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 diaphragm be used?
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.
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
One at a time to assess the pulse amplitude and contour.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


2. What could happen without immediate intervention for a hematoma?
In fatty areas or over major muscles - large breasts - or bony prominences.
The patient may suffer significant blood loss or femoral nerve compression.
Only for a few hours
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


3. What is an air embolism?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
0.5-2.0 ng/ml


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

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5. What is characteristic of ventricular fibrillation?
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!
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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


6. What usually triggers angina pain?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


7. What should you do to treat pulmonary edema?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
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


8. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
To inhibit thrombus and clot formation.
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.


9. What are the proper steps to changing a central venous catheter dressing?
Second Right intercostal space.
It is a sterile procedure so both nurse and patient should wear a mask - arrange sterile field - remove dressing - assess the catheter insertion site for infection - put on sterile gloves - clean the site moving outwardly in a circular motion - apply
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.


10. What type of EKG change indicates MI?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
ST segment elevation (STEMI)


11. What should you remember while taking care of someone with a peripheral arterial occlusion?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
In fatty areas or over major muscles - large breasts - or bony prominences.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


12. What should you explain to the patient about an impedance cardiography test?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
NO because it isn't sterile so keep out.
In the first 72 hours!!!!!


13. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Activity intolerance
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


14. Which type of patient shouldn't take nitrates?
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
Old truck driver or someone on bed rest or with pelvic trauma.
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


15. What is superior vena cava syndrome?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
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.


16. What should you tell someone about taking nitroglycerin tablets (SE)?
NO NSAIDS or ASA.
Poorly controlled hypertension
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+


17. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.)
The internal jugular veins (external are less reliable).


18. What is the treatment for someone in ventricular fibrillation?
0.5-2.0 ng/ml
Cannot
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


19. What are the S&S of cardiac tamponade?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Idiopathic
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


20. What is the most common cause of arterial insufficiency?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
ST segment elevation (STEMI)
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.
Chronic arteriosclerotic disease.


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

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22. Where should you place your stethescope to find the tricuspid valve?
Cannot
4th left intercostal space lower sternal border
Iodine
BP is elevated or decreased depending on activity.


23. What causes essential/primary hypertension?
Second Left intercostal space
A nosebleed
Idiopathic
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


24. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
Second left intercostal space
Whether the patients ulnar and radial arteries are patent.


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

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26. What is a nursing diagnosis for arterial occlusion? Tx
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Lung disease


27. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
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.
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


28. Where is the aortic valve landmark on the chest?
Second right intercostal space
Left sternal border
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


29. What are common risk factors for an MI?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Maintain BED REST
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.


30. What is defibrillation?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
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.
An inflammation of the pericardium. It may result in MI.


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

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32. What are the nursing interventions for a pt. with ventricular tachycardia?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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


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

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34. What is the treatments for hypertension?
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.
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
Pulmonary edema
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.


35. What signals an elevated venous pressure based on the internal jugular veins?
One large emboli (smaller=better)
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.
Open up blood vessels
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


36. What are the nursing interventions for a patient in complete heart block?
A nosebleed
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
D/C the med and call the doctor.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


37. What is CVP? Normal?
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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


38. 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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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
Activity intolerance


39. What should you teach your patient about an abdominal ultrasonography?
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
NO NSAIDS or ASA.


40. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
An enlarged space indicates fluid accumulation in the pericardial sac.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.


41. What would make someone more at risk for digoxin toxicity?
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


42. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Cannot
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 - 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
Include rest periods prior to any activity.


43. Without prompt surgery for an aortic dissection What is someone at risk for developing?
No radial artery punctures if negative
0.5-2.0 ng/ml
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Feeling warm (fire) or tin can taste is expected and will pass.


44. What should you do if the PTT value is 80 for someone on heparin?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Fat - Air - DVT - or Amniotic
D/C the med and call the doctor.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


45. What should you do immediately if you suspect someone of developing a hematoma?
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.
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
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.
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.


46. 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.
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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).


47. What should you teach your patient about MRI?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
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


48. What are the S&S of air embolism?
Idiopathic
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


49. What is the antidote for heparin?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
(S1 - S2) Third left intercostal space
Protamine Sulfate
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.


50. What should a patient do if they feel chest pain or discomfort?
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
The internal jugular veins (external are less reliable).
Left sternal border
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.