The FINAL chapter of your cardiovascular journey! Master pediatric heart defects, surgical procedures, cardiac emergencies, and put it all together with a 50-question Mega Practice Exam spanning ALL 5 CV Parts.
📚 What’s Inside:
📢 LPN Scope Reminder
LPNs COLLECT DATA and REPORT! RNs ASSESS and DIAGNOSE!
In pediatric and surgical settings, LPNs monitor, report findings, reinforce teaching, and administer medications as prescribed. LPNs do NOT independently manage chest tubes, surgical drains, or ventilator settings.
🎓 130+ NCLEX-PN Questions • 80% required to advance • Flashcards for missed questions
Congenital Heart Defects • Kawasaki Disease • Rheumatic Fever • Pediatric HF
Before birth, the baby’s lungs are not working — the placenta does the gas exchange. The fetal heart has 3 special bypass routes that redirect blood AWAY from the lungs. Think of these as temporary detour roads in the factory’s highway system:
🚨 AT BIRTH: When baby takes the first breath, the lungs expand, pulmonary resistance DROPS, and these 3 bypasses start closing:
NCLEX KEY: If ANY of these fail to close, it creates a congenital heart defect. The most common is Patent Ductus Arteriosus (PDA) — the ductus arteriosus stays open!
Congenital heart defects (CHDs) are the most common birth defect. They are categorized by what happens to blood flow:
Blood shunts LEFT → RIGHT through a hole (high pressure → low pressure). Too much blood goes to lungs.
💡 ACYANOTIC initially (oxygenated blood mixes into right side)
Obstruction to pulmonary flow + a hole allows blood to shunt RIGHT → LEFT. Deoxygenated blood enters systemic circulation.
🚨 CYANOTIC — deoxygenated blood enters body!
Blood exiting the heart meets an area of narrowing (stenosis), blocking outflow.
💡 Severity determines if acyanotic or cyanotic
Oxygenated and deoxygenated blood completely mix. Results in systemic desaturation.
🚨 CYANOTIC — always requires surgical intervention
Cell Factory Concept: Imagine the heart factory has a hole in the wall between the high-pressure left side and the low-pressure right side. Blood naturally flows from high → low pressure, so extra oxygenated blood floods the right side and goes back to the lungs unnecessarily. The lung factory gets overwhelmed with too much blood.
The most common CYANOTIC heart defect! Four defects exist simultaneously:
Cell Factory Analogy: “The factory’s lung delivery pipe is partially blocked (stenosis), there’s a hole in the wall between production lines (VSD), the main outgoing highway (aorta) is shifted over the hole, and the right production line has gotten muscular from overwork (RVH). Result: deoxygenated blood gets pumped out to the body!”
🚨 HYPERCYANOTIC SPELLS (Tet Spells / Blue Spells)
Occur when oxygen demand exceeds supply — during crying, feeding, or defecating.
PRIORITY NURSING ACTIONS:
Older Children with ToF: May exhibit squatting (compensatory — increases venous return for oxygenation) and clubbing of fingers (sign of chronic hypoxia).
In infants/children, HF is most commonly caused by congenital heart defects that produce excessive volume or pressure load on the myocardium. A combination of both left- and right-sided HF is usually present.
💡 EARLY Signs of Pediatric HF (NCLEX LOVES These!):
🚨 A weight gain of 0.5 kg (1 lb) in 1 DAY = fluid accumulation → REPORT to RN!
Cell Factory: Digoxin inhibits the Na+/K+ pump → increases intracellular calcium → heart muscle factories contract more efficiently (positive inotropic). Also slows heart rate (negative chronotropic).
📚 Digoxin Administration Rules for Parents:
What: An acute systemic inflammatory illness — cause unknown (may be associated with infection or toxin). Cardiac involvement is the MOST SERIOUS complication — coronary artery aneurysms can develop!
| Stage | Manifestations | Key Features |
|---|---|---|
| Acute Stage | Fever, conjunctival hyperemia, red throat, swollen hands, rash, enlarged cervical lymph nodes | Fever + Red eyes + Red throat + Rash = Think Kawasaki! |
| Subacute Stage | Cracking lips & fissures, desquamation (peeling) of fingertips/toes, joint pain, cardiac manifestations, thrombocytosis | Peeling skin + cardiac symptoms appear here |
| Convalescent Stage | Child appears normal, but signs of inflammation may persist | Looks better but not fully recovered |
What: An inflammatory autoimmune disease that manifests 2–6 weeks after an untreated or partially treated group A β-hemolytic streptococcal infection (strep throat) of the upper respiratory tract.
Most serious complication: Rheumatic heart disease affecting the cardiac valves, particularly the MITRAL valve.
Memory trick: “J ♥ N E S C”
🚨 NCLEX KEY: “Has the child had a sore throat or fever within the past 2 months?” = The assessment question that links strep to RF!
Pre-procedure:
Post-procedure:
🏠 Homecare After Cardiac Surgery:
LPNs COLLECT DATA and REPORT! RNs ASSESS and DIAGNOSE!
20 Questions • 80% Required to Advance • Includes SATA & Fill-in-Blank
A nurse is collecting data on a newborn with a patent ductus arteriosus (PDA). Which characteristic finding would the nurse expect?
An infant with tetralogy of Fallot becomes acutely cyanotic with oxygen saturation dropping to 60%. What is the FIRST action by the nurse?
A child is admitted with suspected rheumatic fever. Which question would the nurse ask to elicit information SPECIFIC to the development of this condition?
A parent of a child with PDA states: "I know my child will outgrow this problem, just give him time." This statement indicates:
Which finding in a child with acute-stage Kawasaki disease would the nurse expect?
The nurse is monitoring an infant with congenital heart disease for EARLY signs of heart failure. Select ALL that apply:
A parent of a child with heart failure states: "If my child vomits after medication administration, I will repeat the dose." This indicates:
With coarctation of the aorta, the nurse would expect to find:
The nurse suspects fluid accumulation in an infant with HF. Which finding MOST supports this?
Which congenital heart defect is MOST commonly associated with Down syndrome?
Indomethacin is administered to a premature infant. The nurse understands this medication is used to:
After a cardiac catheterization in a child, the nurse checks the catheter insertion site and finds bleeding. The FIRST action is to:
In fetal circulation, the ductus arteriosus connects which two structures?
A child with Kawasaki disease received IVIG therapy. The nurse reinforces that which vaccines should be AVOIDED for 11 months?
An older child with tetralogy of Fallot is observed squatting during play. The nurse understands this is a compensatory mechanism to:
A nurse is discharging a child 2 weeks after cardiac surgery. Which parent statement indicates the NEED FOR FURTHER TEACHING?
The most serious complication of Kawasaki disease is:
Describe the 4 defects present in Tetralogy of Fallot and explain why the knee-chest position helps during a hypercyanotic spell.
After cardiac catheterization, how long should the affected extremity be immobilized if an ARTERIAL entry site was used?
Which congenital heart defect presents with SEVERELY cyanotic newborns because the pulmonary artery and aorta are switched?
CABG • Valve Replacement • Cardiac Catheterization • Pacemakers • Cardioversion/Defibrillation
Cell Factory: “When the factory’s main supply highways (coronary arteries) are too clogged to deliver oxygen, surgeons build NEW bypass roads using the worker’s own blood vessels (saphenous vein or internal mammary artery).”
🚨 Post-CABG Kidney Alert:
Client is at risk for acute kidney injury from poor perfusion, hemolysis, or vasopressor therapy. Signals: Decreased urine output + increased BUN and creatinine.
| Feature | Mechanical Prosthetic | Bioprosthetic (Biological) |
|---|---|---|
| Material | Synthetic — very durable | Porcine (pig), bovine (cow), or human cadaver |
| Durability | Longest lasting | May need replacement in 10–15 years |
| Anticoagulation | LIFETIME anticoagulant therapy required! | Long-term anticoagulation NOT indicated (low clot risk) |
| Sound | Soft audible clicking sound may be heard | No mechanical sound |
| Best for | Younger patients (lasts longer) | Older patients or those who cannot take anticoagulants |
📚 Post-Valve Replacement Patient Teaching:
The most definitive diagnostic tool for coronary artery disease. A catheter is threaded through a peripheral vessel to the heart chambers.
🚨 Most Common Post-Insertion Complication:
Pacing electrode dislodgment! Prevent by limiting activities and arm movement on the operative side in the first several hours after insertion.
| Feature | Cardioversion | Defibrillation |
|---|---|---|
| Type | SYNCHRONIZED countershock | ASYNCHRONOUS countershock |
| Synchronized to | R wave (avoids T wave!) | NOT synchronized (no organized rhythm exists) |
| Energy | Lower energy | 120–200 J (biphasic) or 360 J (monophasic) |
| Used for | Stable tachydysrhythmias (A-Fib, SVT) | Pulseless VT or VF ONLY |
| Elective A-Fib prep | Anticoagulants 4–6 weeks before + TEE; hold digoxin 48 hrs | N/A (emergency only) |
| CRITICAL SAFETY | STOP OXYGEN (fire hazard!) • Ensure NO ONE touching bed/client • Check 3 times! | |
| Post-procedure priority | Airway & breathing assessment (ABCs!) | |
20 Questions • 80% Required to Advance
A client is 2 days post-CABG. Lab results show increased BUN and creatinine with decreased urine output. The nurse suspects:
The best nursing action to help a post-cardiac surgery client tolerate ambulation is:
A client with a mechanical prosthetic valve asks about anticoagulation. The nurse reinforces that:
After cardiac catheterization, the client should remain on bed rest with the HOB elevated no more than:
Before cardioversion, the nurse ensures the defibrillator is synchronized to which part of the ECG?
The most common complication in the first several hours after permanent pacemaker insertion is:
Before defibrillation or cardioversion, the nurse MUST ensure that which supply is STOPPED?
For elective cardioversion of atrial fibrillation, the client typically receives anticoagulant therapy for how long BEFORE the procedure?
A post-valve replacement client asks about dental care. The nurse reinforces to:
A client with a permanent pacemaker reports feeling “strange sensations” near a store’s antitheft device. The nurse instructs the client to:
Defibrillation is used ONLY for which rhythms?
Which medications are typically discontinued BEFORE CABG surgery? Select the CORRECT combination.
The HIGHEST priority nursing assessment immediately after cardioversion is:
After cardiac catheterization, the nurse notes that the client’s affected extremity feels COOL. This may indicate:
A CABG client is encouraged to cough, deep breathe, and use the incentive spirometer. The PRIMARY reason is to:
After a PTCA (percutaneous transluminal coronary angioplasty), the client reports chest pain. The nurse understands this could indicate:
Which are appropriate instructions for a client with a permanent pacemaker? Select ALL that apply:
Post-cardiac catheterization, the nurse encourages increased fluid intake primarily to:
Compare mechanical and bioprosthetic heart valves. Include the key difference regarding anticoagulation and why oral hygiene is critical for ALL valve replacement patients.
When monitoring sternal suture lines in a post-CABG client, the nurse checks for instability because this finding may indicate:
Cardiac Tamponade • Cardiogenic Shock • CPR/BLS • Pulmonary Edema • Emergency Medications
Cell Factory: “Imagine the entire heart factory is surrounded by a fluid-filled balloon that keeps squeezing tighter. The factory can’t expand to fill with blood, so output drops to dangerously low levels!”
What: Accumulation of fluid in the pericardial cavity that restricts ventricular filling → cardiac output drops. As little as 20–50 mL accumulating rapidly can cause acute tamponade.
🚨 Beck’s Triad (Classic Signs):
Memory Trick: “3 D’s” — Decreased BP, Distended veins, Distant heart sounds
Treatment: Pericardiocentesis (emergency needle aspiration of fluid from the pericardial sac). This is a MEDICAL EMERGENCY!
Cell Factory: “When more than 40% of the left ventricular factory workers die (usually from a massive MI), the factory can no longer pump adequately. Tissue perfusion drops system-wide.”
What: Failure of the heart to pump adequately → reduced cardiac output → compromised tissue perfusion. Usually occurs when necrosis of >40% of the left ventricle happens from coronary vessel occlusion.
Goal of treatment: Maintain tissue oxygenation and perfusion and improve the pumping ability of the heart.
Key medications: Digoxin (second line for HF), vasopressors, IV fluids as needed
Follow CAB: Compressions → Airway → Breathing
💡 Key Numbers to Remember:
Life-threatening event from severe heart failure — LV fails to eject sufficient blood, pressure increases in lungs from accumulated blood.
🚨 PRIORITY ACTIONS (in order):
20 Questions • 80% Required to Advance
A client presents with hypotension, distended neck veins, and distant muffled heart sounds. The nurse recognizes this as:
During adult CPR, the nurse performs chest compressions at what rate and depth?
The emergency treatment for cardiac tamponade is:
A client develops pulmonary edema. The FIRST nursing action is to:
Cardiogenic shock typically occurs when necrosis affects what percentage of the left ventricle?
During CPR, you check the carotid pulse. The maximum time allowed for this pulse check is:
When a client develops ventricular fibrillation, the nurse should FIRST:
The nurse understands that pulseless electrical activity (PEA) is treated with:
The compression-to-ventilation ratio for adult CPR is:
Morphine sulfate is administered during pulmonary edema primarily to:
If neck injury is suspected during CPR, which airway maneuver is used instead of head-tilt chin-lift?
An AED (Automatic External Defibrillator) delivers shocks ONLY for which rhythms?
Which MI complication occurs weeks to months post-infarction and involves pericarditis + pericardial effusion + pleural effusion?
During pulmonary edema management, furosemide is administered primarily to:
After defibrillation, how long should CPR be continued before rechecking the rhythm?
The nurse is caring for a client with acute pulmonary edema. Which interventions does the nurse anticipate? Select ALL that apply:
The Valsalva maneuver is used to treat which type of dysrhythmia?
Pericarditis pain is characteristically:
Describe Beck’s Triad and explain the cellular-level reason why each sign occurs in cardiac tamponade.
An AICD (automatic implantable cardioverter defibrillator) detects and terminates episodes of:
Cross-System Connections • Drug Matrices • Priority Decision Trees • NCLEX Strategies
Cell Factory: “The heart factory doesn’t work alone. It’s part of a massive industrial complex where every factory depends on every other factory!”
| System Connection | How They Interact | NCLEX Application |
|---|---|---|
| CV + Renal | Heart pumps blood to kidneys for filtration. Low cardiac output → decreased renal perfusion → oliguria. RAAS activated when BP drops. | ACE inhibitors, ARBs, diuretics all affect BOTH systems. Monitor BUN/creatinine + urine output! |
| CV + Respiratory | Left heart failure → fluid backs up into lungs → pulmonary edema. Right heart failure → systemic edema. | Crackles in lungs = left-sided HF. JVD + peripheral edema = right-sided HF. O2 sat monitoring critical! |
| CV + Electrolytes | K+ and Mg2+ levels directly affect cardiac rhythm. Digoxin toxicity worsened by hypokalemia. | ALWAYS check K+ before giving digoxin! Normal K+ = 3.5–5.0. Diuretics waste K+! |
| CV + Hepatic | Liver produces clotting factors. Warfarin works IN the liver. Right HF causes hepatomegaly. | Monitor INR for warfarin. Vitamin K foods: maintain CONSISTENT intake! |
| CV + Endocrine | Diabetes accelerates atherosclerosis. Thyroid disorders affect heart rate. Aldosterone retains Na+/H2O. | Diabetic clients at HIGH risk for CAD, MI. Silent MI more common in diabetics! |
| Drug Class | Watch For | Critical Interactions | LPN Action |
|---|---|---|---|
| Digoxin | Toxicity: N/V, visual changes (halos), bradycardia | Hypokalemia INCREASES toxicity! Loop diuretics waste K+ | Check apical pulse ×1 min BEFORE giving. Hold if <60 adult, <70 child. Report! |
| Beta-Blockers | Bradycardia, hypotension, fatigue, bronchospasm | With digoxin → excessive bradycardia. With CCBs → severe bradycardia/hypotension | Check HR and BP before giving. Do NOT stop abruptly! |
| ACE Inhibitors | Dry cough, hyperkalemia, angioedema | With K+-sparing diuretics → dangerous hyperkalemia. NSAIDs reduce effectiveness | Monitor K+ levels, BP, cough. Report angioedema STAT! |
| Warfarin | Bleeding (INR >3.0) | Many food/drug interactions! Aspirin, NSAIDs increase bleeding. Vitamin K foods affect levels. | Monitor INR (2.0–3.0 standard). Teach CONSISTENT Vit K intake. Report bleeding signs! |
| Heparin | Bleeding, HIT (platelet drop >50%) | Antidote: Protamine sulfate. NSAIDs increase bleeding risk. | Monitor aPTT (45–100 sec). Check for bleeding/bruising. No IM injections! |
| Nitroglycerin | Headache, hypotension, dizziness | NEVER with erectile dysfunction drugs (sildenafil) — severe hypotension/death! | 3 doses sublingual ×5 min apart. If no relief → call 911! |
1. STOP activity, have client REST →
2. Administer sublingual NTG as prescribed (up to 3 doses ×5 min apart) →
3. If pain NOT relieved after 1st NTG → Call 911 / Activate rapid response →
4. Administer oxygen as prescribed →
5. Obtain vital signs →
6. REPORT to RN immediately →
7. Prepare for 12-lead ECG and labs (troponin, CK-MB)
20 Questions • 80% Required to Advance to Mega Exam
A client on digoxin and furosemide has a potassium level of 3.0 mEq/L. The LPN should:
A client on warfarin has an INR of 4.5. The LPN recognizes this means:
A client with left-sided heart failure would exhibit which findings?
An LPN is caring for 4 cardiac clients. Which client should be seen FIRST?
A client on a beta-blocker has a heart rate of 52 bpm. The LPN should:
A client taking an ACE inhibitor reports a persistent dry cough. The LPN understands this is:
Nitroglycerin should NEVER be given with:
The antidote for heparin is:
A client with an MI reports chest pain at 6:00 AM on arrival. Troponin levels rise within how many hours?
A client on warfarin asks about diet. The LPN reinforces:
Which statement by a client with PAD indicates correct understanding of foot care?
HIT (Heparin-Induced Thrombocytopenia) is characterized by:
In the ECG, the P wave represents:
A client post-MI is prescribed aspirin. The LPN understands aspirin’s antiplatelet action lasts:
A DVT client suddenly develops chest pain, dyspnea, and tachycardia. The nurse suspects:
The normal cardiac output is the product of which two factors?
Clopidogrel (Plavix) should NEVER be stopped abruptly after stent placement because:
Which are signs of digoxin toxicity? Select ALL that apply:
Explain the RAAS cascade and identify where ACE inhibitors and ARBs work. Why must the LPN monitor potassium levels with these medications?
When an NCLEX question asks “What would the LPN do FIRST?” the priority framework is:
50 Comprehensive Questions • NGN Clinical Judgment Format • 80% to Pass
Heart Anatomy • CAD/MI/HF/HTN • Vascular Disorders • Anticoagulation • Pediatric/Surgical/Emergencies
80% Required for CV Series Completion Certificate!
The SA node fires at a normal rate of:
MI pain is NOT relieved by NTG because:
A positive Homans’ sign may indicate:
Therapeutic aPTT for heparin is:
An infant having a hypercyanotic (“tet”) spell. FIRST action:
The MOST specific lab for myocardial damage is:
Beck’s Triad includes all EXCEPT:
PDA murmur is described as:
Enoxaparin (Lovenox) is safe in pregnancy because:
Right-sided heart failure causes which findings?
Rheumatic fever occurs how long after a strep throat infection?
Stage 2 hypertension is defined as:
Warfarin’s antidote is:
After cardiac catheterization via femoral artery, a COOL affected extremity may indicate:
The LPN checks apical pulse for 1 full minute before giving digoxin. If HR is <60 in an adult, the LPN should:
Kawasaki disease’s most serious complication is:
A client on nitroglycerin sublingual should be told to:
The compression-to-ventilation ratio for adult CPR is:
Mechanical heart valves require:
PAD (peripheral arterial disease) pain is characterized by:
An infant with VSD would be MOST at risk for:
Before defibrillation, the nurse MUST stop:
DVT prevention includes all EXCEPT:
Cardiac output = Stroke Volume × Heart Rate. Normal CO is approximately:
ACE inhibitors end in the suffix:
Coarctation of the aorta is characterized by:
A client with angina should take NTG and expect:
After a pacemaker insertion, the MOST important teaching is:
Dressler’s syndrome occurs:
The LPN recognizes that the FIRST sign of digoxin toxicity in children is often:
Tetralogy of Fallot includes 4 defects. Which is NOT one?
Post-CABG, the client is at risk for kidney injury. The LPN monitors for:
Morphine is given in pulmonary edema to:
Venous insufficiency is characterized by:
ACE inhibitor + K+-sparing diuretic can cause:
The P wave on an ECG represents:
An LPN is caring for 4 clients. Which should be seen FIRST?
Clopidogrel (Plavix) after stent placement should NEVER be stopped because of risk of:
Cardioversion is synchronized to which ECG component?
A child with Kawasaki disease should receive IVIG. The nurse knows that live vaccines should be delayed for:
Which are signs of LEFT-sided heart failure? Select ALL that apply:
Which are appropriate actions for an LPN when a client has chest pain? Select ALL that apply:
The congenital heart defect MOST associated with Down syndrome is:
Indomethacin is used in neonates to:
Aortic aneurysm >5.5 cm or rapidly expanding requires:
A Jones criteria MAJOR manifestation of rheumatic fever is:
The MOST important teaching for parents giving digoxin to a child at home includes:
Compare Tetralogy of Fallot with Transposition of the Great Arteries. Include: defects, cyanosis level, and surgical timing for each.
A post-cardiac surgery client is being discharged. List 5 key homecare instructions the LPN would reinforce.
When an NCLEX question asks “which finding needs FURTHER TEACHING?” the student should look for:
Congratulations on Completing the Entire Cardiovascular Series!
This certifies that
has successfully completed ALL 5 parts of the
NCLEX-PN Cardiovascular Series
Including: Heart Anatomy • CAD/MI/HF/HTN • Vascular Disorders • Anticoagulation/Pharmacology • Pediatric CV, Surgery & Emergencies
Date:
“LPNs COLLECT DATA and REPORT! RNs ASSESS and DIAGNOSE!”