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 coumadin and heparin used for?
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
To inhibit thrombus and clot formation.
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
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.


2. What is the goal of treatment for an MI? Treatment?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
An enlarged space indicates fluid accumulation in the pericardial sac.
D/C the med and call the doctor.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


3. What is the correct way to insert an oropharyngeal airway?
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
One large emboli (smaller=better)


4. In What time period is the greatest risk of sudden death from an MI?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
In the first 72 hours!!!!!
Second Right intercostal space.


5. What disease can cause right sided heart failure?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Protamine Sulfate
Lung disease


6. What are the steps for infant 1&2 rescuer CPR?
4th left intercostal space lower sternal border
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
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


7. What is the treatment for someone in ventricular fibrillation?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Right sided heart failure
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


8. What should you teach your patient about MRI?
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.
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
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


9. What are the two common complications of pericarditis?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


10. What can result from left sided heart failure if left untreated?
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.
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
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
Pulmonary edema


11. What is impedance cardiography?
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.
Pulmonary edema
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


12. What is the nursing care associated with chemical stress tests (persantine stress test)?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.


13. Test ending in Gram=?
Second left intercostal space
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.
Iodine
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


14. For which heart sounds should the diaphragm be used?
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
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.


15. What are the S&S of aortic dissection?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
(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.
Poorly controlled hypertension


16. What do calcium channel blockers do?
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Open up blood vessels


17. What should you remember while taking care of someone with a peripheral arterial occlusion?
Include rest periods prior to any activity.
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


18. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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


19. What should happen if someone converts to asystole/flatline?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


20. How should you palpate the apical pulse?
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


21. What condition can cause left sided heart failure?
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
Vascular - artery disease causing fluid to back up into the lungs.
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).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


22. What is the treatment for atrial fibrillation?
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
Direct current cardioversion and digoxin/propranolol (inderal).
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.
Second Right intercostal space.


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

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

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25. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Vitamin K (aqua myphiton)
A nosebleed
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


26. 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?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
In the first 72 hours!!!!!
A monitor with four dual electrodes that are applied to the patients neck and thorax.


27. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
NO NSAIDS or ASA.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


28. What SE should you look for with calcium channel blocker use?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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


29. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
Before
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.


30. What should you watch for with PICC lines that have been in place for 6 months?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
BP is elevated or decreased depending on activity.
Air answers (open junctions)


31. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Include rest periods prior to any activity.
If feel more than 3 shocks in a row or develop signs of infection at the site.


32. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
Second left intercostal space


33. Where should you place your stethescope to find the pulmonic valve?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Second Left intercostal space
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


34. How is angina treated?

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35. Where do the internal jugular veins lie?
Air embolism
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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
Must be flushed 1x/month with heparin and between treatments.


36. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Second Right intercostal space.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.


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

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38. What is a therapeutic digoxin level?
In the first 72 hours!!!!!
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.
0.5-2.0 ng/ml
Old truck driver or someone on bed rest or with pelvic trauma.


39. What is cardiac tamponade? Common causes?
In fatty areas or over major muscles - large breasts - or bony prominences.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
Lower left sternal border


40. 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).
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.
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


41. Where should you place your stethescope to find the ERB's Point?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
(S1 - S2) Third left intercostal space
No radial artery punctures if negative


42. Where is the aortic valve landmark on the chest?
Second right intercostal space
Open up blood vessels
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


43. What is epistaxis?
Feeling warm (fire) or tin can taste is expected and will pass.
Open up blood vessels
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
A nosebleed


44. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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
Whether the patients ulnar and radial arteries are patent.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


45. What does the device for impedance cardiography consist of?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Air answers (open junctions)


46. Where is the pulmonic valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
Second left intercostal space
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


47. What will be the treatment for an acute episode of life threatening tamponade?
One at a time to assess the pulse amplitude and contour.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


48. What does a swan ganz measure?
Fat - Air - DVT - or Amniotic
Air answers (open junctions)
Left sternal border
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


49. What is angina? Stable vs. unstable?

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50. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
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.
Pulse before and after giving.
A monitor with four dual electrodes that are applied to the patients neck and thorax.