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 will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
Old truck driver or someone on bed rest or with pelvic trauma.


2. Where is the pulmonic valve landmark on the chest?
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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.


3. What should you explain to the patient about an impedance cardiography test?
D/C the med and call the doctor.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


4. What does the device for impedance cardiography consist of?
Left sternal border
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


5. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.


6. What is the correct way to insert an oropharyngeal airway?
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.
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
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


7. When should bleeding precautions be implemented?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
The patient may suffer significant blood loss or femoral nerve compression.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.


8. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
D/C the med and call the doctor.
Direct current cardioversion and digoxin/propranolol (inderal).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


9. For which heart sounds should the diaphragm be used?
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
Patient who are unable to tolerate exercise stress testing.
Nitrates - Beta blockers - and Calcium channel blockers
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


10. What is the most common cause of arterial insufficiency?
D/C the med and call the doctor.
(S1 - S2) Third left intercostal space
Lower left sternal border
Chronic arteriosclerotic disease.


11. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
An enlarged space indicates fluid accumulation in the pericardial sac.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


12. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Fat - Air - DVT - or Amniotic
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.
Chronic arteriosclerotic disease.
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


13. What is a therapeutic digoxin level?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
0.5-2.0 ng/ml
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.


14. What signals an elevated venous pressure based on the internal jugular veins?
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Left sternal border
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.


15. What is important to remember when removing a CVC from a patient?
Pulse before and after giving.
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
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.


16. What are common risk factors for an MI?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) 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).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


17. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
The internal jugular veins (external are less reliable).
(S1 - S2) Third left intercostal space
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


18. What is intermittent claudication?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


19. What is a good diagnosis for someone with right sided HF?
Activity intolerance
Cannot
Vascular - artery disease causing fluid to back up into the lungs.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


20. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Feeling warm (fire) or tin can taste is expected and will pass.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


21. What do calcium channel blockers do?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Whether the patients ulnar and radial arteries are patent.
Open up blood vessels
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


22. How long is contrast media in the body?
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.
Only for a few hours
BP is elevated or decreased depending on activity.
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


23. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
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


24. What is characteristic of complete heart block?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


25. A femoral artery compression device ______be assigned to an NA?
One at a time to assess the pulse amplitude and contour.
Second Left intercostal space
Cannot
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


26. In What time period is the greatest risk of sudden death from an MI?
Nitrates - Beta blockers - and Calcium channel blockers
In fatty areas or over major muscles - large breasts - or bony prominences.
In the first 72 hours!!!!!
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.


27. What is the treatments for hypertension?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
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.


28. What is a assessment finding with DVT?

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29. What are all the S&S of pericarditis?
Lung disease
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
It is noninvasive. You must not eat - smoke - or drink alcohol for 3 hours before the test. WEAR COMFORTABLE SHOES And LOOSE LIGHTWEIGHT SHORTS OR SLACKS - YOU MAY GET AN INJECTION of THAllIUM - after your blood pressure and ECG are monitored for 10-
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.


30. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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 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.


31. What is cardioversion?

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32. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.


33. In what locations should you not place electrodes?
A nosebleed
In fatty areas or over major muscles - large breasts - or bony prominences.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.


34. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
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


35. What should you do if you are going to ventilate someone with an ambu bag?
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.
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
Fifth left intercostal space medial to the midclavicular line.
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


36. Where should you place your stethescope to find the ERB's Point?
Fifth left intercostal space medial to the midclavicular line.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
(S1 - S2) Third left intercostal space
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.


37. When should you be concerned about premature ventricular contraction?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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!
Fifth left intercostal space medial to the midclavicular line.
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


38. What are the steps to perform the heimlich maneuver?
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.
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.
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
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.


39. What is angina? Stable vs. unstable?

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40. What is more harmful a lot of little emboli or one large emboli?
Nitrates - Beta blockers - and Calcium channel blockers
In fatty areas or over major muscles - large breasts - or bony prominences.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
One large emboli (smaller=better)


41. What is the purpose of compression devices?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Idiopathic
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
An inflammation of the pericardium. It may result in MI.


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

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43. What are the S&S of aortic dissection?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
ST segment elevation (STEMI)
Whether the patients ulnar and radial arteries are patent.
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.


44. What are the steps for adult 2 rescuer CPR?
Must be flushed 1x/month with heparin and between treatments.
Fat - Air - DVT - or Amniotic
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
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


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

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46. What should you do if the PTT value is 80 for someone on heparin?
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unu
D/C the med and call the doctor.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Feeling warm (fire) or tin can taste is expected and will pass.


47. What is the treatment for myocardial infarction?
(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).
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


48. What will be the treatment for an acute episode of life threatening tamponade?
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
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.
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 clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.


49. What are the nursing interventions for a pt. with ventricular tachycardia?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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


50. What should you teach your patient about an abdominal ultrasonography?
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 inhibit thrombus and clot formation.
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.
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