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 a therapeutic digoxin level?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
0.5-2.0 ng/ml
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
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.


2. What is cardioversion?

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3. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).


4. What places someone at risk for an aortic dissection?
Second right intercostal space
D/C the med and call the doctor.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Poorly controlled hypertension


5. What is the purpose of compression devices?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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


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

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7. What should you do immediately if you suspect someone of developing a hematoma?
D/C the med and call the doctor.
Right sided heart failure
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.


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


9. What are the nursing interventions for a pt. with ventricular tachycardia?
Chronic arteriosclerotic disease.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Pneumothorax and will end up with chest tube to help reinflate lung.


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

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11. What are the S&S of superior vena cava syndrome?
A nosebleed
Fifth left intercostal space medial to the midclavicular line.
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.
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


12. What type of EKG change indicates MI?
ST segment elevation (STEMI)
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
Pneumothorax and will end up with chest tube to help reinflate lung.


13. What should you teach your patient about angiography (arteriography)?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
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.)
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.


14. Where is the tricuspid valve landmark on the chest?
Lower left sternal border
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.


15. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
4th left intercostal space lower sternal border
In fatty areas or over major muscles - large breasts - or bony prominences.


16. What can result from left sided heart failure if left untreated?
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
Pulmonary edema
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


17. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Second left intercostal space
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
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer - hurts more - etc.)
The internal jugular veins (external are less reliable).


18. What 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).
Right sided heart failure
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.


19. 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.
(S1 - S2) Third left intercostal space
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Whether the patients ulnar and radial arteries are patent.


20. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Second Right intercostal space.
Lowers BP and makes heart beat stronger. SE: flushed face.
Maintain BED REST


21. What do calcium channel blockers do?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Open up blood vessels
D/C the med and call the doctor.


22. What are all the S&S of pericarditis?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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


23. What are the signs and symptoms of left sided HF?
The patient may suffer significant blood loss or femoral nerve compression.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


24. What is a chemical stress test (persantine stress test)?
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
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.


25. What should be checked in a patient on a beta blocker?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Pulse before and after giving.
Only for a few hours


26. What should you watch for with PICC lines that have been in place for 6 months?
Whether the patients ulnar and radial arteries are patent.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Air answers (open junctions)
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


27. What is the maintenance for venous access port that isn't being regularly 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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
Must be flushed 1x/month with heparin and between treatments.


28. What is an aortic dissection?

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29. What is important to remember when taking care of patients with compression devices?
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


30. What are the nursing interventions for a patient in atrial fibrillation?
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


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

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32. What type of surgery is done for an aortic dissection?
Before
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
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


33. What should happen if someone converts to asystole/flatline?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.
Air answers (open junctions)


34. What are the steps for infant 1&2 rescuer CPR?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


35. What are the four types of pulmonary emboli?
NO because it isn't sterile so keep out.
Fat - Air - DVT - or Amniotic
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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


36. What are common risk factors for an MI?
Protamine Sulfate
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
One at a time to assess the pulse amplitude and contour.


37. What is the goal of treatment for an MI? Treatment?
Second Right intercostal space.
Pulmonary edema
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


38. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
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
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


39. What is characteristic of premature ventricular contractions?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
NO NSAIDS or ASA.


40. What is a major complication of central line placement?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Pneumothorax and will end up with chest tube to help reinflate lung.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


41. For which heart sounds should the bell be used?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


42. What is the antidote for heparin?
Protamine Sulfate
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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
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.


43. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Pneumothorax and will end up with chest tube to help reinflate lung.
Air embolism
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


44. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
D/C the med and call the doctor.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
MRI is painless - you must remain still inside a small/noisy space. If you are claustrophobic you may need sedation. Remove all jewelry and other metal objects. If you have any shrapnel - a pacemaker - or any surgically implanted joints - pins - clip
Protamine Sulfate


45. What landmarks should you be looking for on someone's chest?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
0.5-2.0 ng/ml
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


46. Where is the pulmonic valve landmark on the chest?
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.
BP is elevated or decreased depending on activity.
Second left intercostal space
Steroid treatment or a pregnant woman who is retaining water.


47. What should you teach your patient about MRI?
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.
4th left intercostal space lower sternal border
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.
MRI is painless - you must remain still inside a small/noisy space. If you are claustrophobic you may need sedation. Remove all jewelry and other metal objects. If you have any shrapnel - a pacemaker - or any surgically implanted joints - pins - clip


48. What is the treatment for someone in ventricular fibrillation?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.


49. What should be done immediately if a pulmonary embolism is suspected?
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
Protamine Sulfate
Direct current cardioversion and digoxin/propranolol (inderal).
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


50. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Air answers (open junctions)
Before
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).