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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 should you tell a patient who developed a hematoma in the hospital and is being discharged?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

2. What are the 2 types of pacemakers?
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.
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.
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

3. What needs to be held during the placement of a femoral artery compression device?
The internal jugular veins (external are less reliable).
Activity intolerance
Pulmonary edema
NO NSAIDS or ASA.

4. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
0.5-2.0 ng/ml

5. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
D/C the med and call the doctor.
NO because it isn't sterile so keep out.
Maintain BED REST

6. What does a swan ganz measure?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Patient who are unable to tolerate exercise stress testing.
Steroid treatment or a pregnant woman who is retaining water.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

7. What is cardiac tamponade? Common causes?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
Poorly controlled hypertension
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.

8. What does vasotec (Enalapril Maleate) do/SE?
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

9. What do calcium channel blockers do?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Open up blood vessels
Poorly controlled hypertension
Fat - Air - DVT - or Amniotic

10. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Left sternal border

11. What should you explain to the patient about an impedance cardiography test?
Right sided heart failure
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

12. What are the steps for infant 1&2 rescuer CPR?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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
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.

13. What should happen if someone converts to asystole/flatline?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
4th left intercostal space lower sternal border
Second left intercostal space

14. What are the S&S of cardiac tamponade?
Second right intercostal space
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Patient who are unable to tolerate exercise stress testing.
One at a time to assess the pulse amplitude and contour.

15. What are the nursing interventions for a patient in atrial fibrillation?
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

16. How is the Allen's test done?
The patient may suffer significant blood loss or femoral nerve compression.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

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

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18. What is important to remember when taking care of patients with compression devices?
Right sided heart failure
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
NO because it isn't sterile so keep out.

19. How long is contrast media in the body?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Before
Only for a few hours
Feeling warm (fire) or tin can taste is expected and will pass.

20. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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

21. What causes essential/primary hypertension?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Air answers (open junctions)
Idiopathic

22. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Maintain BED REST
If feel more than 3 shocks in a row or develop signs of infection at the site.
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

23. What will a leg with arterial insufficiency look like?
Activity intolerance
Steroid treatment or a pregnant woman who is retaining water.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

24. What are the S&S of superior vena cava syndrome?
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
An inflammation of the pericardium. It may result in MI.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

25. What should you teach your patient about an electrocardiogram (ECG)?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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
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

26. What is the goal of treatment for an MI? Treatment?
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.
One at a time to assess the pulse amplitude and contour.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

27. What is the hallmark clinical finding associated with pericarditis?
Vascular - artery disease causing fluid to back up into the lungs.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
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.

28. What are the nursing interventions for a patient with premature ventricular contractions?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
D/C the med and call the doctor.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

29. What is labile hypertension?
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
BP is elevated or decreased depending on activity.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

30. 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.
The internal jugular veins (external are less reliable).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.

31. What are the five areas for listening to the heart?

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32. 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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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 patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

33. What should you teach someone with arterial insufficiency?

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34. What things should you do to assess cardiovascular status?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Protamine Sulfate
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

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

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36. What is pericarditis?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
An inflammation of the pericardium. It may result in MI.
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.

37. 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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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
Right sided heart failure

38. What is a good diagnosis for someone with right sided HF?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Right sided heart failure
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
Activity intolerance

39. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.)
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Whether the patients ulnar and radial arteries are patent.

40. What should be done immediately if a pulmonary embolism is suspected?
A nosebleed
Activity intolerance
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
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

41. What is an air embolism?
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Pulmonary edema
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

42. What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

43. What should a patient do if they feel chest pain or discomfort?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
Right sided heart failure

44. What landmarks should you be looking for on someone's chest?
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
Air embolism
NO because it isn't sterile so keep out.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

45. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
In the first 72 hours!!!!!
Fat - Air - DVT - or Amniotic
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

46. What is the treatment for premature ventricular contractions?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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

47. What are all the S&S of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
A nosebleed
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.
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

48. What are common risk factors for an MI?
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-
0.5-2.0 ng/ml
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

49. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

50. Test ending in Gram=?
Iodine
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The patient may suffer significant blood loss or femoral nerve compression.
An inflammation of the pericardium. It may result in MI.

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NCLEX Cardiac

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