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 needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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-


2. What is important to remember when removing a CVC from a patient?
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Don't interfere!
Second left intercostal space


3. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Second right intercostal space
Cannot


4. What are the indications for a chemical stress test (persantine stress test)?
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Patient who are unable to tolerate exercise stress testing.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


5. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


6. Where should you place your stethescope to find the pulmonic valve?
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Second Left intercostal space


7. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
4th left intercostal space lower sternal border
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


8. What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


9. What will a leg with arterial insufficiency look like?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Vascular - artery disease causing fluid to back up into the lungs.


10. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Fat - Air - DVT - or Amniotic
Exercise and use graduated compression devices as directed - don't stand for long period of time - to avoid dislodging blood clots don't rub or massage your legs.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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


11. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
If feel more than 3 shocks in a row or develop signs of infection at the site.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


12. What should be done for someone on bleeding precautions?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


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

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14. What is the goal of treatment for an MI? Treatment?
NO because it isn't sterile so keep out.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
An inflammation of the pericardium. It may result in MI.


15. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table


16. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Air embolism
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.


17. What should you teach your patient about a cardiac catheterization?
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.
Feeling warm (fire) or tin can taste is expected and will pass.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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


18. What should you teach your patient about MRI?
Old truck driver or someone on bed rest or with pelvic trauma.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


19. What condition can cause left sided heart failure?
Cannot
Vascular - artery disease causing fluid to back up into the lungs.
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


20. What should you not allow if a patient has a negative Allen's test?
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
The internal jugular veins (external are less reliable).
No radial artery punctures if negative
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


21. What are the steps for infant 1&2 rescuer CPR?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
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


22. What should be done immediately for someone with PE?
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).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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


23. What is cardiac tamponade? Common causes?
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.
Second left intercostal space
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
The internal jugular veins (external are less reliable).


24. How long is contrast media in the body?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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).
Only for a few hours
Lowers BP and makes heart beat stronger. SE: flushed face.


25. What should you explain to the patient about an impedance cardiography test?
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
One at a time to assess the pulse amplitude and contour.


26. What is the most common cause of arterial insufficiency?
Protamine Sulfate
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Chronic arteriosclerotic disease.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


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

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28. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


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

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30. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
Activity intolerance
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


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

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32. What should you tell someone about taking nitroglycerin tablets (SE)?
(S1 - S2) Third left intercostal space
Open up blood vessels
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


33. What are the steps for adult 2 rescuer CPR?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


34. What is the treatment for a pt. with ventricular tachycardia?
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
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


35. 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?
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.
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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


36. What should you teach someone about iodine?
Old truck driver or someone on bed rest or with pelvic trauma.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Feeling warm (fire) or tin can taste is expected and will pass.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


37. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
The internal jugular veins (external are less reliable).


38. Where is the tricuspid valve landmark on the chest?
Lower left sternal border
Patient who are unable to tolerate exercise stress testing.
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
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.)


39. Where is the apex/mitral valve landmark on the chest?
Pulse before and after giving.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.


40. When should you be concerned about premature ventricular contraction?
Maintain BED REST
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Old truck driver or someone on bed rest or with pelvic trauma.
Must be flushed 1x/month with heparin and between treatments.


41. 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).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Exercise and use graduated compression devices as directed - don't stand for long period of time - to avoid dislodging blood clots don't rub or massage your legs.
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


42. What should you do if the PTT value is 80 for someone on heparin?
Second right intercostal space
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.
D/C the med and call the doctor.
In fatty areas or over major muscles - large breasts - or bony prominences.


43. What things should you do to assess cardiovascular status?
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
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.
Include rest periods prior to any activity.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.


44. What should you teach your patient about an electrocardiogram (ECG)?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


45. What disease can cause right sided heart failure?
Lung disease
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Nitrates - Beta blockers - and Calcium channel blockers


46. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
One at a time to assess the pulse amplitude and contour.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
(S1 - S2) Third left intercostal space


47. What usually triggers angina pain?
Direct current cardioversion and digoxin/propranolol (inderal).
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.


48. What should you observe for in someone on bleeding precautions?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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).
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


49. What is a assessment finding with DVT?

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50. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Whether the patients ulnar and radial arteries are patent.