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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

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 should you teach your patient about an electrocardiogram (ECG)?
Lowers BP and makes heart beat stronger. SE: flushed face.
Activity intolerance
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
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.

2. What factors place you at risk for HTN?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
In fatty areas or over major muscles - large breasts - or bony prominences.
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.

3. What is Deep Vein Thrombosis (DVT)?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Vascular - artery disease causing fluid to back up into the lungs.
Steroid treatment or a pregnant woman who is retaining water.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

4. What is a therapeutic digoxin level?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
0.5-2.0 ng/ml
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.

5. What do calcium channel blockers do?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Open up blood vessels
An enlarged space indicates fluid accumulation in the pericardial sac.
No radial artery punctures if negative

6. What are the 2 types of pacemakers?
D/C the med and call the doctor.
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.
Lower left sternal border
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

7. What is the treatment for someone in ventricular fibrillation?
D/C the med and call the doctor.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Second Right intercostal space.
Only for a few hours

8. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Right sided heart failure

9. What body systems are affected by digoxin toxicity? S&S?
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
0.5-2.0 ng/ml

10. What is cardiac tamponade? Common causes?
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
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
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
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.

11. What is a good diagnosis for someone with right sided HF?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Activity intolerance
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

12. What is superior vena cava syndrome?
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
A complication from a venous access device or port. It is a blockage of the superior vena cava preventing superior blood flow from reaching the heart.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

13. What are the S&S of superior vena cava syndrome?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Patient who are unable to tolerate exercise stress testing.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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

14. When should bleeding precautions be implemented?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
D/C the med and call the doctor.

15. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Poorly controlled hypertension
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
NO because it isn't sterile so keep out.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

16. What are the steps for adult 2 rescuer CPR?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

17. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
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
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

18. What is angina? Stable vs. unstable?

19. Where is the apex/mitral valve landmark on the chest?
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Fourth or fifth intercostal space at or medial to the midclavicular line.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

20. Test ending in Gram=?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Iodine
BP is elevated or decreased depending on activity.
NO because it isn't sterile so keep out.

21. What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Pneumothorax and will end up with chest tube to help reinflate lung.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

22. What type of EKG change indicates MI?
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
ST segment elevation (STEMI)
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

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

24. What should you teach your patient about angiography (arteriography)?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unu
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

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

26. What usually triggers angina pain?
Must be flushed 1x/month with heparin and between treatments.
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

27. How should you palpate the apical pulse?
Open up blood vessels
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

28. What should you do to treat pulmonary edema?
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
0.5-2.0 ng/ml
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

29. What makes the symptoms of superior vena cava syndrome better? Worse?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

30. Where should you place your stethescope to find the aortic valve?
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Second Right intercostal space.
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

31. What should you teach someone about iodine?
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.
Feeling warm (fire) or tin can taste is expected and will pass.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

32. When should you be concerned about premature ventricular contraction?
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
NO because it isn't sterile so keep out.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

33. What SE should you look for with calcium channel blocker use?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Must be flushed 1x/month with heparin and between treatments.
Cannot
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

34. How should you palpate the carotid arteries?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.
One at a time to assess the pulse amplitude and contour.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

35. For which heart sounds should the bell be used?
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.
The internal jugular veins (external are less reliable).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

36. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
MRI is painless - you must remain still inside a small/noisy space. If you are claustrophobic you may need sedation. Remove all jewelry and other metal objects. If you have any shrapnel - a pacemaker - or any surgically implanted joints - pins - clip
Fourth or fifth intercostal space at or medial to the midclavicular line.
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

37. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

38. What is a nursing diagnosis for arterial occlusion? Tx
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
ST segment elevation (STEMI)

39. Which type of patient shouldn't take nitrates?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
D/C the med and call the doctor.

40. What signals an elevated venous pressure based on the internal jugular veins?
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
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

41. What needs to be held during the placement of a femoral artery compression device?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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
NO NSAIDS or ASA.

42. What disease can cause right sided heart failure?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Lung disease
One large emboli (smaller=better)

43. What is important to remember when taking care of patients with compression devices?
Include rest periods prior to any activity.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
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.

44. What is pulsus paradoxus?
Direct current cardioversion and digoxin/propranolol (inderal).
Cannot
Poorly controlled hypertension
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

45. What should you observe for in someone on bleeding precautions?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

46. What are the proper steps to changing a central venous catheter dressing?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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
Left sternal border
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.

47. 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?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
One large emboli (smaller=better)
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

48. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

49. How does the blood flow through the heart? (valves?)
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
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!
Lung disease
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

50. A femoral artery compression device ______be assigned to an NA?
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at
Lower HOB - place patient supine - assess LOC - open airway - assess breathing - get ambu bag - put on gloves - connect tubing from O2 source - adjust flow to 10 to 15 liters. First RESCUER: PLACE APEX of MASK OVER BRIDGE of NOSE And BASE BETWEEN LOW
Vascular - artery disease causing fluid to back up into the lungs.
Cannot