Uworld Cardiology

🩸 Shock: Peripheral Perfusion

Definition

Shock is a state of decreased tissue perfusion, resulting in inadequate oxygen delivery to tissues. As perfusion decreases, cells switch from aerobic to anaerobic metabolism, which can lead to organ dysfunction if untreated.


Peripheral Perfusion

Peripheral perfusion refers to blood flow to the skin and extremities (hands and feet).

Assess Peripheral Perfusion

  • Capillary refill: ≤2 seconds (normal)

  • Skin color: Pink

  • Skin temperature: Warm

  • Peripheral pulses: Present and equal

Signs of Poor Peripheral Perfusion

  • Delayed capillary refill (>2 sec)

  • Pale, cool, or mottled skin

  • Weak or absent peripheral pulses

  • Cyanosis (late finding)


Why the Correct Answers Are Correct

✅ Capillary refill ≤2 seconds

  • Indicates adequate blood flow to peripheral tissues.

  • Delayed refill suggests decreased peripheral circulation.

✅ Warm, pink skin

  • Indicates sufficient blood flow and oxygen delivery to the skin.

  • Cool, pale skin suggests poor perfusion.


Why the Other Answers Are Wrong

❌ Apical pulse

  • Evaluates central cardiac function.

  • Does not indicate blood flow to the extremities.

❌ Lung sounds

  • Assess ventilation and oxygenation.

  • Do not evaluate peripheral circulation.

❌ Pupillary response

  • Assesses neurologic function.

  • Reflects cerebral perfusion, not peripheral perfusion.


NCLEX Pearls

  • Peripheral = hands & feet

  • Think:

    • Capillary refill

    • Skin color

    • Skin temperature

    • Peripheral pulses


❤ Heart Failure: Fluid Overload

Definition

Heart failure occurs when the heart cannot pump blood effectively, causing blood to back up into the lungs and resulting in pulmonary congestion and pulmonary edema.


Expected Assessment Findings

  • Dyspnea

  • Orthopnea

  • Paroxysmal nocturnal dyspnea (PND)

  • Crackles (rales)

  • Tachypnea

  • ↓ Oxygen saturation


Priority Nursing Action

✅ Assess breath sounds FIRST

Why?

  • Determines severity of pulmonary congestion.

  • Identifies the need for oxygen and diuretics.

  • Follows the nursing process (assessment before intervention).


Why the Other Answers Are Wrong

❌ Administer oxygen

  • Oxygen may be necessary after assessing respiratory status.

  • Immediate oxygen is indicated only if the client has obvious severe respiratory distress or hypoxemia.

❌ Initiate cardiac monitoring

  • Appropriate because heart failure can cause dysrhythmias.

  • However, breathing (B of ABCs) takes priority.

❌ Insert peripheral IV

  • Needed for IV medications (ex: furosemide).

  • Respiratory assessment comes first.


Nursing Interventions

  • Assess lung sounds

  • Assess oxygen saturation

  • Administer oxygen if indicated

  • Place in High Fowler’s position

  • Administer prescribed diuretics

  • Monitor intake/output and daily weights


NCLEX Pearls

  • Heart failure + fluid overload = assess the lungs first.

  • Crackles = pulmonary edema.

  • Follow ABCs and assessment before intervention.


🦵 Deep Vein Thrombosis (DVT)

Definition

A DVT is a blood clot in a deep vein, most commonly in the calf, popliteal, or femoral vein. The greatest complication is pulmonary embolism (PE).


Risk Factors (Virchow’s Triad)

Venous Stasis

  • Bed rest

  • Surgery

  • Immobility

  • Long travel

Endothelial Injury

  • Surgery

  • Trauma

Hypercoagulability

  • Pregnancy

  • Cancer

  • Oral contraceptives

  • Inherited clotting disorders


Assessment Findings

Hallmark Finding ⭐

Unilateral leg swelling (edema)

Other findings:

  • Warmth

  • Redness

  • Tenderness

  • Feeling of heaviness or tightness

  • Low-grade fever


Why the Correct Answer Is Correct

✅ Right calf is 4 cm larger than the left

  • Indicates unilateral edema, the classic sign of DVT.

  • Significant swelling following surgery strongly suggests venous thrombosis.


Why the Other Answers Are Wrong

❌ Pain rated 7/10

  • Pain may occur but is not the hallmark finding.

  • Swelling is a stronger indicator.

❌ Negative Homan sign

  • No longer recommended.

  • Poor sensitivity and specificity.

  • Cannot rule out DVT.

❌ Bilateral varicose veins

  • Increase the risk of DVT.

  • Do not indicate an acute clot.


Nursing Interventions

  • Notify the provider.

  • Measure calf circumference.

  • Prepare for venous duplex ultrasound.

  • Administer anticoagulants as prescribed.

  • Do not massage the affected extremity.

  • Monitor for signs of pulmonary embolism.


Pulmonary Embolism (Major Complication)

Signs include:

  • Sudden dyspnea

  • Chest pain

  • Tachypnea

  • Tachycardia

  • Hypoxia

  • Hemoptysis


NCLEX Pearls

  • One swollen leg = suspect DVT.

  • Swelling is more significant than pain.

  • Homan sign is outdated.

  • Surgery + unilateral edema = high suspicion for DVT.


🩺 Orthostatic Hypotension

Definition

Orthostatic hypotension is a drop in blood pressure when moving from lying or sitting to standing, causing decreased cerebral perfusion.


Common Causes

  • Dehydration

  • Blood loss

  • Diuretics

  • Antihypertensives

  • Prolonged bed rest

  • Autonomic dysfunction


Assessment Findings

  • Dizziness

  • Lightheadedness

  • Blurred vision

  • Weakness

  • Syncope


Priority Nursing Action

✅ Assist the client back to a sitting (or lying) position immediately.

Why?

  • Prevents falls and injury.

  • Safety is the priority before additional assessment.


Why the Other Answers Are Wrong

❌ Check orthostatic blood pressures

  • Helps confirm the diagnosis.

  • Performed after the client is safe.

❌ Encourage bed rest

  • May be appropriate later.

  • Does not address the immediate risk for falling.

❌ Apply a gait belt

  • Useful before ambulation.

  • If the client is already dizzy, sitting them down is the priority.


Orthostatic Vital Signs

Positive findings:

  • Systolic BP decreases ≥20 mm Hg

  • OR Diastolic BP decreases ≥10 mm Hg

  • Within 3 minutes of standing

  • Often accompanied by dizziness or lightheadedness.


Nursing Interventions

  • Assist to sitting or lying position.

  • Change positions slowly.

  • Dangle legs before standing.

  • Encourage fluids (if appropriate).

  • Implement fall precautions.

  • Reassess orthostatic vital signs.


NCLEX Pearls

  • Dizzy while standing = sit the client down immediately.

  • Safety before assessment.

  • Orthostatic vital signs are obtained after the client is stabilized.


⭐ NCLEX Master Rules

ABCs

  1. Airway

  2. Breathing

  3. Circulation

Assessment Before Intervention

Assess first unless delaying treatment places the client in immediate danger.

Safety Before Assessment

If the client is at immediate risk for injury (e.g., about to fall), protect the client first.

Hallmark Findings

  • Shock: Delayed capillary refill, cool/pale skin

  • Heart failure: Crackles, dyspnea, orthopnea

  • DVT: Unilateral leg swelling

  • Orthostatic hypotension: Dizziness on standing → sit the client down immediately


❤ CARDIOVASCULAR NCLEX NOTES


❤ MITRAL VALVE PROLAPSE (MVP)

What is it?

The mitral valve bulges (prolapses) into the left atrium during systole, sometimes causing mitral regurgitation.

Assessment

  • Palpitations

  • Dizziness

  • Lightheadedness

  • Chest pain (usually atypical)

  • Anxiety

Chest pain in MVP is NOT usually relieved by nitroglycerin.


Medications

Beta blockers
Purpose:

  • Decrease heart rate

  • Reduce palpitations

  • Decrease chest pain


Nursing Teaching

✅ Stay hydrated

  • Dehydration increases palpitations.

✅ Avoid caffeine

  • Coffee

  • Energy drinks

  • Chocolate

  • Certain OTC medications (pseudoephedrine)

Caffeine stimulates the heart and worsens symptoms.

✅ Reduce stress

✅ Avoid excessive alcohol

✅ Regular aerobic exercise


NCLEX Pearls

❌ Routine prophylactic antibiotics before dental work are NOT recommended.

Only indicated if:

  • Prosthetic valve

  • Valve repair with prosthetic material

  • Previous infective endocarditis


❤ HEART FAILURE (HF)

Heart failure = Pump failure

The heart cannot pump enough blood.

Blood backs up:

  • Left side → lungs

  • Right side → body


LEFT-SIDED HEART FAILURE

Think

LEFT = LUNGS

Blood backs into pulmonary circulation.


Symptoms

Pulmonary edema

Dyspnea

Orthopnea

Paroxysmal nocturnal dyspnea (PND)

Crackles

Hypoxia

Cough

Fatigue

S3 heart sound

Displaced PMI

Cardiomegaly


Why?

The left ventricle cannot pump blood forward.

Blood backs into:
Pulmonary veins → lungs → fluid leaks into alveoli.


Priority Assessment

Patient is short of breath?

FIRST:
✅ Auscultate lung sounds

Listen for:

  • Crackles

  • Rhonchi

  • Wheezes

Then assess:

  • Respiratory rate

  • Oxygen saturation

  • Work of breathing

Remember:

ABCs always come first.


RIGHT-SIDED HEART FAILURE

Think

RIGHT = REST OF BODY

Blood backs into systemic veins.


Symptoms

Jugular venous distention (JVD)

Peripheral edema

Ascites

Hepatomegaly

Splenomegaly

Weight gain

Dependent edema


Why?

Right ventricle cannot pump blood into lungs.

Blood backs into veins.

Fluid accumulates throughout the body.


S3 HEART SOUND

Occurs:

Immediately after S2

Sequence:

Lub → Dub → Duh

S1 → S2 → S3


Cause

Rapid ventricular filling into an enlarged ventricle.


Normal?

Children
Young adults
Pregnancy


Abnormal?

Older adults

Think:

❤ Heart Failure


HEART FAILURE PATIENT TEACHING


Daily Weight

Most sensitive indicator of fluid retention.

Weigh:

  • Every morning

  • Same scale

  • Same clothing

  • After urinating

Notify provider if:

Weight gain:

  • 2–3 lb in one day
    OR

  • 5 lb in one week


Sodium Restriction

Usually:
Less than 2–3 grams/day


Foods HIGH in sodium

Frozen dinners

Restaurant foods

Canned soups

Deli meats

Bacon

Ham

Hot dogs

Processed snacks

Instant noodles


Foods LOW in sodium

Fresh fruits

Fresh vegetables

Fresh chicken

Fresh fish

Home-cooked meals

Herbs instead of salt


NCLEX Trick

Restaurant food AND frozen meals

❌ BOTH are high sodium.


Exercise

Moderate exercise as tolerated.

Benefits:

  • Improves circulation

  • Improves endurance

  • Improves cardiac efficiency


FUROSEMIDE (LASIX)

Classification

Loop diuretic


Action

Removes:

  • Water

  • Sodium

  • Potassium


Side Effects

Hypokalemia

Hypotension

Dehydration


Teach Patient

Eat potassium-rich foods:

  • Bananas

  • Potatoes

  • Beans

  • Broccoli

  • Spinach

  • Oranges

Monitor:
Potassium


DIGOXIN

Purpose

Increases contractility

Slows heart rate

Used in:
Heart failure
Atrial fibrillation


Before Giving

Check apical pulse.

Hold if:
Heart rate <60


Digoxin Toxicity

GI

Anorexia

Nausea

Vomiting

Abdominal pain


Neuro

Weakness

Confusion

Fatigue


Eyes

Yellow vision

Green halos

Blurred vision


Cardiac

Bradycardia

PVCs

Heart block


Potassium

Low potassium

⬆ increases digoxin toxicity.

BUT

Do NOT tell patients to increase potassium unless prescribed.

Only increase if:

  • Provider instructs

  • Taking potassium-wasting medications like Lasix


PERICARDITIS

Inflammation of the pericardium.

Usually viral.


Pain

Sharp

Pleuritic

Worse:

  • Inspiration

  • Coughing

  • Lying flat

Better:

  • Sitting up

  • Leaning forward


Assessment

Pericardial friction rub

Sounds like:

Leather rubbing together


Treatment

NSAIDs

Colchicine


STEMI / MYOCARDIAL INFARCTION

After MI

Common medications:


Aspirin

Antiplatelet

Purpose:
Prevent platelet aggregation.

Give if:
Platelets normal


Metoprolol

Beta blocker

Purpose:
Decrease oxygen demand.

Hold if:
HR <60

Bradycardia = do not give.


Lisinopril

ACE inhibitor

Purpose:
Prevent remodeling after MI.

Before giving:

Check BP

Check potassium


Stool Softener

After MI:
Prevent straining.

Why?

Straining causes:
Valsalva maneuver

↓

Vagal stimulation

↓

Bradycardia

↓

Decreased cardiac output


DEEP VEIN THROMBOSIS (DVT)

Virchow’s Triad

Three causes of clot formation.


1. Venous Stasis

Blood not moving.

Examples:
Bedrest

Immobility

Long travel

Stroke


2. Endothelial Injury

Damage to vessel.

Examples:

Surgery

Trauma

Smoking


3. Hypercoagulability

Blood clots easily.

Examples:

Pregnancy

Birth control pills

Cancer

Polycythemia


Highest Risk

Hip surgery

Orthopedic surgery

Older age

Immobility


Prevent DVT

Walk frequently.

Leg exercises.

Elevate legs.

Hydrate.

Avoid smoking.

Avoid tight clothing.

Do NOT cross legs.


CARDIAC CATHETERIZATION

Purpose

Uses iodinated contrast to visualize coronary arteries.


Before Procedure

Must assess:

Contrast allergy

Metformin use

Kidney function


Contrast Allergy

Notify provider.

May need:
Steroids

Antihistamines

Different contrast.


Metformin

Hold before contrast.

Restart 48 hours later.

Reason:

Prevent lactic acidosis.


Elevated Creatinine

Contrast can worsen kidney injury.

Notify provider.


After Femoral Cardiac Cath

Keep:

Affected leg straight.

Bedrest.

HOB ≤30°.


Monitor:

Bleeding

Hematoma

Distal pulses

Skin temperature

Color

Capillary refill


If bleeding occurs

Apply firm direct pressure immediately.


CABG (Coronary Artery Bypass Graft)

Activity

No lifting >5 lb for ~6 weeks.

No driving 4–6 weeks.

Resume activity gradually.


Incision Care

Shower only.

Wash gently.

Pat dry.


Avoid

Baths

Swimming

Hot tubs

Creams

Lotions

Powders


Call Provider If

Fever

Redness

Drainage

Swelling

Chest pain


Sexual Activity

Resume when able to:
Walk 1 block OR climb 2 flights of stairs without symptoms.


POSITIONING QUESTIONS

Pericarditis

➡ Sit up and lean forward.


Femoral Cardiac Cath

➡ Leg straight
➡ HOB ≤30°


Liver Biopsy

➡ Right side


Lumbar Puncture

➡ Supine afterward


Soap Suds Enema

➡ Left Sims’



❤ Cardiac Catheterization (Q20)

Purpose

  • Diagnoses coronary artery disease using iodinated IV contrast.

  • Contrast can damage kidneys and trigger allergic reactions.

Must Assess Before Procedure

✅ Previous allergy to IV contrast/iodine

  • Risk of anaphylaxis

  • May need steroids/antihistamines before procedure

✅ Metformin use

  • Hold 24–48 hours before contrast (facility policy)

  • Restart 48 hours after ONLY after kidney function is normal

  • Prevents lactic acidosis

✅ Kidney function

  • Elevated creatinine = increased risk for contrast-induced nephropathy (AKI)

NOT Priority

❌ Elevated CRP

  • Marker of inflammation only

❌ First-degree AV block (prolonged PR interval)

  • Usually benign

  • Does not prevent cardiac cath

NCLEX Pearl

Think:

“Contrast = Allergy + Kidneys + Metformin.”


❤ Heart Failure Teaching (Q21)

Goal

Prevent fluid overload and future exacerbations.

Daily Weight

  • Same time every morning

  • Same scale

  • Same clothing

  • After voiding

  • Before breakfast

Report:

  • 3 lb in 2 days
    OR

  • 5 lb in 1 week


Sodium Restriction

Avoid:

  • Frozen meals

  • Restaurant food

  • Canned soup

  • Processed meats

  • Chips

Choose:

  • Fresh foods

  • Home-cooked meals


Furosemide (Lasix)

Causes potassium loss

Eat:

  • Bananas

  • Spinach

  • Potatoes

  • Beans

  • Avocados


Exercise

Moderate exercise is encouraged as tolerated.

NCLEX Pearl

HF teaching =

✔ Daily weight

✔ Low sodium

✔ Exercise

✔ Potassium if taking loop diuretics


❤ Heart Failure + Low Urine Output (Q22)

Finding

200 mL in 8 hours

Normal minimum:

30 mL/hr

Expected:
8 × 30 = 240 mL

Patient is producing less than expected.

First Action

✅ Assess lungs

Why?
Heart failure commonly causes:

  • pulmonary congestion

  • fluid overload

  • crackles

Assessment always comes before intervention.


Don’t

❌ Encourage fluids

Could worsen heart failure.

❌ Start IV diuretic

Need provider order.

❌ Report before assessing

Assessment comes first.

NCLEX Rule

Assess → Report → Treat


❄ Raynaud Phenomenon (Q23)

Cause

Vasospasm of small arteries

Triggered by:

  • Cold

  • Stress


Color Changes

White
⬇
Blue
⬇
Red

Remember:

White → Blue → Red


Teach Patients

✔ Wear gloves

✔ Dress warmly

✔ Reduce stress

✔ Avoid caffeine

✔ Stop smoking


Avoid

❌ Cold water

❌ Smoking

❌ Vasoconstrictors


NCLEX Pearl

Everything that causes vasoconstriction makes Raynaud worse.


💉 Heparin Monitoring (Q24)

Heparin is monitored with:

aPTT

Normal:
30–40 sec

Therapeutic:
1.5–2.5 × normal

Approximately:
45–100 sec

Question:
aPTT = 110 sec

Too high.

Stop or decrease infusion.


NOT Used

❌ PT

Used for warfarin.

❌ INR

Warfarin.


Platelets

Monitor for HIT.


NCLEX Memory

HeParin → PTT

Both contain P


❤ Hypertension Follow-up (Q25)

BP:
170/94

Priority Question

✅ “How often do you take your blood pressure medicine?”

Most common cause:
Medication noncompliance.


Other Factors

Stress

Smoking

Diet

Important—but medication adherence comes first.


NCLEX Pearl

Always ask:

“Are they taking the medication?”

before assuming it isn’t working.


❤ Heart Failure Discharge Teaching (Q26)

Teach:

✔ Daily weights

✔ Low sodium

✔ Take pulse before digoxin


Digoxin

Hold and call provider if:

Adult pulse
<60 bpm


Potassium

Depends on diuretic.

Loop diuretics
→ Need potassium

Spironolactone
→ Potassium sparing

Avoid extra potassium.


Home Oxygen

Only if prescribed.

Normal SpO₂ doesn’t automatically require oxygen.


❤ Chest Pain Labs (Q27)

Priority Lab

Troponin T = 0.7

Normal:
<0.1

Elevated = myocardial injury

Treat as MI.


Troponin

Most specific marker for MI.

Rises:
4–6 hours

Peaks:
24 hours

Returns to normal:
10–14 days


Potassium

3.4

Slightly low

Needs treatment but not before positive troponin.


NCLEX Priority

Positive troponin beats almost every routine lab.


💊 OTC Cold Medicine + Hypertension (Q28)

OTC decongestants:

Pseudoephedrine

Phenylephrine

Cause:

✔ Vasoconstriction

✔ Increased BP

✔ Tachycardia

✔ Palpitations


Hypertensive Patient

Avoid OTC cold medications containing decongestants.


Pharmacologic Stress Test Teaching

Before test:

✔ No caffeine for 24 hours

✔ Usually NPO several hours before

✔ Don’t smoke

✔ Follow medication instructions


Why No Caffeine?

It interferes with:

  • Adenosine

  • Dipyridamole

Making the stress test inaccurate.


⭐ NCLEX One-Liners to Memorize

  • Cardiac cath = Contrast → Allergy + Creatinine + Metformin.

  • Heart failure = Daily weights + Low sodium + Fluid restriction.

  • HF + low urine output → Assess lungs first.

  • Raynaud = White → Blue → Red; keep warm.

  • Heparin → Monitor aPTT.

  • Warfarin → Monitor PT/INR.

  • HTN + high BP = Check medication adherence first.

  • Digoxin = Hold if pulse <60 bpm.

  • Troponin = Best marker for MI.

  • Pseudoephedrine/phenylephrine increase blood pressure.

  • Stress test = No caffeine for 24 hours.


❤ Infective Endocarditis Priorities (Q29)

What is Infective Endocarditis?

Infection of the heart valves causing vegetations (clumps of bacteria, platelets, fibrin).

Biggest Danger

🚨 Vegetations can break off → become emboli → block blood flow.

Possible emboli:

  • Brain → Stroke

  • Kidneys → Renal infarction

  • Spleen → Splenic infarction

  • Extremities → Acute limb ischemia


Priority Finding

✅ Pain + pallor + cold foot

Think:
Acute arterial embolism

This is limb-threatening and requires immediate intervention.


Expected Findings

✔ Fever
✔ Fatigue
✔ New murmur
✔ Arthralgia
✔ Splinter hemorrhages
✔ Osler nodes
✔ Petechiae

These are common and expected early findings.


NCLEX Pearl

Infective Endocarditis

Fever = Expected

Cold painful limb = Emergency


❤ Heart Failure Discharge Teaching (Q30)

Statements needing more teaching:

❌ “I’ll weigh myself every other day.”

Correct:
✔ Every morning

  • Same scale

  • Same clothes

  • After voiding

  • Before breakfast


❌ “Ibuprofen works best for me.”

Avoid NSAIDs:

  • Ibuprofen

  • Naproxen

Why?
They cause:

  • Sodium retention

  • Fluid retention

  • HF exacerbation


Correct Teaching

✔ Avoid frozen meals

✔ Take diuretics in the morning

✔ Participate in cardiac rehab


NCLEX Pearl

HF + NSAIDs = BAD

Think:
NSAIDs = Salt + Water retention


❤ Older Adult Home Health Priority (Q31)

Priority Finding

✅ New dependent edema

Think:
Heart failure until proven otherwise.

New edema =
Fluid overload =
Needs immediate evaluation.


Lower Priority

Painful red buttocks
→ Early pressure injury

Central vision loss
→ Macular degeneration

Memory loss
→ Possible dementia

Important—but not immediately life threatening.


NCLEX Pearl

New edema = New heart failure exacerbation


💊 Furosemide (Lasix) Monitoring (Q32)

Before Giving Lasix Assess:

✅ Blood pressure

Lasix lowers BP.


✅ Kidney function

Check:

  • BUN

  • Creatinine

Poor kidneys increase complications.


✅ Potassium

Lasix wastes potassium.

Low potassium can cause:

  • PVCs

  • VT

  • VF

  • Muscle weakness


Not Necessary

❌ Liver enzymes

❌ WBC


NCLEX Memory

Lasix →

BP

BUN

Creatinine

Potassium


❤ Holter Monitor Teaching (Q33)

Purpose

Continuous ECG recording

Usually:
24–48 hours


Teach Patient

✔ Keep symptom diary

Record:

  • Chest pain

  • Dizziness

  • Palpitations

  • Activities

Provider matches symptoms to ECG.


Continue Normal Activity

Don’t stay in bed.

Need normal routine to catch arrhythmias.


Don’t

❌ Shower

❌ Bathe

Monitor must stay dry.


NCLEX Pearl

Holter =
Live life normally
+
Keep a diary


❤ Premature Ventricular Contractions (PVCs) (Q34)

ECG

Wide

Early

Bizarre QRS

No preceding P wave


Common Causes

Caffeine

Stress

Hypoxia

Electrolyte imbalance

Digoxin

Heart disease


Treatment

Treat the cause.

Examples:

  • Correct potassium

  • Reduce caffeine

  • Improve oxygenation


Healthy Person

Usually harmless.

After MI

PVCs become concerning.

May progress to:

VT

VF


NCLEX Memory

PVC =

Premature

Wide

Weird


❤ Normal Sinus Rhythm (Q35)

Normal Findings

Heart rate:
60–100

Rhythm:
Regular

P wave before every QRS

PR:
0.12–0.20 sec

QRS:
<0.12 sec


NCLEX Rhythm Checklist

  1. Rate

  2. Rhythm

  3. P waves

  4. PR interval

  5. QRS


Rhythm Memory

NSR =
Everything looks organized.


❤ Heart Failure Telephone Triage (Q36)

Patient reports:

Weight gain

3 lb

In 2 days

Priority Question

“Are you short of breath?”

Also ask about:

✔ Cough

✔ Edema

✔ Orthopnea

These indicate worsening fluid overload.


Report

3 lb in 2 days

OR

5 lb in 1 week


NCLEX Pearl

Weight gain alone isn’t the emergency.

Weight gain + symptoms = Emergency.


❤ Atypical Myocardial Infarction (Q37)

High-Risk Groups

Women

Older adults

Diabetics


May NOT Have

❌ Crushing chest pain


Instead May Have

✔ Nausea

✔ Vomiting

✔ Sweating

✔ Fatigue

✔ Dizziness

✔ Shortness of breath

✔ Epigastric discomfort


Priority

Treat as MI until ruled out.

Obtain:

ECG

Troponin


NCLEX Pearl

Diabetic + nausea + sweating = Think MI first.


⭐ High-Yield NCLEX Summary

Infective Endocarditis

  • Vegetations → emboli

  • 🚨 Cold painful limb = emergency

  • Splinter hemorrhages and fever are expected.


Heart Failure

  • Daily morning weights

  • Report 3 lb/2 days or 5 lb/week

  • Low sodium diet

  • Avoid NSAIDs

  • Morning diuretics

  • New edema = worsening HF

  • Ask about SOB, cough, orthopnea.


Furosemide

Assess:

  • BP

  • Potassium

  • BUN

  • Creatinine


Holter Monitor

  • Keep symptom diary

  • Continue normal activity

  • No shower or bath


PVCs

  • Wide premature QRS

  • Causes: caffeine, hypoxia, low potassium, digoxin

  • After MI → increased risk of VT/VF


Normal Sinus Rhythm

  • HR 60–100

  • Regular rhythm

  • P before every QRS

  • PR 0.12–0.20 sec

  • QRS <0.12 sec


Atypical MI

Especially in:

  • Women

  • Elderly

  • Diabetics

Symptoms:

  • Nausea

  • Sweating

  • Fatigue

  • Dizziness

  • SOB


❤ Pulmonary Edema After Myocardial Infarction (Q38)

What happened?

Acute MI → Left ventricle fails → Blood backs up into lungs → Pulmonary edema

Classic Symptoms

🚨 Sudden dyspnea

🚨 Pink, frothy sputum

🚨 Orthopnea

🚨 Tachypnea

🚨 Anxiety/restlessness

🚨 Hypoxia


Lung Sounds

✅ Bilateral crackles (rales), usually at the lung bases

Why?
Fluid fills the alveoli.


NOT Expected

❌ Clear lungs

❌ Bronchial breath sounds in lung periphery

  • Suggest pneumonia

❌ Stridor

  • Upper airway obstruction


NCLEX Pearl

Pink frothy sputum = Pulmonary edema

Think:
“Fluid in alveoli = Crackles.”


❤ Atrial Pacemaker (Q39)

Atrial Pacemaker

Stimulates the:

✅ Atrium

Therefore ECG shows:

Pacemaker spike → P wave → QRS


Remember

Atrial pacing

Spike BEFORE P wave


Ventricular pacing

Spike BEFORE QRS


Dual chamber

Spike before P

Spike before QRS


NCLEX Memory

A = Atrium = Spike before P

V = Ventricle = Spike before QRS


❤ Deep Vein Thrombosis (Q40)

Classic Findings

✔ Warm calf

✔ Tenderness

✔ Swelling

✔ Redness


Priority Assessment

Perform a thorough:

✅ Neurovascular assessment

Assess:

  • Pulses

  • Temperature

  • Cap refill

  • Color

  • Sensation

  • Circumference

  • Compare both legs


Don’t

Massage leg

Walk excessively before evaluation

Apply SCDs to affected leg


Complication

🚨 Pulmonary embolism

Symptoms:

  • Sudden SOB

  • Chest pain

  • Tachycardia

  • Hypoxia


NCLEX Pearl

Warm swollen calf =

Think DVT first


❤ Implantable Cardioverter Defibrillator (ICD) (Q41)

Purpose

Detects dangerous ventricular rhythms:

  • VT

  • VF

Automatically shocks patient.


Teach Patient

Don’t raise affected arm above shoulder

Until provider clears

Prevents lead displacement.


Firing

Can be painful.

Feels like:

“A kick in the chest.”


Travel

Allowed

Carry ICD identification card.

Airport security:
Tell TSA.


Driving

May be restricted temporarily.

Depends on:

  • State law

  • Provider recommendation

  • Arrhythmia history


NCLEX Pearl

ICD = Prevent sudden cardiac death.


❤ Stable Angina Triggers (Q42)

Anything that:

⬆ Oxygen demand

OR

⬇ Oxygen supply

can trigger angina.


Common Triggers

✔ Exercise

✔ Cold weather

✔ Smoking

✔ Emotional stress

✔ Heavy meals

✔ Sexual activity

✔ Cocaine

✔ Amphetamines


NOT Trigger

❌ Deep sleep


NCLEX Memory

Think:

“Heart working harder = Angina.”


❤ Peripheral Arterial Disease (PAD) Teaching (Q43)

PAD

Problem:

Poor arterial blood flow.


Teach

✔ Walk daily

Promotes collateral circulation.


✔ Keep legs BELOW heart

Improves arterial perfusion.


✔ Moisturize legs

(Not between toes)

Prevents skin cracking.


Avoid

❌ Heating pads

Burn risk due to poor sensation.


❌ Crossing legs


❌ Tight clothing


❌ Elevating legs above heart

Decreases arterial blood flow.


Classic PAD

Cool

Pale

Pain

Pulseless


NCLEX Pearl

PAD

Legs DOWN


❤ Hospice Heart Failure Dyspnea (Q44)

Patient:
Advanced HF

Trouble breathing


FIRST Intervention

Raise head of bed.

Simple

Fast

Noninvasive

Improves lung expansion.


Why?

Reduces pressure on diaphragm.

Improves ventilation.


After Positioning

May receive:

Morphine

Reduces:

  • Air hunger

  • Anxiety

  • Dyspnea


Not First

Albuterol

Not a bronchospasm problem.


NCLEX Rule

Always try:

Positioning

Before medications.


❤ Chronic Venous Insufficiency (Q45)

Problem

Venous valves fail.

Blood pools.


Findings

✔ Brown discoloration

(Hemosiderin staining)


✔ Thick, hardened skin

(Lipodermatosclerosis)


✔ Warm legs


✔ Edema


✔ Varicose veins


Venous Ulcers

Around medial ankle

Irregular

Drain a lot


NOT Venous

Cold feet

Absent pulses

Hair loss

Pale skin

These suggest PAD.


NCLEX Memory

Venous

Brown

Brawny

Bulky (edema)


⭐ High-Yield Cardiovascular Summary (Q38–45)

Pulmonary Edema

  • Pink frothy sputum

  • Bilateral crackles

  • Orthopnea

  • Acute MI complication


Pacemakers

  • Atrial: Spike → P wave

  • Ventricular: Spike → QRS

  • Dual: Spike before both P and QRS


DVT

  • Warm

  • Red

  • Swollen

  • Tender

  • Perform neurovascular assessment first

  • Watch for pulmonary embolism


ICD

  • Shocks VT/VF

  • Can be painful

  • Don’t lift arm above shoulder until cleared

  • Carry ICD card

  • Travel is allowed


Stable Angina Triggers

  • Exercise

  • Smoking

  • Cold exposure

  • Stress

  • Sexual activity

  • Amphetamines/cocaine


Peripheral Arterial Disease (PAD)

  • Legs down

  • Walk daily

  • Moisturize legs

  • No heating pads

  • Cool, pale, painful, pulseless extremities


Chronic Venous Insufficiency (CVI)

  • Brown, hardened skin

  • Warm extremities

  • Edema

  • Varicose veins

  • Medial ankle ulcers


Hospice Heart Failure

First intervention for dyspnea:

  1. Elevate HOB

  2. Oxygen if ordered

  3. Morphine for persistent air hunger

  4. Comfort measures


🧠 NCLEX “Red Flag” Emergencies to Memorize

🚨 Pink frothy sputum → Pulmonary edema

🚨 Warm swollen calf → DVT

🚨 Cold painful pale limb → Arterial embolus (often from infective endocarditis)

🚨 Positive troponin → Acute MI

🚨 3 lb weight gain in 2 days + SOB → Heart failure exacerbation

🚨 Diabetic with nausea + sweating → Think MI even without chest pain



❤ Q46 – Heart Failure + 5-lb Weight Gain + Hyponatremia

What’s happening?

Heart failure → ↓ Cardiac output

↓

Kidneys think the body is dehydrated

↓

Activate RAAS

↓

Retain water and sodium

↓

Water retention becomes greater than sodium retention

↓

Dilutional hyponatremia


Labs

Na = 126 ↓

K = 4.8 (normal)

Ca = 9.0 (normal)

Weight gain = 5 lb in 3 days

➡ Fluid overload


Medication

✅ Furosemide (Lasix)

Removes excess water

Improves:

  • Pulmonary edema

  • Peripheral edema

  • Hyponatremia (by removing free water)


Not Correct

❌ 0.45% NS

  • Hypotonic

  • Adds more free water

  • Worsens hyponatremia

❌ Calcium gluconate

  • Calcium is normal

❌ Sodium polystyrene sulfonate (Kayexalate)

  • Used for hyperkalemia

  • Potassium is normal


NCLEX Pearl

Heart failure + low sodium = usually too much water, NOT too little sodium.

Treat the fluid overload.


❤ Q47 – Priority After Abdominal Aortic Aneurysm (AAA) Repair

Priority Findings

Patient has:

  • Weak pedal pulses

  • Cool/mottled legs

These suggest:

🚨 Arterial graft occlusion

↓

Limb ischemia

↓

Possible limb loss


Assess

Always check:

  • Pedal pulses

  • Skin color

  • Temperature

  • Cap refill

  • Pain

  • Sensation

  • Movement


Less Urgent

Elevated WBC after surgery

Expected CHF symptoms

Subcutaneous emphysema with chest tube (monitor, but less urgent)


NCLEX Pearl

After AAA repair:
Always think

➡ Are the legs getting blood?


❤ Q48 – Resuming Sexual Activity After MI

General Rule

Patient can resume sex when they can:

✅ Walk 1 block

OR

✅ Climb 2 flights of stairs

WITHOUT

  • Chest pain

  • Shortness of breath

  • Fatigue


Usually after provider approval.


Important

Cardiac rehab is NOT required before sex.


Sildenafil

Never use with nitrates

Can cause life-threatening hypotension.


NCLEX Memory

2 flights of stairs = okay for sex


❤ Q49 – Vital Signs Requiring Immediate Intervention

Know NORMAL vs EMERGENCY


Expected

Albuterol

Can cause

✔ Tremor

✔ Tachycardia

✔ Palpitations


IV Hydromorphone

Can cause

✔ Mild hypotension

✔ Mild bradycardia

Monitor.


Requires Intervention

Before giving nifedipine

BP = 90/60

❌ Hold medication


Sudden BP drop

120/80 → 90/70

Needs evaluation.


Fetal Heart Rate

140 → 100 after contraction

Late deceleration

↓

Placental insufficiency

↓

Emergency


NCLEX Pearl

Expected medication side effects are different from dangerous changes in vital signs.


❤ Q50 – Deep Vein Thrombosis (DVT)

Classic Findings

✔ Warm

✔ Red

✔ Swollen

✔ Tender calf

✔ Pain


NOT DVT

Hairless shiny skin

↓

Peripheral arterial disease


NOT DVT

Blue toes

↓

Severe arterial ischemia/Raynaud


Complication

🚨 Pulmonary embolism

Watch for:

  • Sudden SOB

  • Chest pain

  • Tachycardia


NCLEX Memory

Warm + swollen = venous

Cold + pale = arterial


❤ Q51 – Cardiac Tamponade

Life-threatening emergency.


Classic Signs

Beck’s Triad

✔ Muffled heart sounds

✔ Jugular vein distention (JVD)

✔ Hypotension


Also

Pulsus paradoxus

↓

Drop in systolic BP >10 mm Hg during inspiration


Why?

Fluid compresses the heart.

↓

Heart cannot fill.

↓

Cardiac output drops.


Treatment

Emergency

Pericardiocentesis


NCLEX Pearl

Muffled heart sounds + JVD + hypotension = Tamponade


❤ Q52 – Lower GI Bleed

Patient has

  • Bright red blood

  • Pale

  • Diaphoretic

  • Dizzy

=

Hemodynamic instability


FIRST

Lower head of bed (supine)

Improves cerebral perfusion.


Then

Notify provider

Labs

Documentation


NCLEX Rule

Always stabilize circulation first.


❤ Q53 – CPR + AED Says “No Shock Advised”

AED analyzes rhythm.

If it says

NO SHOCK

Immediately

✅ Resume chest compressions.

Do NOT check pulse.

Do NOT delay.


High-quality CPR

Rate

100-120/min

Depth

2-2.4 inches


CAB

Compressions

Airway

Breathing


NCLEX Pearl

No shock = restart CPR immediately.


❤ Q54 – Holter Monitor / Ambulatory ECG

Portable monitor

Patient goes home wearing it.


Electrodes

Placed on

✅ Chest (torso)

NOT arms or legs.

Movement causes artifact.


Before Placement

✔ Skin clean

✔ Skin dry

✔ No lotion

✔ Clip excess hair


Don’t

Shave

Can cause skin injury.


Gel

Should remain moist.

Never wipe it off.


NCLEX Memory

Holter monitor = Chest only


⭐ High-Yield Summary (Q46–54)

Heart Failure

  • Weight gain

  • Dilutional hyponatremia

  • Lasix removes excess water


AAA Repair

  • Weak pulses

  • Cool legs

  • Limb ischemia

  • Priority assessment


MI Teaching

  • Resume sex when able to climb 2 flights of stairs without symptoms

  • Avoid PDE-5 inhibitors (eg, sildenafil) if taking nitrates


Medication Side Effects

Expected:

  • Albuterol → tremor, tachycardia

  • Opioids → mild hypotension

Dangerous:

  • BP too low before antihypertensives

  • Fetal late decelerations


DVT

  • Warm

  • Red

  • Swollen

  • Painful

  • Risk for pulmonary embolism


Cardiac Tamponade

  • Beck’s triad:

    • Muffled heart sounds

    • JVD

    • Hypotension

  • Pulsus paradoxus

  • Requires emergent pericardiocentesis


GI Bleed

  • Bright red blood + dizziness = hypovolemia

  • Position supine first to improve perfusion


CPR

  • AED: “No shock advised” → resume compressions immediately

  • Compression rate: 100–120/min

  • Depth: 2–2.4 in (5–6 cm)


Holter Monitor

  • Electrodes on torso

  • Clean, dry skin

  • Clip (don’t shave) hair

  • Keep electrode gel moist


🧠 Cardiovascular NCLEX “Must Know” Red Flags

🚨 Pink frothy sputum → Pulmonary edema

🚨 Weight gain + low Na in heart failure → Fluid overload → Give Lasix

🚨 Weak pulses after AAA repair → Graft occlusion → Limb ischemia

🚨 Warm swollen calf → DVT

🚨 Muffled heart sounds + JVD + hypotension → Cardiac tamponade

🚨 Bright red GI bleed + dizziness → Hypovolemic shock

🚨 AED says “No shock advised” → Resume CPR immediately

🚨 Able to climb 2 flights of stairs without symptoms → Generally safe to resume sexual activity after an uncomplicated MI with provider approval