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. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


2. What body systems are affected by digoxin toxicity? S&S?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


3. What are the steps to perform the heimlich maneuver?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
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


4. 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
Air embolism
Idiopathic
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


5. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
An enlarged space indicates fluid accumulation in the pericardial sac.
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-
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


6. What are the 2 types of pacemakers?
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
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.


7. What should you do when applying a femoral artery compression device?
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Feeling warm (fire) or tin can taste is expected and will pass.
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


8. What does vasotec (Enalapril Maleate) do/SE?
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
Lowers BP and makes heart beat stronger. SE: flushed face.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


9. What is the most common cause of arterial insufficiency?
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.
Chronic arteriosclerotic disease.
Second right intercostal space
One at a time to assess the pulse amplitude and contour.


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

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11. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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
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.
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.
Second Right intercostal space.


12. When should bleeding precautions be implemented?
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.
Protamine Sulfate
Only for a few hours
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. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Air embolism
To inhibit thrombus and clot formation.


14. What factors place you at risk for HTN?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Pneumothorax and will end up with chest tube to help reinflate lung.


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

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16. What should you not allow if a patient has a negative Allen's test?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
No radial artery punctures if negative
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.


17. What SE should you look for with calcium channel blocker use?
Second Left intercostal space
Second right intercostal space
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


18. What should you teach your patient about an exercise ECG (stress test)?
Direct current cardioversion and digoxin/propranolol (inderal).
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-
Cannot
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


19. What lab value is used to evaluate a patient on coumadin? What is the normal value?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
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.
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


20. What are the nursing interventions for a patient with premature ventricular contractions?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Patient who are unable to tolerate exercise stress testing.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


21. What is CVP? Normal?
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
Patient who are unable to tolerate exercise stress testing.
0.5-2.0 ng/ml
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.


22. What needs to be held during the placement of a femoral artery compression device?
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
NO NSAIDS or ASA.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


23. How is angina treated?

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24. What is important to remember when removing a CVC from a patient?
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.
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.
Open up blood vessels
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


25. What are common risk factors for an MI?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.


26. What should you do if the PT value is 45 sec?
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.
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
Vascular - artery disease causing fluid to back up into the lungs.


27. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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


28. What are the four types of pulmonary emboli?
Second Right intercostal space.
Fat - Air - DVT - or Amniotic
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
An inflammation of the pericardium. It may result in MI.


29. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
Must be flushed 1x/month with heparin and between treatments.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
(S1 - S2) Third left intercostal space


30. What are the steps for adult 2 rescuer CPR?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
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
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


31. What is important to remember when taking care of patients with compression devices?
D/C the med and call the doctor.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


32. What does a swan ganz measure?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Right sided heart failure


33. What is a transthoracic echocardiograph (TTE)?
If feel more than 3 shocks in a row or develop signs of infection at the site.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
D/C the med and call the doctor.
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.


34. For which heart sounds should the diaphragm be used?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
Second left intercostal space


35. Which type of patient shouldn't take nitrates?
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.
Nitrates - Beta blockers - and Calcium channel blockers
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


36. What are the nursing interventions for a patient in atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


37. What is epistaxis?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
A nosebleed
Fourth or fifth intercostal space at or medial to the midclavicular line.


38. What should you teach your patient about a cardiac catheterization?
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


39. What is an aortic dissection?

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40. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Open up blood vessels
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.


41. What is defibrillation?
Must be flushed 1x/month with heparin and between treatments.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
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.


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

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43. Where do the internal jugular veins lie?
Second Left intercostal space
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Pulmonary edema


44. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
Fifth left intercostal space medial to the midclavicular line.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


45. What landmarks should you be looking for on someone's chest?
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Steroid treatment or a pregnant woman who is retaining water.


46. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Direct current cardioversion and digoxin/propranolol (inderal).
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.


47. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


48. What should a patient do if they feel chest pain or discomfort?
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table


49. What are the treatments/ S&S of peripheral venous disease?
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
Pneumothorax and will end up with chest tube to help reinflate lung.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Pulse before and after giving.


50. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.