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 the treatment for a pt. with ventricular tachycardia?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.
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.


2. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Protamine Sulfate
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


3. What should you teach your patient about an exercise ECG (stress test)?
Vascular - artery disease causing fluid to back up into the lungs.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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-
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.


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

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5. What does a swan ganz measure?
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
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


6. What should be done immediately if a pulmonary embolism is suspected?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
4th left intercostal space lower sternal border
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


7. What should happen if someone converts to asystole/flatline?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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


8. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
A nosebleed
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
Lower left sternal border


9. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
In fatty areas or over major muscles - large breasts - or bony prominences.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


10. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Open up blood vessels
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
0.5-2.0 ng/ml
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


11. What are the S&S of aortic dissection?
Right atrium - TRICUSPID VALVE (tissue) - right ventricle - PULMONIC VALVE (paper) - lungs - left atrium - MITRAL VALVE (My) - left ventricle - AORTIC VALVE (Assets). Tissue PAPER MY ASSETS!
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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


12. 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?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Lowers BP and makes heart beat stronger. SE: flushed face.


13. What is characteristic of premature ventricular contractions?
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.
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.
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.


14. What are the S&S associated with right sided heart failure?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


15. What should be immediately done for a patient experiencing digoxin toxicity?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Pulse before and after giving.


16. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
Activity intolerance
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


17. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
In fatty areas or over major muscles - large breasts - or bony prominences.
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
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


18. What should you teach your patient about angiography (arteriography)?
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


19. What causes secondary hypertension?
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
Steroid treatment or a pregnant woman who is retaining water.
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.


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

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21. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
NO because it isn't sterile so keep out.
Feeling warm (fire) or tin can taste is expected and will pass.
NO NSAIDS or ASA.


22. Where should you place your stethescope to find the ERB's Point?
An enlarged space indicates fluid accumulation in the pericardial sac.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
(S1 - S2) Third left intercostal space


23. What should be done immediately for someone with PE?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Direct current cardioversion and digoxin/propranolol (inderal).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


24. What should you teach someone with arterial insufficiency?

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25. What are the steps for adult/child 1 rescuer CPR?
Lowers BP and makes heart beat stronger. SE: flushed face.
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 a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
A nosebleed


26. What does plan of care include?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Fifth left intercostal space medial to the midclavicular line.


27. What is the antidote for heparin?
Protamine Sulfate
(S1 - S2) Third left intercostal space
Fifth left intercostal space medial to the midclavicular line.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.


28. What should you teach your patient about a cardiac catheterization?
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
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.
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
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


29. What should you do to treat pulmonary edema?
Don't interfere!
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho


30. What is cardioversion?

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31. What is epistaxis?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A nosebleed
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
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


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

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33. What is the treatment for a patient in complete heart block?
Nitrates - Beta blockers - and Calcium channel blockers
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
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.


34. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.


35. What does vasotec (Enalapril Maleate) do/SE?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Vascular - artery disease causing fluid to back up into the lungs.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Lowers BP and makes heart beat stronger. SE: flushed face.


36. What landmarks should you be looking for on someone's chest?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


37. Where is the aortic valve landmark on the chest?
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.
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.
ST segment elevation (STEMI)
Second right intercostal space


38. What can result from left sided heart failure if left untreated?
To inhibit thrombus and clot formation.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Pulmonary edema
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.


39. Where should you place your stethescope to find the pulmonic valve?
Steroid treatment or a pregnant woman who is retaining water.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Right sided heart failure
Second Left intercostal space


40. What should you teach your patient about an abdominal ultrasonography?
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.
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
Old truck driver or someone on bed rest or with pelvic trauma.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.


41. What are the nursing interventions for a patient with premature ventricular contractions?
A nosebleed
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).
Pneumothorax and will end up with chest tube to help reinflate lung.


42. For which heart sounds should the diaphragm be used?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.


43. What does an Allen's test determine?
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
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.
Whether the patients ulnar and radial arteries are patent.
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


44. What places someone at risk for an aortic dissection?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
Poorly controlled hypertension
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


45. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Include rest periods prior to any activity.
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.


46. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Open up blood vessels
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
A nosebleed


47. How does the blood flow through the heart? (valves?)
Right atrium - TRICUSPID VALVE (tissue) - right ventricle - PULMONIC VALVE (paper) - lungs - left atrium - MITRAL VALVE (My) - left ventricle - AORTIC VALVE (Assets). Tissue PAPER MY ASSETS!
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


48. What could happen without immediate intervention for a hematoma?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
The patient may suffer significant blood loss or femoral nerve compression.
Iodine


49. What are coumadin and heparin used for?
Second Right intercostal space.
To inhibit thrombus and clot formation.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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


50. What should you go when applying nitroglycerin ointment for angina?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
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.
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