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 can result from left sided heart failure if left untreated?
The internal jugular veins (external are less reliable).
Pulmonary edema
Vascular - artery disease causing fluid to back up into the lungs.
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


2. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.)


3. What are the two common complications of pericarditis?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
One large emboli (smaller=better)
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.


4. What things should you do to assess cardiovascular status?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Pneumothorax and will end up with chest tube to help reinflate lung.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.


5. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Whether the patients ulnar and radial arteries are patent.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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


6. What is characteristic of atrial fibrillation?
Cannot
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Right sided heart failure
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


7. What causes essential/primary hypertension?
Idiopathic
Pulse before and after giving.
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
Patient who are unable to tolerate exercise stress testing.


8. What is the treatment for a patient in complete heart block?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Direct current cardioversion and digoxin/propranolol (inderal).
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.


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

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10. What could happen without immediate intervention for a hematoma?
Pulse before and after giving.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
The patient may suffer significant blood loss or femoral nerve compression.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.


11. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
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).
In the first 72 hours!!!!!


12. Where is the tricuspid valve landmark on the chest?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Lower left 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
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.


13. What should a patient do if they feel chest pain or discomfort?
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
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.)
Fifth left intercostal space medial to the midclavicular line.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


14. What is the correct way to insert an oropharyngeal airway?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
D/C the med and call the doctor.


15. What is a assessment finding with DVT?

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16. What should you teach your patient about an exercise ECG (stress test)?
Iodine
NO NSAIDS or ASA.
Second right 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-


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

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18. What are the S&S associated with right sided heart failure?
Old truck driver or someone on bed rest or with pelvic trauma.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
In the first 72 hours!!!!!


19. What are all the S&S of pericarditis?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
The patient may suffer significant blood loss or femoral nerve compression.


20. What is the treatment for myocardial infarction?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Cannot
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).


21. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Air embolism
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Open up blood vessels


22. What is impedance cardiography?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.


23. What is INR?
Air embolism
Activity intolerance
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
In the first 72 hours!!!!!


24. What should you teach your patient about a cardiac catheterization?
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
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).


25. What are the proper steps to changing a central venous catheter dressing?
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.
Pulmonary edema
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


26. Where should you place your stethescope to find the mitral (apex) valve?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Vascular - artery disease causing fluid to back up into the lungs.
Fifth left intercostal space medial to the midclavicular line.
Air answers (open junctions)


27. What is characteristic of ventricular tachycardia?
If feel more than 3 shocks in a row or develop signs of infection at the site.
NO because it isn't sterile so keep out.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Old truck driver or someone on bed rest or with pelvic trauma.


28. What should be done immediately if a pulmonary embolism is suspected?
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
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
Air embolism
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


29. What are examples of calcium channel blockers?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


30. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Vascular - artery disease causing fluid to back up into the lungs.
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.
Pulmonary edema


31. What should you teach your patient about an electrocardiogram (ECG)?
Nitrates - Beta blockers - and Calcium channel blockers
Patient who are unable to tolerate exercise stress testing.
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.
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


32. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Pneumothorax and will end up with chest tube to help reinflate lung.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.


33. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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


34. What are the five areas for listening to the heart?

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35. Where do the internal jugular veins lie?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
D/C the med and call the doctor.


36. How does the blood flow through the heart? (valves?)
ST segment elevation (STEMI)
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!
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.


37. What are common risk factors for an MI?
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
NO NSAIDS or ASA.


38. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.


39. For which heart sounds should the bell be used?
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
Air answers (open junctions)
An inflammation of the pericardium. It may result in MI.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


40. What are the S&S of superior vena cava syndrome?
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
Vitamin K (aqua myphiton)
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
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.)


41. What should be immediately done for a patient experiencing digoxin toxicity?
The patient may suffer significant blood loss or femoral nerve compression.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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


42. What is a transthoracic echocardiograph (TTE)?
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
An enlarged space indicates fluid accumulation in the pericardial sac.
Second left intercostal space


43. What is the treatments for hypertension?
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.
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
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


44. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
0.5-2.0 ng/ml
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


45. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Second left intercostal space
Open up blood vessels
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.


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

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47. What should you teach someone about iodine?
Must be flushed 1x/month with heparin and between treatments.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Feeling warm (fire) or tin can taste is expected and will pass.


48. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Fourth or fifth intercostal space at or medial to the midclavicular line.
D/C the med and call the doctor.


49. What are the steps for adult 2 rescuer CPR?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Protamine Sulfate
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
In fatty areas or over major muscles - large breasts - or bony prominences.


50. What condition can cause left sided heart failure?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Vascular - artery disease causing fluid to back up into the lungs.