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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 the correct way to insert an oropharyngeal airway?
Activity intolerance
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
A nosebleed

2. What should you do if you are going to ventilate someone with an ambu bag?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
(S1 - S2) Third left intercostal space
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

3. What are the steps for adult/child 1 rescuer CPR?
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
One large emboli (smaller=better)
Second Left intercostal space
Patient who are unable to tolerate exercise stress testing.

4. What should you do if the PT value is 45 sec?
Steroid treatment or a pregnant woman who is retaining water.
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.
D/C the med and call the doctor.
Patient who are unable to tolerate exercise stress testing.

5. What disease can cause right sided heart failure?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Whether the patients ulnar and radial arteries are patent.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Lung disease

6. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Pulmonary edema
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Second left intercostal space

7. What should you observe for in someone on bleeding precautions?
Pneumothorax and will end up with chest tube to help reinflate lung.
Open up blood vessels
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).
Protamine Sulfate

8. Where is the right ventricle landmark on the chest?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Left sternal border

9. For what disease should you do the Allen's test?

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10. What is a major complication of central line placement?
D/C the med and call the doctor.
Pneumothorax and will end up with chest tube to help reinflate lung.
Pulse before and after giving.
Vitamin K (aqua myphiton)

11. In what locations should you not place electrodes?
Old truck driver or someone on bed rest or with pelvic trauma.
In fatty areas or over major muscles - large breasts - or bony prominences.
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
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

12. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
(S1 - S2) Third left intercostal space

13. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
The patient may suffer significant blood loss or femoral nerve compression.

14. For which heart sounds should the diaphragm be used?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
One large emboli (smaller=better)
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

15. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Premature beats that are not preceded by a P- wave - QRS is wide and bizarre - and the T wave of the premature beat is generally large and in the opposite direction of the QRS.
(S1 - S2) Third left intercostal space
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

16. 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?
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

17. What factors place you at risk for HTN?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
The patient may suffer significant blood loss or femoral nerve compression.
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.
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.

18. What is CVP? Normal?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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
File toe nails - if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.

19. What are coumadin and heparin used for?
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.
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
To inhibit thrombus and clot formation.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

20. What is a assessment finding with DVT?

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21. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
Open up blood vessels
D/C the med and call the doctor.
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

22. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Protamine Sulfate
Don't interfere!
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

23. What body systems are affected by digoxin toxicity? S&S?
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table

24. What are the S&S of air embolism?
Steroid treatment or a pregnant woman who is retaining water.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

25. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
0.5-2.0 ng/ml
Feeling warm (fire) or tin can taste is expected and will pass.

26. What is the treatments for hypertension?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
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.

27. What is the most common cause of arterial insufficiency?
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
Chronic arteriosclerotic disease.
Vascular - artery disease causing fluid to back up into the lungs.
Open up blood vessels

28. What are the nursing interventions for a patient in complete heart block?
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Feeling warm (fire) or tin can taste is expected and will pass.

29. What drugs are most commonly used for angina?
To report to her healthcare provider if she feels a large bump in her groin - if she has groin pain unrelieved by acetaminophen - or if she develops numbness - tingling - etc. in the affected leg.
Right sided heart failure
Nitrates - Beta blockers - and Calcium channel blockers
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

30. What should you remember while taking care of someone with a peripheral arterial occlusion?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer - hurts more - etc.)
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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

31. What is more harmful a lot of little emboli or one large emboli?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
One large emboli (smaller=better)
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
Pulmonary edema

32. What are the indications for a chemical stress test (persantine stress test)?
Second Left intercostal space
Lowers BP and makes heart beat stronger. SE: flushed face.
Patient who are unable to tolerate exercise stress testing.
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

33. What are the proper steps to changing a central venous catheter dressing?
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
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.
Iodine
A nosebleed

34. What should you teach your patient about a holter monitor?

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35. What should be checked in a patient on a beta blocker?
A nosebleed
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Pulse before and after giving.
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.

36. 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.
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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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

37. What are the S&S of pulmonary embolism?
Poorly controlled hypertension
Before
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table

38. What needs to be held during the placement of a femoral artery compression device?
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
One at a time to assess the pulse amplitude and contour.
In the first 72 hours!!!!!
NO NSAIDS or ASA.

39. What is a therapeutic digoxin level?
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
No radial artery punctures if negative
0.5-2.0 ng/ml
An enlarged space indicates fluid accumulation in the pericardial sac.

40. How should you palpate the carotid arteries?
Air embolism
Pulmonary edema
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.
One at a time to assess the pulse amplitude and contour.

41. In What time period is the greatest risk of sudden death from an MI?
If feel more than 3 shocks in a row or develop signs of infection at the site.
To inhibit thrombus and clot formation.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
In the first 72 hours!!!!!

42. What should you teach your patient about an abdominal ultrasonography?
Steroid treatment or a pregnant woman who is retaining water.
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

43. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Right sided heart failure
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
An enlarged space indicates fluid accumulation in the pericardial sac.
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

44. What are all the S&S of pericarditis?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

45. What is an air embolism?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

46. During an Allen's test don't compress one artery _____ the other.
In fatty areas or over major muscles - large breasts - or bony prominences.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Before

47. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Fifth left intercostal space medial to the midclavicular line.
Activity intolerance
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

48. What is the treatment for atrial fibrillation?
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-
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Direct current cardioversion and digoxin/propranolol (inderal).

49. What is Deep Vein Thrombosis (DVT)?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
One large emboli (smaller=better)
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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.

50. What should you do if the PTT value is 80 for someone on heparin?
Nitrates - Beta blockers - and Calcium channel blockers
D/C the med and call the doctor.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table