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 is characteristic of premature ventricular contractions?
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Chronic arteriosclerotic disease.


2. Where should you place your stethescope to find the ERB's Point?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
(S1 - S2) Third left intercostal space
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Poorly controlled hypertension


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

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4. How should you palpate the carotid arteries?
Nitrates - Beta blockers - and Calcium channel blockers
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
One at a time to assess the pulse amplitude and contour.


5. What should you teach your patient about an abdominal ultrasonography?
The patient may suffer significant blood loss or femoral nerve compression.
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
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
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.


6. What is angina? Stable vs. unstable?

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

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8. What is a good diagnosis for someone with right sided HF?
Close the open catheter lumen with the clamp - and place the pt on their left side in trendelenburg to move the air embolus away from the pulmonic valve. If you hear a churning sound in his chest (a classic sign of air embolus) and the patient starts
Activity intolerance
Pneumothorax and will end up with chest tube to help reinflate lung.
Second left intercostal space


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

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10. What is Raynauds disease? Tx?
Second Left intercostal space
Vascular - artery disease causing fluid to back up into the lungs.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.


11. Who would most likely have peripheral venous 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.
Old truck driver or someone on bed rest or with pelvic trauma.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
A nosebleed


12. What should be immediately done for a patient experiencing digoxin toxicity?
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.
In the first 72 hours!!!!!
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


13. What is cardiac tamponade? Common causes?
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
4th left intercostal space lower sternal border


14. How is angina treated?

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15. What can result from left sided heart failure if left untreated?
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.
Whether the patients ulnar and radial arteries are patent.
Pulmonary edema
One at a time to assess the pulse amplitude and contour.


16. What are the nursing interventions for a patient in complete heart block?
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
D/C the med and call the doctor.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.


17. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Lower left sternal border
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
In fatty areas or over major muscles - large breasts - or bony prominences.


18. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Idiopathic
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.


19. 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?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


20. What should you do if the PT value is 45 sec?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
D/C the med and call the doctor.


21. In what locations should you not place electrodes?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
In fatty areas or over major muscles - large breasts - or bony prominences.
(S1 - S2) Third left intercostal space
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.


22. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
In fatty areas or over major muscles - large breasts - or bony prominences.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


23. What should be done immediately if a pulmonary embolism is suspected?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Air embolism
Close the open catheter lumen with the clamp - and place the pt on their left side in trendelenburg to move the air embolus away from the pulmonic valve. If you hear a churning sound in his chest (a classic sign of air embolus) and the patient starts
To 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.


24. What type of EKG change indicates MI?
ST segment elevation (STEMI)
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.
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


25. 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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.
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


26. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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


27. What is the treatment for myocardial infarction?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


28. What are the four types of pulmonary emboli?
Chronic arteriosclerotic disease.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
Fat - Air - DVT - or Amniotic


29. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Second Left intercostal space
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


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

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31. In What time period is the greatest risk of sudden death from an MI?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
In the first 72 hours!!!!!
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


32. What SE should you look for with calcium channel blocker use?
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).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


33. What causes secondary 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
Steroid treatment or a pregnant woman who is retaining water.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.


34. What is the treatment for someone with right sided HF? How do you know working?
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).


35. What is the goal of treatment for an MI? Treatment?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Fifth left intercostal space medial to the midclavicular line.
Protamine Sulfate
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.


36. 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.
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


37. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Don't interfere!
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


38. What are the S&S of superior vena cava syndrome?
If feel more than 3 shocks in a row or develop signs of infection at the site.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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


39. What is important to remember when taking care of patients with compression devices?
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
BP is elevated or decreased depending on activity.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.


40. What landmarks should you be looking for on someone's chest?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
ST segment elevation (STEMI)
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


41. What should you do immediately if you suspect someone of developing a hematoma?
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
An inflammation of the pericardium. It may result in MI.
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.
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.


42. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.


43. What should you do to treat pulmonary edema?
Maintain BED REST
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
Second right intercostal space
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.


44. What do calcium channel blockers do?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Open up blood vessels


45. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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


46. Where is the right ventricle landmark on the chest?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Whether the patients ulnar and radial arteries are patent.
Left sternal border
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.


47. What are the steps for adult 2 rescuer CPR?
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 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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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


48. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.


49. What is the most common cause of arterial insufficiency?
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.
Chronic arteriosclerotic disease.


50. What is important to remember when removing a CVC from a patient?
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer - hurts more - etc.)