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 are the treatments/ S&S of peripheral venous disease?
To inhibit thrombus and clot formation.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
An inflammation of the pericardium. It may result in MI.


2. For which heart sounds should the bell be used?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


3. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.


4. What is the treatment for someone with right sided HF? How do you know working?
Old truck driver or someone on bed rest or with pelvic trauma.
Feeling warm (fire) or tin can taste is expected and will pass.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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


5. What should happen if someone converts to asystole/flatline?
Include rest periods prior to any activity.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


6. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
In fatty areas or over major muscles - large breasts - or bony prominences.
Air embolism


7. What should you teach your patient about an electrocardiogram (ECG)?
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.
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
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
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.


8. 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?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.


9. A femoral artery compression device ______be assigned to an NA?
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
D/C the med and call the doctor.
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
Cannot


10. What is a good diagnosis for someone with right sided HF?
Activity intolerance
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.


11. What is labile hypertension?
Second Left intercostal space
BP is elevated or decreased depending on activity.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


12. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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 can result from left sided heart failure if left untreated?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Old truck driver or someone on bed rest or with pelvic trauma.
Pulmonary edema
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


14. What are the S&S of pulmonary embolism?
Nitrates - Beta blockers - and Calcium channel blockers
Fat - Air - DVT - or Amniotic
ST segment elevation (STEMI)
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


15. What is the goal of treatment for an MI? Treatment?
0.5-2.0 ng/ml
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Lowers BP and makes heart beat stronger. SE: flushed face.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


16. What is cardioversion?

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17. What is a transthoracic echocardiograph (TTE)?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Maintain BED REST
Fifth left intercostal space medial to the midclavicular line.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


18. What should you tell someone about taking nitroglycerin tablets (SE)?
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
Right sided heart failure
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.


19. What will a leg with arterial insufficiency look like?
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
The patient may suffer significant blood loss or femoral nerve compression.


20. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.


21. What is an air embolism?
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.


22. What is defibrillation?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.


23. Where is the tricuspid valve landmark on the chest?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
ST segment elevation (STEMI)
An inflammation of the pericardium. It may result in MI.
Lower left sternal border


24. What should you explain to the patient about an impedance cardiography test?
To inhibit thrombus and clot formation.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Idiopathic
Old truck driver or someone on bed rest or with pelvic trauma.


25. What is characteristic of ventricular fibrillation?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


26. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
(S1 - S2) Third left intercostal space


27. What is characteristic of ventricular tachycardia?
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
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.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


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

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29. What is characteristic of premature ventricular contractions?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Patient who are unable to tolerate exercise stress testing.
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.


30. What is cardiac tamponade? Common causes?
Old truck driver or someone on bed rest or with pelvic trauma.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


31. Where should you place your stethescope to find the ERB's Point?
Before
(S1 - S2) Third left intercostal space
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


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

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33. What is the most common cause of arterial insufficiency?
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.
(S1 - S2) Third left intercostal space
Patient who are unable to tolerate exercise stress testing.
Chronic arteriosclerotic disease.


34. What things should you do to assess cardiovascular status?
Whether the patients ulnar and radial arteries are patent.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


35. What signals an elevated venous pressure based on the internal jugular veins?
Vitamin K (aqua myphiton)
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


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

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37. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


38. What are the signs and symptoms of left sided HF?
BP is elevated or decreased depending on activity.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


39. What disease can cause right sided heart failure?
Lung disease
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
To inhibit thrombus and clot formation.


40. When should bleeding precautions be implemented?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
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.


41. What are common risk factors for an MI?
Don't interfere!
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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


42. In What time period is the greatest risk of sudden death from an MI?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
In the first 72 hours!!!!!


43. What should you do if you are going to ventilate someone with an ambu bag?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


44. What is INR?
Iodine
Steroid treatment or a pregnant woman who is retaining water.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
One large emboli (smaller=better)


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

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46. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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


47. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
Nitrates - Beta blockers - and Calcium channel blockers
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?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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
Lung disease
0.5-2.0 ng/ml


49. What is the treatment for a pt. with ventricular tachycardia?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


50. What is characteristic of complete heart block?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Fourth or fifth intercostal space at or medial to the midclavicular line.