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 S&S of air embolism?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.


2. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
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
Vascular - artery disease causing fluid to back up into the lungs.
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.


3. What is the antidote for heparin?
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
An enlarged space indicates fluid accumulation in the pericardial sac.
Protamine Sulfate


4. What is INR?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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


5. What is a nursing diagnosis for arterial occlusion? Tx
If feel more than 3 shocks in a row or develop signs of infection at the site.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).


6. What should happen if someone converts to asystole/flatline?
ST segment elevation (STEMI)
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


7. What are coumadin and heparin used for?
Air answers (open junctions)
To inhibit thrombus and clot formation.
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


8. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Pulmonary edema
Vitamin K (aqua myphiton)
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
Air embolism


9. What should you teach someone with arterial insufficiency?

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10. What is the treatment for someone with right sided HF? How do you know working?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Chronic arteriosclerotic disease.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


11. What is more harmful a lot of little emboli or one large emboli?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
One large emboli (smaller=better)
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.


12. What is characteristic of ventricular fibrillation?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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


13. What should you do immediately if you suspect someone of developing a hematoma?
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!
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.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
In fatty areas or over major muscles - large breasts - or bony prominences.


14. What is important to remember when removing a CVC from a patient?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.
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
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.


15. What are the nursing interventions for a patient in atrial fibrillation?
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
One large emboli (smaller=better)


16. 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).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.


17. Which type of patient shouldn't take nitrates?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


18. How is the Allen's test done?
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
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.


19. What are the S&S associated with right sided heart failure?
Nitrates - Beta blockers - and Calcium channel blockers
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
An enlarged space indicates fluid accumulation in the pericardial sac.


20. What is the antidote for coumadin?
One at a time to assess the pulse amplitude and contour.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
Vitamin K (aqua myphiton)


21. How do you prepare a patient for Impedance cardiography monitoring?
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
Second Right intercostal space.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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


22. What is the nursing care associated with chemical stress tests (persantine stress test)?
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
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!
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


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

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24. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
Fourth or fifth intercostal space at or medial to the midclavicular line.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
In the first 72 hours!!!!!


25. What are signs and symptoms of an MI?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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


26. What body systems are affected by digoxin toxicity? S&S?
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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


27. What are the 2 types of pacemakers?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
Right sided heart failure
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


28. What should you do to treat pulmonary edema?
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
ST segment elevation (STEMI)
To inhibit thrombus and clot formation.
Steroid treatment or a pregnant woman who is retaining water.


29. What is a transthoracic echocardiograph (TTE)?
(S1 - S2) Third left intercostal space
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
An inflammation of the pericardium. It may result in MI.


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

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31. What should you teach your patient about MRI?
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-
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.
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


32. How does the blood flow through the heart? (valves?)
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.
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!
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.


33. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


34. Who would most likely have peripheral venous disease?
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Old truck driver or someone on bed rest or with pelvic trauma.


35. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
Second left intercostal space
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


36. What are the S&S of superior vena cava syndrome?
Air embolism
Nitrates - Beta blockers - and Calcium channel blockers
Open up blood vessels
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


37. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


38. What is characteristic of premature ventricular contractions?
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
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


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

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40. What should be checked in a patient on a beta blocker?
NO because it isn't sterile so keep out.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Pulse before and after giving.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


41. What should you do if you are going to ventilate someone with an ambu bag?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
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


42. What should you observe for in someone on bleeding precautions?
Vascular - artery disease causing fluid to back up into the lungs.
In the first 72 hours!!!!!
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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).


43. What places someone at risk for an aortic dissection?
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.
Poorly controlled hypertension
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


44. What does vasotec (Enalapril Maleate) do/SE?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
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


45. For which heart sounds should the bell be used?
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).


46. What are the steps to perform the heimlich maneuver?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Stand behind the victim - wrap arms around waist (IF PREGNANT WRAP ABOVE The BABy) - make a fist with one had and place thumb against abdomen midline - grasp fist with other hand - press into victims abdomen with quick upward thrusts.
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.
Poorly controlled hypertension


47. What should you not allow if a patient has a negative Allen's test?
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
No radial artery punctures if negative
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).
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


48. 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).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Air embolism
Right sided heart failure


49. What is cardioversion?

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50. What SE should you look for with calcium channel blocker use?
An enlarged space indicates fluid accumulation in the pericardial sac.
To inhibit thrombus and clot formation.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).