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 should you teach your patient about an exercise ECG (stress test)?
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Steroid treatment or a pregnant woman who is retaining water.
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. In what locations should you not place electrodes?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
In fatty areas or over major muscles - large breasts - or bony prominences.


3. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
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
One at a time to assess the pulse amplitude and contour.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


4. What landmarks should you be looking for on someone's chest?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Activity intolerance
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


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

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6. What is cardioversion?

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7. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Chronic arteriosclerotic disease.


8. What is epistaxis?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
A nosebleed
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.


9. Test ending in Gram=?
NO because it isn't sterile so keep out.
Iodine
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.


10. What are coumadin and heparin used for?
BP is elevated or decreased depending on activity.
To inhibit thrombus and clot formation.
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.
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.


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

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12. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
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.
An inflammation of the pericardium. It may result in MI.
NO NSAIDS or ASA.


13. What should you not allow if a patient has a negative Allen's test?
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
No radial artery punctures if negative
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


14. What should be done for someone on bleeding precautions?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


15. What is impedance cardiography?
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.
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


16. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Second Left intercostal space
Right sided heart failure
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Second right intercostal space


17. What is the treatment for someone with right sided HF? How do you know working?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
One large emboli (smaller=better)
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


18. What should be checked in a patient on a beta blocker?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pulse before and after giving.
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.


19. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


20. What signals an elevated venous pressure based on the internal jugular veins?
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.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Only for a few hours


21. What is the treatment for myocardial infarction?
Second right intercostal space
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.
Activity intolerance


22. What is Deep Vein Thrombosis (DVT)?
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.


23. What should you do when applying a femoral artery compression device?
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
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
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
Before


24. When should bleeding precautions be implemented?
Open up blood vessels
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.
One at a time to assess the pulse amplitude and contour.
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


25. 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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Steroid treatment or a pregnant woman who is retaining water.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


26. 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?
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Second Left intercostal space
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.


27. 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).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
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


28. 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
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.
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.
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


29. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Feeling warm (fire) or tin can taste is expected and will pass.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
Don't interfere!


30. What causes essential/primary hypertension?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Pulmonary edema
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Idiopathic


31. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Feeling warm (fire) or tin can taste is expected and will pass.
An enlarged space indicates fluid accumulation in the pericardial sac.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
If feel more than 3 shocks in a row or develop signs of infection at the site.


32. What is characteristic of ventricular tachycardia?
Steroid treatment or a pregnant woman who is retaining water.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
(S1 - S2) Third left intercostal space


33. What should you remember while taking care of someone with a peripheral arterial occlusion?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Whether the patients ulnar and radial arteries are patent.


34. What is INR?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


35. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


36. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.


37. What should you do if you are going to ventilate someone with an ambu bag?
Air embolism
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
One at a time to assess the pulse amplitude and contour.
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


38. What are the 2 types of pacemakers?
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
No radial artery punctures if negative


39. What is the nursing care associated with chemical stress tests (persantine stress test)?
Fifth left intercostal space medial to the midclavicular line.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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
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


40. What are common risk factors for an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.


41. What is a assessment finding with DVT?

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42. What should you teach your patient about a cardiac catheterization?
Activity intolerance
The patient may suffer significant blood loss or femoral nerve compression.
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
Nitrates - Beta blockers - and Calcium channel blockers


43. What condition can cause left sided heart failure?
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Vascular - artery disease causing fluid to back up into the lungs.
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.


44. What are the S&S of cardiac tamponade?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


45. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
No radial artery punctures if negative
Pulse before and after giving.


46. What makes the symptoms of superior vena cava syndrome better? Worse?
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


47. What is an aortic dissection?

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

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49. What should a patient do if they feel chest pain or discomfort?
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
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
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
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.


50. What are the S&S of aortic dissection?
Second right intercostal space
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.