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 epistaxis?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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


2. What is a assessment finding with DVT?

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3. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
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.
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


4. 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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Steroid treatment or a pregnant woman who is retaining water.


5. When should bleeding precautions be implemented?
One large emboli (smaller=better)
4th left intercostal space lower sternal border
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.
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


6. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
Patient who are unable to tolerate exercise stress testing.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


7. What is an acute peripheral arterial occlusion?
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.
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


8. A femoral artery compression device ______be assigned to an NA?
Cannot
Fat - Air - DVT - or Amniotic
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.)


9. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


10. In What time period is the greatest risk of sudden death from an MI?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.
In the first 72 hours!!!!!


11. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


12. What are the steps to perform the heimlich maneuver?
Chronic arteriosclerotic disease.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


13. For what disease should you do the Allen's test?

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

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15. What are the 2 types of pacemakers?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
Open up blood vessels


16. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Before
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.


17. What should you teach someone about iodine?
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.
Nitrates - Beta blockers - and Calcium channel blockers
Feeling warm (fire) or tin can taste is expected and will pass.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


18. What is a chemical stress test (persantine stress test)?
Vascular - artery disease causing fluid to back up into the lungs.
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
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.
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


19. What should happen if someone converts to asystole/flatline?
Before
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.
To inhibit thrombus and clot formation.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


20. What is characteristic of complete heart block?
Vascular - artery disease causing fluid to back up into the lungs.
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
NO because it isn't sterile so keep out.


21. What are the nursing interventions for a patient in atrial fibrillation?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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


22. What are common risk factors for an MI?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


23. Where is the pulmonic valve landmark on the chest?
Fat - Air - DVT - or Amniotic
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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
Second left intercostal space


24. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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


25. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
An enlarged space indicates fluid accumulation in the pericardial sac.


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

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27. What does a swan ganz measure?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.)
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


28. What is the treatment for someone in ventricular fibrillation?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


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

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30. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
Protamine Sulfate


31. For which heart sounds should the diaphragm be used?
Include rest periods prior to any activity.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Nitrates - Beta blockers - and Calcium channel blockers
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


32. What is angina? Stable vs. unstable?

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33. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
A nosebleed


34. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
D/C the med and call the doctor.
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!
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


35. What is defibrillation?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Protamine Sulfate
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.


36. What should you teach your patient about an abdominal ultrasonography?
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
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


37. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
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.


38. What landmarks should you be looking for on someone's chest?
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Pulmonary edema


39. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
Pulmonary edema
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.


40. What is more harmful a lot of little emboli or one large emboli?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Air embolism
One large emboli (smaller=better)
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


41. What should you teach your patient about an exercise ECG (stress test)?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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-


42. What should you do when applying a femoral artery compression device?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.)
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


43. What drugs are most commonly used for angina?
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.
Before
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
Nitrates - Beta blockers - and Calcium channel blockers


44. What should you do if you are going to ventilate someone with an ambu bag?
Second Left intercostal space
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.


45. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Right sided heart failure


46. Where should you place your stethescope to find the mitral (apex) valve?
4th left intercostal space lower sternal border
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.
Fifth left intercostal space medial to the midclavicular line.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!


47. What is characteristic of ventricular tachycardia?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Chronic arteriosclerotic disease.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


48. What should be done immediately for someone with PE?
Protamine Sulfate
An inflammation of the pericardium. It may result in MI.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.


49. How does the blood flow through the heart? (valves?)
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Air embolism
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
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!


50. What are the S&S of aortic dissection?
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Lung disease