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 should you always assume with a patient who has a central line placed and is experiencing SOB?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Air embolism
Chronic arteriosclerotic disease.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


2. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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
Maintain BED REST
NO NSAIDS or ASA.
Cannot


3. What should you go when applying nitroglycerin ointment for angina?
In fatty areas or over major muscles - large breasts - or bony prominences.
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
0.5-2.0 ng/ml


4. What should you teach a patient regarding discharge after a DVT?

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5. In what locations should you not place electrodes?
Lower left sternal border
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Poorly controlled hypertension
In fatty areas or over major muscles - large breasts - or bony prominences.


6. What is characteristic of ventricular tachycardia?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.


7. What is intermittent claudication?
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
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.
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


8. What is important to remember when removing a CVC from a patient?
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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).


9. Where is the tricuspid valve landmark on the chest?
Lower left sternal border
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.)
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.


10. What is more harmful a lot of little emboli or one large emboli?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
One large emboli (smaller=better)


11. What should you do if the PT value is 45 sec?
NO NSAIDS or ASA.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
4th left intercostal space lower sternal border
D/C the med and call the doctor.


12. What is CVP? Normal?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
4th left intercostal space lower sternal border
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


13. What is pulsus paradoxus?
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 drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
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


14. What causes secondary hypertension?
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
Steroid treatment or a pregnant woman who is retaining water.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


15. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Lowers BP and makes heart beat stronger. SE: flushed face.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Must be flushed 1x/month with heparin and between treatments.


16. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
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.


17. What is the hallmark clinical finding associated with pericarditis?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Pulmonary edema
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.


18. Where should you place your stethescope to find the pulmonic valve?
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
Second Left intercostal space
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
4th left intercostal space lower sternal border


19. What disease can cause right sided heart failure?
Include rest periods prior to any activity.
Must be flushed 1x/month with heparin and between treatments.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Lung disease


20. What is an aortic dissection?

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

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22. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Maintain BED REST
Lowers BP and makes heart beat stronger. SE: flushed face.
Only for a few hours


23. During an Allen's test don't compress one artery _____ the other.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Before
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
D/C the med and call the doctor.


24. What would make someone more at risk for digoxin toxicity?
(S1 - S2) Third left intercostal space
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.
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
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.


25. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!


26. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


27. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Include rest periods prior to any activity.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


28. What is a chemical stress test (persantine stress test)?
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
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


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

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30. 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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Direct current cardioversion and digoxin/propranolol (inderal).
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.


31. What condition can cause left sided heart failure?
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.)
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Vascular - artery disease causing fluid to back up into the lungs.
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.


32. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
Whether the patients ulnar and radial arteries are patent.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Protamine Sulfate


33. What are common risk factors for an MI?
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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
A nosebleed
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


34. When should you be concerned about premature ventricular contraction?
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).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Only for a few hours


35. 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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


36. What is a assessment finding with DVT?

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37. What should happen if someone converts to asystole/flatline?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


38. What should you teach your patient about an exercise ECG (stress test)?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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-
NO because it isn't sterile so keep out.


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


40. What are the S&S of pulmonary embolism?
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
4th left intercostal space lower sternal border


41. What should you teach your patient about an abdominal ultrasonography?
Second Left intercostal space
D/C the med and call the doctor.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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


42. What is characteristic of premature ventricular contractions?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
An inflammation of the pericardium. It may result in MI.


43. What are the nursing interventions for a patient with premature ventricular contractions?
Must be flushed 1x/month with heparin and between treatments.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.


44. What is pericarditis?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
An inflammation of the pericardium. It may result in MI.


45. What are coumadin and heparin used for?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
To inhibit thrombus and clot formation.
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
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.


46. What is the treatment for a pt. with ventricular tachycardia?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
Whether the patients ulnar and radial arteries are patent.
One large emboli (smaller=better)


47. What is cardioversion?

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48. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Pneumothorax and will end up with chest tube to help reinflate lung.
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.


49. What are the S&S associated with right sided heart failure?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Lung disease
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


50. What is an air embolism?
Cannot
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).