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. How long is contrast media in the body?
Poorly controlled hypertension
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Only for a few hours
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).


2. What will a leg with arterial insufficiency look like?
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
D/C the med and call the doctor.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


3. Where is the aortic valve landmark on the chest?
Second right intercostal space
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
Fifth left intercostal space medial to the midclavicular line.
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


4. What can result from left sided heart failure if left untreated?
Second right intercostal space
Pulmonary edema
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


5. What could happen without immediate intervention for a hematoma?
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.
One at a time to assess the pulse amplitude and contour.
The patient may suffer significant blood loss or femoral nerve compression.
In the first 72 hours!!!!!


6. What should you teach your patient about an electrocardiogram (ECG)?
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
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


7. What should you do immediately if you suspect someone of developing a hematoma?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


8. What is characteristic of ventricular tachycardia?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Second left intercostal space
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


9. What is the most common cause of arterial insufficiency?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Chronic arteriosclerotic disease.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


10. What will be the treatment for an acute episode of life threatening tamponade?
Lung disease
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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
Vitamin K (aqua myphiton)


11. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Open up blood vessels
Steroid treatment or a pregnant woman who is retaining water.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


12. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
NO because it isn't sterile so keep out.
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


13. What should you teach your patient about MRI?
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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


14. What is cardioversion?

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15. What should you remember while taking care of someone with a peripheral arterial occlusion?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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).
Protamine Sulfate


16. What SE should you look for with calcium channel blocker use?
Patient who are unable to tolerate exercise stress testing.
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.


17. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Left sternal border
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.


18. What places someone at risk for an aortic dissection?
Pulse before and after giving.
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.
Second left intercostal space
Poorly controlled hypertension


19. Where should you place your stethescope to find the aortic valve?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Second Right intercostal space.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
ST segment elevation (STEMI)


20. What type of surgery is done for an aortic dissection?
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
Activity intolerance
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


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

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22. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.


23. Where is the pulmonic valve landmark on the chest?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Second left intercostal space
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.


24. Where should you place your stethescope to find the pulmonic valve?
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.
Second Left intercostal space
Direct current cardioversion and digoxin/propranolol (inderal).
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.


25. What is a good diagnosis for someone with right sided HF?
Activity intolerance
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
Fifth left intercostal space medial to the midclavicular line.
Second right intercostal space


26. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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


27. What is angina? Stable vs. unstable?

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28. What is defibrillation?
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.


29. What is important to remember when taking care of patients with compression devices?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Chronic arteriosclerotic disease.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


30. What is labile hypertension?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Fifth left intercostal space medial to the midclavicular line.
BP is elevated or decreased depending on activity.
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.)


31. What is superior vena cava syndrome?
Must be flushed 1x/month with heparin and between treatments.
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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


32. Where do the internal jugular veins lie?
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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).
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.


33. What are the S&S of superior vena cava syndrome?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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 radial artery punctures if negative
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.


34. What are common risk factors for an MI?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Idiopathic
Include rest periods prior to any activity.


35. What should be done immediately for someone with PE?
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).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A nosebleed


36. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Open up blood vessels
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.
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.


37. What should you always assume with a patient who has a central line placed and is experiencing SOB?
In fatty areas or over major muscles - large breasts - or bony prominences.
Don't interfere!
Air embolism
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


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

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39. How is angina treated?

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40. Where should you place your stethescope to find the mitral (apex) valve?
Second right intercostal space
Fifth left intercostal space medial to the midclavicular line.
Cannot
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+


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


42. What is epistaxis?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
A nosebleed
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 is the treatment for myocardial infarction?
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


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

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45. What is pulsus paradoxus?
Cannot
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Iodine
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


46. How is the Allen's test done?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
(S1 - S2) Third left intercostal space
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


47. What are the treatments/ S&S of peripheral venous disease?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Iodine
If feel more than 3 shocks in a row or develop signs of infection at the site.


48. What are the two common complications of pericarditis?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Must be flushed 1x/month with heparin and between treatments.


49. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


50. What is the maintenance for venous access port that isn't being regularly used?
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
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
Air embolism
Must be flushed 1x/month with heparin and between treatments.