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 INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
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
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


2. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


3. 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.
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.
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
Include rest periods prior to any activity.


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

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5. What drugs are most commonly used for angina?
Air answers (open junctions)
NO NSAIDS or ASA.
Nitrates - Beta blockers - and Calcium channel blockers
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


6. What is the treatments for hypertension?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Second right intercostal space
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.


7. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.


8. What is the treatment for atrial fibrillation?
Patient who are unable to tolerate exercise stress testing.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
BP is elevated or decreased depending on activity.
Direct current cardioversion and digoxin/propranolol (inderal).


9. What should you go when applying nitroglycerin ointment for angina?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
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
In fatty areas or over major muscles - large breasts - or bony prominences.


10. What is Deep Vein Thrombosis (DVT)?
Fifth left intercostal space medial to the midclavicular line.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
BP is elevated or decreased depending on activity.
NO because it isn't sterile so keep out.


11. What does vasotec (Enalapril Maleate) do/SE?
One at a time to assess the pulse amplitude and contour.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
Lowers BP and makes heart beat stronger. SE: flushed face.


12. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
In the first 72 hours!!!!!
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.
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


13. What could happen without immediate intervention for a hematoma?
Whether the patients ulnar and radial arteries are patent.
Second Left intercostal space
(S1 - S2) Third left intercostal space
The patient may suffer significant blood loss or femoral nerve compression.


14. What should you teach your patient about an exercise ECG (stress test)?
Fifth left intercostal space medial to the midclavicular line.
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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-


15. What should a patient do if they feel chest pain or discomfort?
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
Steroid treatment or a pregnant woman who is retaining water.
The internal jugular veins (external are less reliable).
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


16. What SE should you look for with calcium channel blocker use?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Second Left intercostal space


17. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Poorly controlled hypertension
In fatty areas or over major muscles - large breasts - or bony prominences.
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.


18. What are the nursing interventions for a patient in atrial fibrillation?
Activity intolerance
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


19. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
D/C the med and call the doctor.
Vascular - artery disease causing fluid to back up into the lungs.
Must be flushed 1x/month with heparin and between treatments.


20. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Whether the patients ulnar and radial arteries are patent.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
One at a time to assess the pulse amplitude and contour.


21. Where should you place your stethescope to find the aortic valve?
D/C the med and call the doctor.
Second Right intercostal space.
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


22. What are examples of calcium channel blockers?
(S1 - S2) Third left intercostal space
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Pneumothorax and will end up with chest tube to help reinflate lung.


23. When should bleeding precautions be implemented?
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.
Poorly controlled hypertension
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.


24. What is characteristic of ventricular fibrillation?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
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


25. What should be done for someone on bleeding precautions?
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


26. Where should you place your stethescope to find the mitral (apex) valve?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


27. What type of surgery is done for an aortic dissection?
Second Right intercostal space.
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


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

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29. Test ending in Gram=?
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
Iodine
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.
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


30. What is the antidote for heparin?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Protamine Sulfate
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
D/C the med and call the doctor.


31. What should happen if someone converts to asystole/flatline?
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


32. What are the steps for adult 2 rescuer CPR?
Steroid treatment or a pregnant woman who is retaining water.
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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


33. What is intermittent claudication?
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
Poorly controlled hypertension
0.5-2.0 ng/ml
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.


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

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35. Where is the aortic valve landmark on the chest?
Second right intercostal space
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A nosebleed
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


36. What are the S&S of cardiac tamponade?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


37. 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).
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.
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
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


38. What is cardiac tamponade? Common causes?
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
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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


39. What is the goal of treatment for an MI? Treatment?
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
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.
Pulmonary edema
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


40. What should you remember while taking care of someone with a peripheral arterial occlusion?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Second Right intercostal space.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


41. How is angina treated?

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42. What is a assessment finding with DVT?

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43. What should be done immediately if a pulmonary embolism is suspected?
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
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
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.)
One large emboli (smaller=better)


44. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
NO NSAIDS or ASA.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


45. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.


46. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
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.
Air answers (open junctions)
Activity intolerance


47. What is important to remember when removing a CVC from a patient?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
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.


48. What are the nursing interventions for a patient in complete heart block?
4th left intercostal space lower sternal border
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Fifth left intercostal space medial to the midclavicular line.
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.


49. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
The patient may suffer significant blood loss or femoral nerve compression.


50. What is defibrillation?
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
Fifth left intercostal space medial to the midclavicular line.
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.
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