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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 landmarks should you be looking for on someone's chest?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Pulmonary edema
If feel more than 3 shocks in a row or develop signs of infection at the site.

2. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
An inflammation of the pericardium. It may result in MI.

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

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4. What is pericarditis?
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.
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits - leans forward - and breaths out.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
An inflammation of the pericardium. It may result in MI.

5. What should you teach your patient about a cardiac catheterization?
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause
NO NSAIDS or ASA.
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

6. Where should you place your stethescope to find the tricuspid valve?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
4th left intercostal space lower sternal border

7. What does vasotec (Enalapril Maleate) do/SE?
Air answers (open junctions)
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Lowers BP and makes heart beat stronger. SE: flushed face.
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

8. What is impedance cardiography?
Second Right intercostal space.
BP is elevated or decreased depending on activity.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Iodine

9. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Fat - Air - DVT - or Amniotic

10. What should you always assume with a patient who has a central line placed and is experiencing SOB?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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
Air embolism
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.

11. What is cardiac tamponade? Common causes?
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.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

12. What is the treatments for hypertension?
D/C the med and call the doctor.
An inflammation of the pericardium. It may result in MI.
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.
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.

13. What should you teach a patient regarding discharge after a DVT?

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14. What should you tell someone about taking nitroglycerin tablets (SE)?
Direct current cardioversion and digoxin/propranolol (inderal).
Second Left intercostal space
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.
Open up blood vessels

15. What makes the symptoms of superior vena cava syndrome better? Worse?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
D/C the med and call the doctor.

16. In what locations should you not place electrodes?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
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
In fatty areas or over major muscles - large breasts - or bony prominences.

17. What should you do if the PT value is 45 sec?
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits - leans forward - and breaths out.
0.5-2.0 ng/ml
D/C the med and call the doctor.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

18. What are the four types of pulmonary emboli?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Fat - Air - DVT - or Amniotic
(S1 - S2) Third left intercostal space
Poorly controlled hypertension

19. What body systems are affected by digoxin toxicity? S&S?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Cannot
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
D/C the med and call the doctor.

20. What are the treatments/ S&S of peripheral venous disease?
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
To inhibit thrombus and clot formation.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

21. Test ending in Gram=?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Second Left intercostal space
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
Iodine

22. 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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Idiopathic
NO because it isn't sterile so keep out.

23. What is the nursing care associated with chemical stress tests (persantine stress test)?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Fifth left intercostal space medial to the midclavicular line.
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

24. What is characteristic of ventricular fibrillation?
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
Idiopathic
One at a time to assess the pulse amplitude and contour.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

25. What is a chemical stress test (persantine stress test)?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
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.
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

26. What is intermittent claudication?
Iodine
4th left intercostal space lower sternal border
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.
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

27. What is epistaxis?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
A nosebleed
Protamine Sulfate
If feel more than 3 shocks in a row or develop signs of infection at the site.

28. What is labile hypertension?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
BP is elevated or decreased depending on activity.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
The internal jugular veins (external are less reliable).

29. What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
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
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.
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

30. When should bleeding precautions be implemented?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
(S1 - S2) Third 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.
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.

31. What are the S&S of aortic dissection?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Left sternal border

32. What should you watch for with PICC lines that have been in place for 6 months?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Air answers (open junctions)
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

33. In What time period is the greatest risk of sudden death from an MI?
Fat - Air - DVT - or Amniotic
In fatty areas or over major muscles - large breasts - or bony prominences.
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
In the first 72 hours!!!!!

34. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Idiopathic
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

35. What SE should you look for with calcium channel blocker use?
NO NSAIDS or ASA.
Whether the patients ulnar and radial arteries are patent.
Air embolism
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

36. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
Cannot
Left sternal border
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

37. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

38. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
No radial artery punctures if negative
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

39. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
A nosebleed
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.

40. What are the nursing interventions for a pt. with ventricular tachycardia?
Poorly controlled hypertension
Must be flushed 1x/month with heparin and between treatments.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

41. What should you do if the PTT value is 80 for someone on heparin?
Pneumothorax and will end up with chest tube to help reinflate lung.
0.5-2.0 ng/ml
An inflammation of the pericardium. It may result in MI.
D/C the med and call the doctor.

42. Where should you place your stethescope to find the mitral (apex) valve?
In fatty areas or over major muscles - large breasts - or bony prominences.
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
Fifth left intercostal space medial to the midclavicular line.
The internal jugular veins (external are less reliable).

43. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Pulse before and after giving.
An enlarged space indicates fluid accumulation in the pericardial sac.
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.

44. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
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.

45. What is characteristic of premature ventricular contractions?
One at a time to assess the pulse amplitude and contour.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
Nitrates - Beta blockers - and Calcium channel blockers

46. When should you be concerned about premature ventricular contraction?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

47. What should you explain to the patient about an impedance cardiography test?
Lowers BP and makes heart beat stronger. SE: flushed face.
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).
Must be flushed 1x/month with heparin and between treatments.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

48. What is the treatment for someone with right sided HF? How do you know working?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Pulmonary edema
Idiopathic

49. What is defibrillation?
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.
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Direct current cardioversion and digoxin/propranolol (inderal).

50. What are all the S&S of pericarditis?
Nitrates - Beta blockers - and Calcium channel blockers
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Right sided heart failure

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NCLEX Cardiac

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