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 is the nursing care associated with chemical stress tests (persantine stress test)?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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


2. When should you be concerned about premature ventricular contraction?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.


3. For which heart sounds should the diaphragm be used?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
To inhibit thrombus and clot formation.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


4. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


5. What is important to remember when taking care of patients with compression devices?
Second left intercostal space
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


6. What should you do if the PT value is 45 sec?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
D/C the med and call the doctor.


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

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8. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
To inhibit thrombus and clot formation.
Lower left sternal border
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.


9. What are the five areas for listening to the heart?

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10. 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
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
Second Left intercostal space
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).


11. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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
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.
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


12. When should bleeding precautions be implemented?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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.


13. What is Deep Vein Thrombosis (DVT)?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
No radial artery punctures if negative
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.


14. What is epistaxis?
A nosebleed
Protamine Sulfate
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


15. How do you prepare a patient for Impedance cardiography monitoring?
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
4th left intercostal space lower sternal border
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


16. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Include rest periods prior to any activity.
Fat - Air - DVT - or Amniotic
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


17. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Fifth left intercostal space medial to the midclavicular line.
Fourth or fifth intercostal space at or medial to the midclavicular line.


18. What type of EKG change indicates MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
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
ST segment elevation (STEMI)


19. What is superior vena cava syndrome?
Second right intercostal space
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.


20. What is a good diagnosis for someone with right sided HF?
Activity intolerance
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.


21. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
BP is elevated or decreased depending on activity.


22. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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


23. How should you palpate the apical pulse?
BP is elevated or decreased depending on activity.
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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


24. Where is the right ventricle landmark on the chest?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Left sternal border
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.
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.


25. What is the treatment for someone with right sided HF? How do you know working?
Vascular - artery disease causing fluid to back up into the lungs.
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


26. 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.
Vascular - artery disease causing fluid to back up into the lungs.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.)


27. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
Protamine Sulfate
Don't interfere!
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-


28. What is characteristic of ventricular fibrillation?
BP is elevated or decreased depending on activity.
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.
Pulse before and after giving.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


29. What places someone at risk for an aortic dissection?
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.
Only for a few hours
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Poorly controlled hypertension


30. What is characteristic of premature ventricular contractions?
ST segment elevation (STEMI)
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.
Chronic arteriosclerotic disease.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


31. What are the nursing interventions for a pt. with ventricular tachycardia?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


32. What are the S&S of aortic dissection?
The patient may suffer significant blood loss or femoral nerve compression.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.


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

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34. What is the treatment for myocardial infarction?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Only for a few hours


35. What is angina? Stable vs. unstable?

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36. In what locations should you not place electrodes?
Air answers (open junctions)
In fatty areas or over major muscles - large breasts - or bony prominences.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


37. What needs to be held during the placement of a femoral artery compression device?
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
NO NSAIDS or ASA.


38. What is important to remember when removing a CVC from a patient?
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.
Steroid treatment or a pregnant woman who is retaining water.
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.
Left sternal border


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

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40. What are common risk factors for an MI?
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.
Don't interfere!
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).


41. What should you teach your patient about a cardiac catheterization?
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
The patient may suffer significant blood loss or femoral nerve compression.
Left sternal border
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


42. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.


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

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44. What causes secondary hypertension?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A nosebleed
Steroid treatment or a pregnant woman who is retaining water.


45. What will be the treatment for an acute episode of life threatening tamponade?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.


46. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Nitrates - Beta blockers - and Calcium channel blockers
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).


47. What is the purpose of compression devices?
Nitrates - Beta blockers - and Calcium channel blockers
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
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


48. Who would most likely have peripheral venous disease?
Second right intercostal space
Old truck driver or someone on bed rest or with pelvic trauma.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.


49. What is the treatment for a patient in complete heart block?
D/C the med and call the doctor.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
BP is elevated or decreased depending on activity.


50. What should you teach your patient about an electrocardiogram (ECG)?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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
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
0.5-2.0 ng/ml