NCLEX: Cardiology Questions with 100% Solutions 2024 final exam solution Graded A, Exams of Cardiology

Download NCLEX: Cardiology Questions with 100% Solutions 2024 final exam solution Graded A and more Exams Cardiology in PDF only on Docsity! NCLEX: Cardiology Questions with 100% Solutions 2024 final exam solution Graded A What are coumadin and heparin used for? - Solution To inhibit thrombus and clot formation. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value? - Solution 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. What is the antidote for heparin? - Solution Protamine Sulfate What should you do if the PTT value is 80 for someone on heparin? - Solution D/C the med and call the doctor. What is the antidote for coumadin? - Solution Vitamin K (aqua myphiton) What lab value is used to evaluate a patient on coumadin? What is the normal value? - Solution 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. What should you do if the PT value is 45 sec? - Solution D/C the med and call the doctor. What is INR? - Solution International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3. What should be done for someone on bleeding precautions? - Solution RANDI= Razor-electric, Aspirin- NO, Needles- small gauge, Decrease- needle sticks, and Injury- protect from. No percodan or NSAIDS, no open toed shoes. What should you observe for in someone on bleeding precautions? - Solution 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). When should bleeding precautions be implemented? - Solution 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. What landmarks should you be looking for on someone's chest? - Solution Aortic valve, Pulmonic valve, right ventricle, tricuspid valve, and apex or mitral valve. Where is the aortic valve landmark on the chest? - Solution Second right intercostal space Where is the pulmonic valve landmark on the chest? - Solution Second left intercostal space Where is the right ventricle landmark on the chest? - Solution Left sternal border Where is the tricuspid valve landmark on the chest? - Solution Lower left sternal border Where is the apex/mitral valve landmark on the chest? - Solution Fourth or fifth intercostal space at or medial to the midclavicular line. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium? - Solution The internal jugular veins (external are less reliable). Where do the internal jugular veins lie? - Solution Deep in the sternomastoid muscle, so look for pulsations in the soft tissue surrounding that area. What signals an elevated venous pressure based on the internal jugular veins? - Solution 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. 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 10-15 mins. Wait 1 hour before showering and use warm water. What should you teach your patient about a holter monitor? - Solution 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 monitor and avoid magnets, metal detectors, and electric blankets. What is a chemical stress test (persantine stress test)? - Solution 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 heart by increasing the strength of the heart muscles contraction. What are the indications for a chemical stress test (persantine stress test)? - Solution Patient who are unable to tolerate exercise stress testing. What is the nursing care associated with chemical stress tests (persantine stress test)? - Solution 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 vasodilators or calcium channel blockers bc will give for test and pt will end up with double. Digoxin is okay to take prior to testing). What is CVP? Normal? - Solution A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20. What does a swan ganz measure? - Solution The right and left ventricular pressures, cardiac output, arterial venous O2 difference, and pulmonary artery pressure. What should be done during the insertion of both a CVP catheter and a swan ganz catheter? - Solution Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract. What are the proper steps to changing a central venous catheter dressing? - Solution 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 a skin prep or protectant, allow it to air dry then cover the site with a sterile dry occlusive dressing. What should you watch for with PICC lines that have been in place for 6 months? - Solution Air answers (open junctions) What is a major complication of central line placement? - Solution Pneumothorax and will end up with chest tube to help reinflate lung. What is important to remember when removing a CVC from a patient? - Solution 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. What should you always assume with a patient who has a central line placed and is experiencing SOB? - Solution Air embolism What are the S&S of air embolism? - Solution Difficulty breathing, pain in midchest and shoulder, pale, nausea, and light headedness. What is an air embolism? - Solution When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery. What should be done immediately if a pulmonary embolism is suspected? - Solution 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 to become cyanotic you administer 100% oxygen and page a surgeon (O2 causes nitrogen in the air embolus to dissolve into the blood). What should you do frequently for someone with a central line to help prevent pulmonary emboli? - Solution Check all junctions frequently to make sure secure, especially before patient gets out of bed, and always use tubing with twist lock connections. When would a nurse use an external femoral artery compression device? - Solution After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal). What should you do when applying a femoral artery compression device? - Solution 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 REPORT SEVERE PAIN THAT MAY INDICATE RETROPERITONEAL BLEEDING OR A PSEUDOANEURYSM, SUCH AS ABD/FLANK/OR BACK PAIN. Can a femoral artery compression device be assigned to an NA? - Solution NO!!! What needs to be held during the placement of a femoral artery compression device? - Solution NO NSAIDS or ASA. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing, swelling around site, palpable 2 inch fullness, and a bruit is present? - Solution A hematoma= bleeding into the soft tissue surrounding the femoral artery access site. What could happen without immediate intervention for a hematoma? - Solution The patient may suffer significant blood loss or femoral nerve compression. What should you do immediately if you suspect someone of developing a hematoma? - Solution Using both gloved hands, apply firm pressure just above the skin puncture site and over the hematoma to compress the area. Wait at least 15 mins before removing pressure and reassessing the site. Then notify the health care provider. In what locations should you not place electrodes? - Solution In fatty areas or over major muscles, large breasts, or bony prominences. What causes essential/primary hypertension? - Solution Idiopathic What is labile hypertension? - Solution BP is elevated or decreased depending on activity. What causes secondary hypertension? - Solution Steroid treatment or a pregnant woman who is retaining water. What factors place you at risk for HTN? - Solution 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. What is the treatments for hypertension? - Solution 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. What is characteristic of atrial fibrillation? - Solution No clearly defined or measurable P waves and an irregular-irregular ventricular response. What are the nursing interventions for a patient in atrial fibrillation? - Solution (1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd). What is the treatment for atrial fibrillation? - Solution Direct current cardioversion and digoxin/propranolol (inderal). What is characteristic of premature ventricular contractions? - Solution 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. When should you be concerned about premature ventricular contraction? - Solution When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out). What are the nursing interventions for a patient with premature ventricular contractions? - Solution (1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd). What is the treatment for premature ventricular contractions? - Solution IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity). What is characteristic of ventricular fibrillation? - Solution Totally disorganized, chaotic pattern, and no discernible waves or complexes. What nursing interventions are associated with a pt. experiencing ventricular fibrillation? - Solution (1ST) BEGIN CARDIOPULMONARY RESUSCITATION (THE PT. IS DYING) AND NOTIFY PHYSICIAN (2ND). What is the treatment for someone in ventricular fibrillation? - Solution Direct current shock (defibrillation) and IV anti-arrhythmic drugs (lidocaine, Procainamide, and Bretylium). What is characteristic of complete heart block? - Solution Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes. What are the nursing interventions for a patient in complete heart block? - Solution (1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd). What is the treatment for a patient in complete heart block? - Solution Temporary or permanent transvenous PACEMAKER INSERTION, and if the client is symptomatic and showing S&S of decreased cardiac output, GIVE ATROPINE. What is characteristic of ventricular tachycardia? - Solution Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre. What are the nursing interventions for a pt. with ventricular tachycardia? - Solution (1st) Assess LOC, (2nd) if unconscious= begin CPR, and (3rd) Notify physician. What is the treatment for a pt. with ventricular tachycardia? - Solution 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. What should happen if someone converts to asystole/flatline? - Solution CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized). What are the steps for adult/child 1 rescuer CPR? - Solution 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 compression <23 sec, 1 1/2-2" DEEP), give 2 breaths (1 sec each), deliver second cycle of compressions, give 2 breaths. What are the steps for infant 1&2 rescuer CPR? - Solution 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 compression <23 sec, 1/3-1/2" DEEP), 2 breaths, (2nd rescuer arrives) 1st rescuer deliver 2nd cycle of compression, 2nd rescuer gives 2 breaths, (after 2 cycles they switch positions). What are the steps for adult 2 rescuer CPR? - Solution 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 rescuer to give 2 breaths, delivers cycle of compressions, pauses for 2 more breaths, switches places after 2 cycles. What are the steps to perform the heimlich maneuver? - Solution Stand behind the victim, wrap arms around waist (IF PREGNANT WRAP ABOVE THE BABY), make a fist with one had and place thumb against abdomen midline, grasp fist with other hand, press into victims abdomen with quick upward thrusts. If a victim is choking but can cough, speak, or breath what should you do? - Solution Don't interfere! What should a patient do if they feel chest pain or discomfort? - Solution 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 tablets and 15 mins of rest call 911 and DONT TRY TO DRIVE YOURSELF TO THE HOSPITAL. What should you tell someone about taking nitroglycerin tablets (SE)? - Solution 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. How is angina treated? - Solution 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. What drugs are most commonly used for angina? - Solution Nitrates, Beta blockers, and Calcium channel blockers Which type of patient shouldn't take nitrates? - Solution A patient on sildenafil (Viagra), Cealis, or Levitra bc these drugs together can cause very low blood pressure and heart attack. What should be checked in a patient on a beta blocker? - Solution Pulse before and after giving. What are examples of calcium channel blockers? - Solution Verapamil (calan), diltiazem (cardizem), nifedipine (procardia), amlodipine (norvasc). What do calcium channel blockers do? - Solution Open up blood vessels What SE should you look for with calcium channel blocker use? - Solution Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider). What is the treatment for myocardial infarction? - Solution MONA=Magnesium sulfate, O2, Nitroglycerin, Aspirin (mona has a heart so EKG also if select all that apply). In what time period is the greatest risk of sudden death from an MI? - Solution IN the first 72 hours!!!!! What are common risk factors for an MI? - Solution Smoking, elevated cholesterol, diabetes, hypertension, old age, and family hx of coronary artery disease. What are signs and symptoms of an MI? - Solution Crushing chest pain that lasts 30 mins or longer and may radiate to the neck, shoulders, or jaw, diaphoresis, nausea, and SOB. What type of EKG change indicates MI? - Solution ST segment elevation (STEMI) What is the goal of treatment for an MI? Treatment? - Solution Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment. What should you go when applying nitroglycerin ointment for angina? - Solution 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 chest back or upper arm and place the application paper on the skin drug side down, secure it with transparent dressing or strip of tape. Don't apply to broken or irritated skin, Don't massage or rub the ointment, and don't get on your own skin. What is pericarditis? - Solution An inflammation of the pericardium. It may result in MI. What is the hallmark clinical finding associated with pericarditis? - Solution 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. What are all the S&S of pericarditis? - Solution Pericardial friction rub, chest pain (sharp and aggravated with breathing), abnormal EKG findings, possible fever and tachycardia. What are the two common complications of pericarditis? - Solution Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF). What activity should a patient with pericarditis, who is undergoing treatment, be allowed? - Solution Maintain BED REST What is pulsus paradoxus? - Solution A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise. What are the S&S associated with right sided heart failure? - Solution Fatigue, JVD, Increased peripheral venous pressure, ascites, anorexia/complaints of GI distress, cyanosis, and dependent edema. What disease can cause right sided heart failure? - Solution Lung disease What is a good diagnosis for someone with right sided HF? - Solution Activity intolerance What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF? - Solution Include rest periods prior to any activity. What is the treatment for someone with right sided HF? How do you know working? - Solution Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert! What are the signs and symptoms of left sided HF? - Solution Paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, BLOOD TINGED SPUTUM, cough, orthopnea, exertional dyspnea, cyanosis. What condition can cause left sided heart failure? - Solution Vascular- artery disease causing fluid to back up into the lungs. What can result from left sided heart failure if left untreated? - Solution Pulmonary edema What should you do to treat pulmonary edema? - Solution 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 What is an aortic dissection? - Solution 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. What are the S&S of aortic dissection? - Solution Pallor, diaphoresis, tachypnea, severe tearing chest pain radiating to back, PULSES IN ARMS ARE STRONG BUT LEG PULSES ARE WEAK, low SP02. What places someone at risk for an aortic dissection? - Solution Poorly controlled hypertension Without prompt surgery for an aortic dissection what is someone at risk for developing? - Solution Stroke, renal or heart failure, paraplegia secondary to compromised blood flow, or death from aortic rupture. What type of surgery is done for an aortic dissection? - Solution The damaged portion of the aorta is removed and is repaired with a synthetic graft. What should you teach someone after they have had a pacemaker placed? - Solution 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 CARDIOLOGIST IF EXPERIENCE CONTINUOUS RHYTHMIC HICCUPING, TELL DENTIST THAT HAVE (should be given an antibiotic before having procedures done, STAY AWAY FROM ELECTROMAGNETIC FIELDS, DON'T STOP IN MIDDLE OF ANTI- THEFT DEVICES OR LEAN ON THEM, KEEP CELL PHONES AT LEAST 6 INCHES AWAY FROM PACEMAKER. (ANTIBIOTICS ARE NEEDED FOR A MANICURE). What are the 2 types of pacemakers? - Solution 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. What is cardioversion? - Solution 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. What is defibrillation? - Solution 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. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)? - Solution For the first month post op, do not lift more than 10 or 15 lbs. And avoid excessive pushing, pulling, or twisting. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed? - Solution If you feel lightheaded, dizzy, or heart palpitations but feel no shock from the ICD. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed? - Solution If feel more than 3 shocks in a row or develop signs of infection at the site. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)? - Solution 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. Who would most likely have peripheral venous disease? - Solution Old truck driver or someone on bed rest or with pelvic trauma. What are the treatments/ S&S of peripheral venous disease? - Solution Varicose veins, elevate legs, weight reduction, brawny in color, ted hose, topical steroids, ulcers, and skin color changes. What is Deep Vein Thrombosis (DVT)? - Solution A disease in which thrombi trap blood in the deep veins of the pelvis and legs. What is a assessment finding with DVT? - Solution Positive Homan's sign (calf tenderness on dorsiflexion of the foot). If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do? - Solution INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level. What does plan of care include? - Solution Elevated legs, anticoagulation therapy (aggressive: generally IV heparin), Be alert for signs of PE. What should you teach a patient regarding discharge after a DVT? - Solution 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. What are the four types of pulmonary emboli? - Solution Fat, Air, DVT, or Amniotic What are the S&S of pulmonary embolism? - Solution Anxiousness, restlessness, tachycardia, tachypneic, 90% SP02, dyspnea, substernal pain, coughing, hemoptysis, and fever. What should be done immediately for someone with PE? - Solution Administer 100% O2, left trendelenburg position, heparin administered, and oral warfarin started (give heparin and warfarin together for at least 5 days). What should be taught upon discharge for someone going home on coumadin as a result of a PE? - Solution 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. What is more harmful a lot of little emboli or one large emboli? - Solution One large emboli (smaller=better) What is the purpose of compression devices? - Solution To reduce a patients risk of DVT and PE. They include graduated compression stockings, vena cava filters, and intermittent sequential external compression devices. What is important to remember when taking care of patients with compression devices? - Solution You need to maintain use of those devices continually except when the patient is ambulating, bathing, or during physical therapy or skin assessment.