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 nursing interventions are associated with a pt. experiencing ventricular fibrillation?
4th left intercostal space lower sternal border
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


2. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
Only for a few hours
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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


3. What is an air embolism?
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.
Iodine
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Don't interfere!


4. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Fourth or fifth intercostal space at or medial to the midclavicular line.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Lowers BP and makes heart beat stronger. SE: flushed face.


5. What will be the treatment for an acute episode of life threatening tamponade?
Steroid treatment or a pregnant woman who is retaining water.
Vascular - artery disease causing fluid to back up into the lungs.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


6. What should you do when applying a femoral artery compression device?
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


7. What is impedance cardiography?
Iodine
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
Feeling warm (fire) or tin can taste is expected and will pass.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


8. What should you teach someone with arterial insufficiency?

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9. What causes essential/primary hypertension?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Fat - Air - DVT - or Amniotic
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Idiopathic


10. What is the treatment for a pt. with ventricular tachycardia?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Awake and alert: IV lidocaine bolus and drip Unconscious - hypotensive - or S&S of angina/CHF: Direct current cardioversion and IV Lidocaine bolus and drip.
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
Include rest periods prior to any activity.


11. What should you do if you are going to ventilate someone with an ambu bag?
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.


12. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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
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.
D/C the med and call the doctor.
Nitrates - Beta blockers - and Calcium channel blockers


13. What factors place you at risk for HTN?
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
BP is elevated or decreased depending on activity.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


14. 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.
(S1 - S2) Third left intercostal space
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.


15. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.


16. What is superior vena cava syndrome?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
To inhibit thrombus and clot formation.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.


17. What is pulsus paradoxus?
Right sided heart failure
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.


18. What is the treatment for myocardial infarction?
Second Right intercostal space.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Feeling warm (fire) or tin can taste is expected and will pass.


19. What landmarks should you be looking for on someone's chest?
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.
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 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-
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


20. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.


21. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
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
Whether the patients ulnar and radial arteries are patent.
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


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

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23. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
If feel more than 3 shocks in a row or develop signs of infection at the site.


24. What is the treatments for hypertension?
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.
One at a time to assess the pulse amplitude and contour.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Vascular - artery disease causing fluid to back up into the lungs.


25. What is the purpose of compression devices?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Open up blood vessels
Fourth or fifth intercostal space at or medial to the midclavicular line.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


26. What are the S&S of cardiac tamponade?
To inhibit thrombus and clot formation.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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


27. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
NO NSAIDS or ASA.
Fifth left intercostal space medial to the midclavicular line.


28. What disease can cause right sided heart failure?
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.
Lung disease
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
Idiopathic


29. What is the hallmark clinical finding associated with pericarditis?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.


30. How should you palpate the carotid arteries?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
One at a time to assess the pulse amplitude and contour.
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.
Second right intercostal space


31. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
4th left intercostal space lower sternal border
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


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

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33. What would make someone more at risk for digoxin toxicity?
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
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


34. What is an acute peripheral arterial occlusion?
NO NSAIDS or ASA.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Nitrates - Beta blockers - and Calcium channel blockers


35. What SE should you look for with calcium channel blocker use?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Iodine
In fatty areas or over major muscles - large breasts - or bony prominences.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


36. What condition can cause left sided heart failure?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
ST segment elevation (STEMI)
Vascular - artery disease causing fluid to back up into the lungs.


37. What does an Allen's test determine?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Whether the patients ulnar and radial arteries are patent.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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


38. What are coumadin and heparin used for?
Chronic arteriosclerotic disease.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
To inhibit thrombus and clot formation.
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


39. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


40. What are the signs and symptoms of left sided HF?
Open up blood vessels
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
To inhibit thrombus and clot formation.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


41. During an Allen's test don't compress one artery _____ the other.
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
Patient who are unable to tolerate exercise stress testing.
Before
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


42. What drugs are most commonly used for angina?
Second right intercostal space
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.
Fifth left intercostal space medial to the midclavicular line.
Nitrates - Beta blockers - and Calcium channel blockers


43. Where should you place your stethescope to find the tricuspid valve?
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
4th left intercostal space lower sternal border
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Lower left sternal border


44. What is more harmful a lot of little emboli or one large emboli?
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
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).
One large emboli (smaller=better)
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.


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

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46. What is characteristic of complete heart block?
Activity intolerance
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
Vitamin K (aqua myphiton)
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


47. How long is contrast media in the body?
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
Only for a few hours
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


48. What should you watch for with PICC lines that have been in place for 6 months?
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.
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
Old truck driver or someone on bed rest or with pelvic trauma.
Air answers (open junctions)


49. When should you be concerned about premature ventricular contraction?
Air answers (open junctions)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Left sternal border


50. How is angina treated?

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