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 will be the treatment for an acute episode of life threatening tamponade?
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


2. What things should you do to assess cardiovascular status?
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Pulmonary edema


3. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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
Protamine Sulfate
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


4. Where is the aortic valve landmark on the chest?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Second right intercostal space
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.


5. What are signs and symptoms of an MI?
Whether the patients ulnar and radial arteries are patent.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.


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

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7. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
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.
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause


8. 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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


9. What lab value is used to evaluate a patient on coumadin? What is the normal value?
4th left intercostal space lower sternal border
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).


10. What should you teach your patient about a cardiac catheterization?
4th left intercostal space lower sternal border
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause


11. What type of surgery is done for an aortic dissection?
Vitamin K (aqua myphiton)
Vascular - artery disease causing fluid to back up into the lungs.
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


12. What are the signs and symptoms of left sided HF?
0.5-2.0 ng/ml
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.


13. What disease can cause right sided heart failure?
A nosebleed
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
Lung disease
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


14. How is angina treated?

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15. Where is the pulmonic valve landmark on the chest?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
Second left intercostal space


16. What should you do to treat pulmonary edema?
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
Iodine
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


17. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Left sternal border
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


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

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19. 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).
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.


20. What are the nursing interventions for a patient with premature ventricular contractions?
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
Pulmonary edema
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


21. What is a transthoracic echocardiograph (TTE)?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
In the first 72 hours!!!!!
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause


22. When should bleeding precautions be implemented?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.


23. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
Air embolism
Chronic arteriosclerotic disease.


24. 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?
Cannot
Air embolism
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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


25. 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.
Idiopathic
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


26. What is an aortic dissection?

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27. What is important to remember when removing a CVC from a patient?
Fifth left intercostal space medial to the midclavicular line.
One at a time to assess the pulse amplitude and contour.
Lower left sternal border
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.


28. What do calcium channel blockers do?
Fat - Air - DVT - or Amniotic
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
Open up blood vessels
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


29. What is important to remember when taking care of patients with compression devices?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.


30. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.


31. What should you do when applying a femoral artery compression device?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
0.5-2.0 ng/ml
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.
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


32. What would make someone more at risk for digoxin toxicity?
Cannot
Lower 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.
Only for a few hours


33. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Vitamin K (aqua myphiton)
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.


34. A femoral artery compression device ______be assigned to an NA?
Maintain BED REST
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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
Cannot


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

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36. What are the S&S associated with right sided heart failure?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.


37. What are the S&S of air embolism?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Must be flushed 1x/month with heparin and between treatments.


38. During an Allen's test don't compress one artery _____ the other.
Before
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
An inflammation of the pericardium. It may result in MI.


39. How long is contrast media in the body?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Only for a few hours
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).


40. Who would most likely have peripheral venous disease?
Second left intercostal space
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Old truck driver or someone on bed rest or with pelvic trauma.
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.


41. What is characteristic of atrial fibrillation?
(S1 - S2) Third left intercostal space
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


42. What is cardiac tamponade? Common causes?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
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.)
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


43. What should you explain to the patient about an impedance cardiography test?
Fat - Air - DVT - or Amniotic
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A nosebleed


44. When would a nurse use an external femoral artery compression device?
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).


45. What is the treatment for premature ventricular contractions?
D/C the med and call the doctor.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Must be flushed 1x/month with heparin and between treatments.
Nitrates - Beta blockers - and Calcium channel blockers


46. What should you teach your patient about an abdominal ultrasonography?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
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.
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.)


47. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Protamine Sulfate
Steroid treatment or a pregnant woman who is retaining water.


48. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
One large emboli (smaller=better)
Fourth or fifth intercostal space at or medial to the midclavicular line.
Vascular - artery disease causing fluid to back up into the lungs.
Right sided heart failure


49. What does an Allen's test determine?
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
Whether the patients ulnar and radial arteries are patent.
Old truck driver or someone on bed rest or with pelvic trauma.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.


50. How does the blood flow through the heart? (valves?)
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.
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!
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.