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 common risk factors for an MI?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Maintain BED REST
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


2. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
Fat - Air - DVT - or Amniotic
Right sided heart failure


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

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4. What are examples of calcium channel blockers?
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


5. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Cannot
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


6. During an Allen's test don't compress one artery _____ the other.
Protamine Sulfate
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Before


7. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Protamine Sulfate
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


8. What should you teach someone about 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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Feeling warm (fire) or tin can taste is expected and will pass.


9. What is an air embolism?
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).


10. What makes the symptoms of superior vena cava syndrome better? Worse?
Chronic arteriosclerotic disease.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


11. What is defibrillation?
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.
Protamine Sulfate
No radial artery punctures if negative
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.


12. Where should you place your stethescope to find the aortic valve?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Pulse before and after giving.
ST segment elevation (STEMI)
Second Right intercostal space.


13. What things should you do to assess cardiovascular status?
Right sided heart failure
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.


14. What are signs and symptoms of an MI?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


15. What should you teach someone with arterial insufficiency?

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16. 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
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
The patient may suffer significant blood loss or femoral nerve compression.
Patient who are unable to tolerate exercise stress testing.


17. What is the antidote for heparin?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Pulse before and after giving.
Protamine Sulfate


18. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


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

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20. What places someone at risk for an aortic dissection?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Pneumothorax and will end up with chest tube to help reinflate lung.
Poorly controlled hypertension
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


21. What are the proper steps to changing a central venous catheter dressing?
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
Don't interfere!
Pulse before and after giving.
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


22. What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Nitrates - Beta blockers - and Calcium channel blockers
Lower left sternal border


23. What are the S&S of superior vena cava syndrome?
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.
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.
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).


24. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
Fat - Air - DVT - or Amniotic


25. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


26. How long is contrast media in the body?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
Only for a few hours
Cannot


27. What is important to remember when taking care of patients with compression devices?
D/C the med and call the doctor.
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.
Second Right intercostal space.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


28. What should you do if the PT value is 45 sec?
One large emboli (smaller=better)
D/C the med and call the doctor.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


29. Where do the internal jugular veins lie?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.


30. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
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
Protamine Sulfate
NO NSAIDS or ASA.


31. What is the treatments for hypertension?
NO because it isn't sterile so keep out.
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


32. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
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


33. What are coumadin and heparin used for?
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
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.
To inhibit thrombus and clot formation.
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


34. What are the S&S of air embolism?
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
0.5-2.0 ng/ml


35. What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.


36. A femoral artery compression device ______be assigned to an NA?
Fifth left intercostal space medial to the midclavicular line.
Cannot
D/C the med and call the doctor.
An enlarged space indicates fluid accumulation in the pericardial sac.


37. What should you observe for in someone on bleeding precautions?
Patient who are unable to tolerate exercise stress testing.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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
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).


38. What is the hallmark clinical finding associated with pericarditis?
Lower left sternal border
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


39. What is an aortic dissection?

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40. Where is the apex/mitral valve landmark on the chest?
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
In fatty areas or over major muscles - large breasts - or bony prominences.
Fourth or fifth intercostal space at or medial to the midclavicular line.
One at a time to assess the pulse amplitude and contour.


41. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Fifth left intercostal space medial to the midclavicular line.
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


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

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43. What is more harmful a lot of little emboli or one large emboli?
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
No radial artery punctures if negative
One large emboli (smaller=better)
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.


44. What are the indications for a chemical stress test (persantine stress test)?
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.
Second Right intercostal space.
Patient who are unable to tolerate exercise stress testing.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


45. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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


46. What should you do if you are going to ventilate someone with an ambu bag?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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
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.
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!


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

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48. What is cardioversion?

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49. Who would most likely have peripheral venous disease?
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).
Old truck driver or someone on bed rest or with pelvic trauma.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).


50. What would make someone more at risk for digoxin toxicity?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.