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 antidote for heparin?
Protamine Sulfate
The internal jugular veins (external are less reliable).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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


2. What places someone at risk for an aortic dissection?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
NO because it isn't sterile so keep out.
Poorly controlled hypertension


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

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4. What signals an elevated venous pressure based on the internal jugular veins?
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+


5. What can result from left sided heart failure if left untreated?
Pulmonary edema
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Idiopathic


6. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Lowers BP and makes heart beat stronger. SE: flushed face.
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
D/C the med and call the doctor.


7. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.


8. What drugs are most commonly used for angina?
Lowers BP and makes heart beat stronger. SE: flushed face.
An enlarged space indicates fluid accumulation in the pericardial sac.
Nitrates - Beta blockers - and Calcium channel blockers
If feel more than 3 shocks in a row or develop signs of infection at the site.


9. What is the treatment for premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


10. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Second right intercostal space
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
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.
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 should you always assume with a patient who has a central line placed and is experiencing SOB?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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
Air embolism
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


12. How should you palpate the carotid arteries?
An inflammation of the pericardium. It may result in MI.
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.
Protamine Sulfate
One at a time to assess the pulse amplitude and contour.


13. What does an Allen's test determine?
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).
Vitamin K (aqua myphiton)
Whether the patients ulnar and radial arteries are patent.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


14. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
Pulmonary edema
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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


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

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16. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
BP is elevated or decreased depending on activity.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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
Whether the patients ulnar and radial arteries are patent.


17. What should you teach your patient about MRI?
Don't interfere!
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
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


18. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
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
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


19. What do calcium channel blockers do?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Open up blood vessels
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


20. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Nitrates - Beta blockers - and Calcium channel blockers
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


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

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22. What are the S&S of air embolism?
The patient may suffer significant blood loss or femoral nerve compression.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.


23. What should be done immediately if a pulmonary embolism is suspected?
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
Left sternal border


24. What is defibrillation?
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
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.
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


25. What are the 2 types of pacemakers?
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.
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.
Must be flushed 1x/month with heparin and between treatments.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!


26. What is the hallmark clinical finding associated with pericarditis?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


27. Where should you place your stethescope to find the aortic valve?
Only for a few hours
Second Right intercostal space.
BP is elevated or decreased depending on activity.
No radial artery punctures if negative


28. What is the treatment for someone in ventricular fibrillation?
Air answers (open junctions)
Don't interfere!
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Must be flushed 1x/month with heparin and between treatments.


29. What is the most common cause of arterial insufficiency?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Second Right intercostal space.
Chronic arteriosclerotic disease.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


30. 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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


31. 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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


32. What are common risk factors for an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Lung disease
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.


33. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Protamine Sulfate
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.
Before
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


34. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Fifth left intercostal space medial to the midclavicular line.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.


35. What should be done immediately for someone with PE?
Fifth left intercostal space medial to the midclavicular line.
Patient who are unable to tolerate exercise stress testing.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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


36. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
Maintain BED REST
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Pneumothorax and will end up with chest tube to help reinflate lung.


37. What is the correct way to insert an oropharyngeal airway?
Lung disease
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.
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.
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


38. How is angina treated?

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39. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
Left sternal border
Air embolism


40. What should you teach your patient about an exercise ECG (stress test)?
NO because it isn't sterile so keep out.
The patient may suffer significant blood loss or femoral nerve compression.
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-
Second Left intercostal space


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

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42. What are the signs and symptoms of left sided HF?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.


43. What should you teach someone about iodine?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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
Feeling warm (fire) or tin can taste is expected and will pass.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


44. What should you explain to the patient about an impedance cardiography test?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Cannot
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.


45. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Feeling warm (fire) or tin can taste is expected and will pass.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.


46. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
An enlarged space indicates fluid accumulation in the pericardial sac.


47. A femoral artery compression device ______be assigned to an NA?
Maintain BED REST
Cannot
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Open up blood vessels


48. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
D/C the med and call the doctor.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
In the first 72 hours!!!!!


49. Who would most likely have peripheral venous disease?
A nosebleed
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Old truck driver or someone on bed rest or with pelvic trauma.


50. Where should you place your stethescope to find the mitral (apex) valve?
Air answers (open junctions)
Fifth left intercostal space medial to the midclavicular line.
0.5-2.0 ng/ml
The damaged portion of the aorta is removed and is repaired with a synthetic graft.