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. How does the blood flow through the heart? (valves?)
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
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!


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

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3. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Nitrates - Beta blockers - and Calcium channel blockers
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


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

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5. Where is the tricuspid valve landmark on the chest?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Lower left sternal border
NO because it isn't sterile so keep out.


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

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7. Who would most likely have peripheral venous disease?
One large emboli (smaller=better)
Activity intolerance
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).
Old truck driver or someone on bed rest or with pelvic trauma.


8. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
One at a time to assess the pulse amplitude and contour.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.


9. What is defibrillation?
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.
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
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


10. What does the device for impedance cardiography consist of?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
A monitor with four dual electrodes that are applied to the patients neck and thorax.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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-


11. What should be done immediately for someone with PE?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


12. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Air answers (open junctions)
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Vitamin K (aqua myphiton)


13. How do you prepare a patient for Impedance cardiography monitoring?
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


14. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.
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.


15. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
NO NSAIDS or ASA.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Second Left intercostal space


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

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17. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Must be flushed 1x/month with heparin and between treatments.
Chronic arteriosclerotic disease.
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


18. What is labile hypertension?
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
BP is elevated or decreased depending on activity.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


19. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Must be flushed 1x/month with heparin and between treatments.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


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

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21. What is intermittent claudication?
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
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.


22. What signals an elevated venous pressure based on the internal jugular veins?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
An inflammation of the pericardium. It may result in MI.
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.
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.


23. What type of EKG change indicates MI?
ST segment elevation (STEMI)
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Second Right intercostal space.
Pulse before and after giving.


24. What should you explain to the patient about an impedance cardiography test?
4th left intercostal space lower sternal border
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.
Don't interfere!
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


25. What should you teach your patient about an electrocardiogram (ECG)?
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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


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


27. What is pericarditis?
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
BP is elevated or decreased depending on activity.
An inflammation of the pericardium. It may result in MI.
Right sided heart failure


28. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Lower left sternal border
Only for a few hours
If feel more than 3 shocks in a row or develop signs of infection at the site.


29. What is superior vena cava syndrome?
4th left intercostal space lower sternal border
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.
One large emboli (smaller=better)
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


30. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Feeling warm (fire) or tin can taste is expected and will pass.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Activity intolerance


31. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Only for a few hours
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
The internal jugular veins (external are less reliable).


32. What should you do if the PT value is 45 sec?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
D/C the med and call the doctor.
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


33. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
Vitamin K (aqua myphiton)
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


34. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


35. What is a good diagnosis for someone with right sided HF?
In fatty areas or over major muscles - large breasts - or bony prominences.
In the first 72 hours!!!!!
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Activity intolerance


36. What do calcium channel blockers do?
Open up blood vessels
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


37. What is Deep Vein Thrombosis (DVT)?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Fifth left intercostal space medial to the midclavicular line.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Fat - Air - DVT - or Amniotic


38. What is the treatment for a pt. with ventricular tachycardia?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
Awake and alert: IV lidocaine bolus and drip Unconscious - hypotensive - or S&S of angina/CHF: Direct current cardioversion and IV Lidocaine bolus and drip.
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


39. 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?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Must be flushed 1x/month with heparin and between treatments.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.


40. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
0.5-2.0 ng/ml
Protamine Sulfate
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


41. What is a transthoracic echocardiograph (TTE)?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.


42. Where is the aortic valve landmark on the chest?
Second right intercostal space
In fatty areas or over major muscles - large breasts - or bony prominences.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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


43. A femoral artery compression device ______be assigned to an NA?
In fatty areas or over major muscles - large breasts - or bony prominences.
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
Nitrates - Beta blockers - and Calcium channel blockers
Cannot


44. Where should you place your stethescope to find the aortic valve?
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Second Right intercostal space.


45. What is the purpose of compression devices?
Don't interfere!
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Second right intercostal space
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


46. Where should you place your stethescope to find the tricuspid valve?
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
Fifth left intercostal space medial to the midclavicular line.
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


47. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Second Left intercostal space
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


48. 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?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.


49. What are the steps for adult/child 1 rescuer CPR?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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


50. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Second right intercostal space
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Before