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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 is more harmful a lot of little emboli or one large emboli?
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.
One large emboli (smaller=better)
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
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.

2. What will be the treatment for an acute episode of life threatening tamponade?
Fifth left intercostal space medial to the midclavicular line.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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

3. What is the hallmark clinical finding associated with pericarditis?
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.
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.
Open up blood vessels
Cannot

4. What is angina? Stable vs. unstable?

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5. What places someone at risk for an aortic dissection?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
Poorly controlled hypertension

6. What should you teach your patient about an exercise ECG (stress test)?
4th left intercostal space lower sternal border
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-
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.
Idiopathic

7. What does an Allen's test determine?
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-
Fifth left intercostal space medial to the midclavicular line.
Whether the patients ulnar and radial arteries are patent.
BP is elevated or decreased depending on activity.

8. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Maintain BED REST
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea
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

9. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Activity intolerance
The internal jugular veins (external are less reliable).
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
(S1 - S2) Third left intercostal space

10. What is the maintenance for venous access port that isn't being regularly used?
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.
Whether the patients ulnar and radial arteries are patent.
Must be flushed 1x/month with heparin and between treatments.
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.

11. What is characteristic of ventricular tachycardia?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Steroid treatment or a pregnant woman who is retaining water.

12. How do you prepare a patient for Impedance cardiography monitoring?
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

13. What is intermittent claudication?
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.
Lung disease
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.
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.

14. What is INR?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
Open up blood vessels

15. What is characteristic of atrial fibrillation?
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
Iodine
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

16. What are the steps for adult 2 rescuer CPR?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the
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

17. What should you do when applying a femoral artery compression device?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Only for a few hours
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 REPO
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.

18. What is the treatment for atrial fibrillation?
No radial artery punctures if negative
Direct current cardioversion and digoxin/propranolol (inderal).
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
Air answers (open junctions)

19. Who would most likely have peripheral venous disease?
A nosebleed
Old truck driver or someone on bed rest or with pelvic trauma.
BP is elevated or decreased depending on activity.
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 REPO

20. What do calcium channel blockers do?
Second right intercostal space
Open up blood vessels
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

21. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Fat - Air - DVT - or Amniotic

22. What should you remember while taking care of someone with a peripheral arterial occlusion?
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 CARD
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

23. What is the purpose of compression devices?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

24. What is Raynauds disease? Tx?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
Fifth left intercostal space medial to the midclavicular line.

25. What are the S&S of aortic dissection?
Elderly - hypothyroidism - renal dysfunction - dehydration - HYPOKALEMIA - hypomagnesemia - or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Lower left sternal border

26. Where do the internal jugular veins lie?
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Must be flushed 1x/month with heparin and between treatments.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

27. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
The internal jugular veins (external are less reliable).
One large emboli (smaller=better)
Fifth left intercostal space medial to the midclavicular line.

28. What is the treatment for premature ventricular contractions?
Vascular - artery disease causing fluid to back up into the lungs.
Second right intercostal space
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

29. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

30. What is pericarditis?
4th left intercostal space lower sternal border
An inflammation of the pericardium. It may result in MI.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

31. What are the S&S of superior vena cava syndrome?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
Whether the patients ulnar and radial arteries are patent.
An inflammation of the pericardium. It may result in MI.

32. What is the treatment for someone in ventricular fibrillation?
Vascular - artery disease causing fluid to back up into the lungs.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

33. What should you observe for in someone on bleeding precautions?
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).
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.
One at a time to assess the pulse amplitude and contour.
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

34. What are the nursing interventions for a patient in complete heart block?
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.
A nosebleed
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Second Right intercostal space.

35. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Maintain BED REST

36. What is defibrillation?
One at a time to assess the pulse amplitude and contour.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

37. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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-
Air embolism
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.
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.

38. What drugs are most commonly used for angina?
Fat - Air - DVT - or Amniotic
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Nitrates - Beta blockers - and Calcium channel blockers
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

39. How is angina treated?

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40. What should happen if someone converts to asystole/flatline?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Second Left intercostal space

41. What are signs and symptoms of an MI?
D/C the med and call the doctor.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

42. What body systems are affected by digoxin toxicity? S&S?
Air answers (open junctions)
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

43. What are the steps for infant 1&2 rescuer CPR?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Chronic arteriosclerotic disease.
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

44. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
Clip hair if necessary - abrade the skin (use abrader pads or fine sandpaper and lightly rub skin using 2 or 3 brisk strokes - improves tracings) - dry skin if necessary - and attach the lead wires to the electrodes before you apply them to the patie
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

45. What are the four types of pulmonary emboli?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Must be flushed 1x/month with heparin and between treatments.
Fat - Air - DVT - or Amniotic
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.

46. What does vasotec (Enalapril Maleate) do/SE?
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.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
Old truck driver or someone on bed rest or with pelvic trauma.

47. What is important to remember when removing a CVC from a patient?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

48. What are the nursing interventions for a patient in atrial fibrillation?
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
Fat - Air - DVT - or Amniotic
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Left sternal border

49. What is the antidote for coumadin?
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
Vitamin K (aqua myphiton)
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Cannot

50. What is labile hypertension?
One at a time to assess the pulse amplitude and contour.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
BP is elevated or decreased depending on activity.
An enlarged space indicates fluid accumulation in the pericardial sac.