. During an Allen's test don't compress one artery _____ the other.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Fat - Air - DVT - or Amniotic
Lung disease
Before


12. What should you teach someone about iodine?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Air answers (open junctions)
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Feeling warm (fire) or tin can taste is expected and will pass.


13. What are the proper steps to changing a central venous catheter dressing?
Air embolism
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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
Feeling warm (fire) or tin can taste is expected and will pass.


14. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Protamine Sulfate
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
If feel more than 3 shocks in a row or develop signs of infection at the site.


15. What should you always assume with a patient who has a central line placed and is experiencing SOB?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
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!
Air embolism


16. What factors place you at risk for HTN?
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A monitor with four dual electrodes that are applied to the patients neck and thorax.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


17. What are all the S&S of pericarditis?
Second Left intercostal space
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


18. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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
Chronic arteriosclerotic disease.
Idiopathic


19. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Pulmonary edema
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Second Right intercostal space.


20. 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?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
4th left intercostal space lower sternal border
ST segment elevation (STEMI)
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


21. When should bleeding precautions be implemented?
Right sided heart failure
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
Old truck driver or someone on bed rest or with pelvic trauma.
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.


22. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


23. Where should you place your stethescope to find the ERB's Point?
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
NO NSAIDS or ASA.
(S1 - S2) Third left intercostal space
A nosebleed


24. Where do the internal jugular veins lie?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
BP is elevated or decreased depending on activity.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


25. How should you palpate the carotid arteries?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
One at a time to assess the pulse amplitude and contour.


26. What type of EKG change indicates MI?
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
ST segment elevation (STEMI)
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 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


27. What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Old truck driver or someone on bed rest or with pelvic trauma.


28. What do calcium channel blockers do?
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.
Open up blood vessels
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
An inflammation of the pericardium. It may result in MI.


29. What needs to be held during the placement of a femoral artery compression device?
Iodine
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
NO NSAIDS or ASA.
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


30. What drugs are most commonly used for angina?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
In the first 72 hours!!!!!
Nitrates - Beta blockers - and Calcium channel blockers


31. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


32. What is cardioversion?

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33. For what disease should you do the Allen's test?

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34. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
Idiopathic
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


35. How is the Allen's test done?
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.)
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


36. What should you do if the PTT value is 80 for someone on heparin?
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
D/C the med and call the doctor.
0.5-2.0 ng/ml
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.


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

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38. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
NO NSAIDS or ASA.


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

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40. What is angina? Stable vs. unstable?

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41. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
NO NSAIDS or ASA.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Before
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.


42. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


43. What will be the treatment for an acute episode of life threatening tamponade?
The internal jugular veins (external are less reliable).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.


44. What is labile hypertension?
BP is elevated or decreased depending on activity.
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.)
The patient may suffer significant blood loss or femoral nerve compression.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


45. What should be checked in a patient on a beta blocker?
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
Protamine Sulfate
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
Pulse before and after giving.


46. What is the treatments for hypertension?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.


47. 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.
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


48. What should you do to treat pulmonary edema?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.


49. What are common risk factors for an MI?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
NO because it isn't sterile so keep out.
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.


50. What are the S&S of cardiac tamponade?
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
4th left intercostal space lower sternal border
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.