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 is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
Iodine
Maintain BED REST


2. What are the nursing interventions for a patient in complete heart block?
D/C the med and call the doctor.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


3. What is a assessment finding with DVT?

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4. What are examples of calcium channel blockers?
Steroid treatment or a pregnant woman who is retaining water.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Air answers (open junctions)
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).


5. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
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
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.


6. What are signs and symptoms of an MI?
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
(S1 - S2) Third left intercostal space
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


7. What is an air embolism?
BP is elevated or decreased depending on activity.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
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


8. What does plan of care include?
Maintain BED REST
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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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


9. What are the S&S of air embolism?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
D/C the med and call the doctor.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


10. Where should you place your stethescope to find the mitral (apex) valve?
Second left intercostal space
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Fifth left intercostal space medial to the midclavicular line.


11. What is the treatment for someone with right sided HF? How do you know working?
NO NSAIDS or ASA.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.


12. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Only for a few hours
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
Air embolism


13. What should you teach someone with arterial insufficiency?

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14. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Iodine
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Idiopathic


15. What are coumadin and heparin used for?
A nosebleed
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
To inhibit thrombus and clot formation.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


16. What should be done immediately if a pulmonary embolism is suspected?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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


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

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18. What is CVP? Normal?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


19. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
An inflammation of the pericardium. It may result in MI.
To inhibit thrombus and clot formation.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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


20. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
0.5-2.0 ng/ml
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
The internal jugular veins (external are less reliable).
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.


21. What landmarks should you be looking for on someone's chest?
Only for a few hours
Pulmonary edema
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).


22. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Cannot
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).


23. What is characteristic of premature ventricular contractions?
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


24. Where should you place your stethescope to find the tricuspid valve?
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.
Identify the highest point of pulsation and measure from this point to the sternal angle. A measurement of greater than 3 cm= an elevated venous pressure.
Decrease in weight - diuretics (watch K loss) - aldactone (k sparing but check renal fx) - inderal (do Not give to asthma patients or diabetic patients) - more exercise - no smoking - and decreased Na intake.
4th left intercostal space lower sternal border


25. What is an acute peripheral arterial occlusion?
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.
Open up blood vessels
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


26. What are all the S&S of pericarditis?
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
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


27. What should you teach someone about iodine?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Feeling warm (fire) or tin can taste is expected and will pass.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
BP is elevated or decreased depending on activity.


28. What are the steps for adult 2 rescuer CPR?
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.
Fifth left intercostal space medial to the midclavicular line.
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


29. What are the S&S of superior vena cava syndrome?
Feeling warm (fire) or tin can taste is expected and will pass.
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
Steroid treatment or a pregnant woman who is retaining water.
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


30. What does vasotec (Enalapril Maleate) do/SE?
Feeling warm (fire) or tin can taste is expected and will pass.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Lowers BP and makes heart beat stronger. SE: flushed face.


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

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32. What are the treatments/ S&S of peripheral venous disease?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Protamine Sulfate


33. What type of EKG change indicates MI?
BP is elevated or decreased depending on activity.
ST segment elevation (STEMI)
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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


34. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Cannot
Direct current cardioversion and digoxin/propranolol (inderal).
Poorly controlled hypertension
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.


35. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Fifth left intercostal space medial to the midclavicular line.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
In fatty areas or over major muscles - large breasts - or bony prominences.


36. How is the Allen's test done?
0.5-2.0 ng/ml
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
Vitamin K (aqua myphiton)
Poorly controlled hypertension


37. What is the antidote for heparin?
Include rest periods prior to any activity.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Must be flushed 1x/month with heparin and between treatments.
Protamine Sulfate


38. Where should you place your stethescope to find the ERB's Point?
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(S1 - S2) Third left intercostal space


39. What is cardiac tamponade? Common causes?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
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


40. What should you tell someone about taking nitroglycerin tablets (SE)?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.


41. What is a chemical stress test (persantine stress test)?
Iodine
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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


42. How long is contrast media in the body?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Iodine
Only for a few hours
Cannot


43. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


44. Where is the right ventricle landmark on the chest?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Left sternal border
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 is cardioversion?

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46. What body systems are affected by digoxin toxicity? S&S?
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-
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.


47. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


48. What should you explain to the patient about an impedance cardiography test?
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


49. Who would most likely have peripheral venous disease?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Old truck driver or someone on bed rest or with pelvic trauma.
Check for response - activate ERS - open airway head tilt chin lift - check breathing (5-10 sec) - give 2 breaths (1 sec) with visible chest rise - checks brachial pulse (5-10 sec) - locates CPR finger position - deliver 1st cycle of compressions (30
Cannot


50. What is the treatment for a patient in complete heart block?
NO because it isn't sterile so keep out.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.