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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. Should the tubing for a venous access port be included under the dressing site?

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2. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
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.

3. What should you teach your patient about an exercise ECG (stress test)?
(S1 - S2) Third left intercostal space
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-
ST segment elevation (STEMI)
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

4. What should be checked in a patient on a beta blocker?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Pulse before and after giving.

5. What is the treatment for a patient in complete heart block?
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.
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Only for a few hours

6. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
Idiopathic
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

7. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.

8. Where should you place your stethescope to find the ERB's Point?
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.
(S1 - S2) Third left intercostal space
Must be flushed 1x/month with heparin and between treatments.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

9. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
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.
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

10. What is CVP? Normal?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
NO NSAIDS or ASA.
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.

11. In what locations should you not place electrodes?
Fourth or fifth intercostal space at or medial to the midclavicular line.
In fatty areas or over major muscles - large breasts - or bony prominences.
NO NSAIDS or ASA.
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

12. What is characteristic of premature ventricular contractions?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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-

13. What is the treatment for someone with right sided HF? How do you know working?
An enlarged space indicates fluid accumulation in the pericardial sac.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Right sided heart failure
An inflammation of the pericardium. It may result in MI.

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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

15. What should be immediately done for a patient experiencing digoxin toxicity?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Fifth left intercostal space medial to the midclavicular line.

16. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

17. What is a good diagnosis for someone with right sided HF?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Poorly controlled hypertension
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.
Activity intolerance

18. What should you teach your patient about an abdominal ultrasonography?
Fat - Air - DVT - or Amniotic
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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

19. What should you not allow if a patient has a negative Allen's test?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Fat - Air - DVT - or Amniotic
No radial artery punctures if negative

20. What are the nursing interventions for a patient in atrial fibrillation?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Protamine Sulfate
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

21. What does vasotec (Enalapril Maleate) do/SE?
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
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
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
Lowers BP and makes heart beat stronger. SE: flushed face.

22. What should you teach your patient about MRI?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Activity intolerance
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

23. What is a transthoracic echocardiograph (TTE)?
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Air embolism
0.5-2.0 ng/ml

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

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25. What makes the symptoms of superior vena cava syndrome better? Worse?
Activity intolerance
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
ST segment elevation (STEMI)

26. A femoral artery compression device ______be assigned to an NA?
Cannot
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
D/C the med and call the doctor.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

27. What drugs are most commonly used for angina?
4th left intercostal space lower sternal border
Nitrates - Beta blockers - and Calcium channel blockers
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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

28. How should you palpate the apical pulse?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
No radial artery punctures if negative
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

29. What should be done immediately for someone with PE?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Pulmonary edema
Idiopathic

30. What places someone at risk for an aortic dissection?
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Poorly controlled hypertension

31. What is pericarditis?
Open up blood vessels
An inflammation of the pericardium. It may result in MI.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.

32. What are the S&S of pulmonary embolism?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
Must be flushed 1x/month with heparin and between treatments.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

33. What is cardiac tamponade? Common causes?
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
Pneumothorax and will end up with chest tube to help reinflate lung.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

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

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35. What are all the S&S of pericarditis?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
The patient may suffer significant blood loss or femoral nerve compression.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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

36. What is an acute peripheral arterial occlusion?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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

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

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38. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Pulmonary edema
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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

39. What does plan of care include?
Must be flushed 1x/month with heparin and between treatments.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

40. What type of EKG change indicates MI?
ST segment elevation (STEMI)
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Protamine Sulfate
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

41. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
If feel more than 3 shocks in a row or develop signs of infection at the site.
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
ST segment elevation (STEMI)

42. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
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.

43. What is the goal of treatment for an MI? Treatment?
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

44. What would make someone more at risk for digoxin toxicity?
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-
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Whether the patients ulnar and radial arteries are patent.
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.

45. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Pneumothorax and will end up with chest tube to help reinflate lung.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
An enlarged space indicates fluid accumulation in the pericardial sac.

46. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
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.

47. What do calcium channel blockers do?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Open up blood vessels
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

48. What are common risk factors for an MI?
0.5-2.0 ng/ml
Old truck driver or someone on bed rest or with pelvic trauma.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

49. What could happen without immediate intervention for a hematoma?
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.
Fifth left intercostal space medial to the midclavicular line.
The patient may suffer significant blood loss or femoral nerve compression.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

50. What causes essential/primary hypertension?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Idiopathic
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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

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NCLEX Cardiac

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