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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. A femoral artery compression device ______be assigned to an NA?
Cannot
One large emboli (smaller=better)
Pulmonary edema
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

2. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
The internal jugular veins (external are less reliable).
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

3. What should a patient do if they feel chest pain or discomfort?
This noninvasive test takes 24 hours and causes no discomfort. Electrodes are applied to your body - you need to log your activities for a 24 hour period (walking - sleeping - urinating - physical symptoms - and medications). Don't tamper with the mo
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 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
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

4. What are examples of calcium channel blockers?
No radial artery punctures if negative
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

5. What is an air embolism?
Include rest periods prior to any activity.
Pneumothorax and will end up with chest tube to help reinflate lung.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

6. What is the treatment for atrial fibrillation?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
Direct current cardioversion and digoxin/propranolol (inderal).
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.

7. What is the maintenance for venous access port that isn't being regularly used?
Vascular - artery disease causing fluid to back up into the lungs.
Must be flushed 1x/month with heparin and between treatments.
An enlarged space indicates fluid accumulation in the pericardial sac.
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.

8. In what locations should you not place electrodes?
(S1 - S2) Third left intercostal space
Idiopathic
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
In fatty areas or over major muscles - large breasts - or bony prominences.

9. What is epistaxis?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Lower left sternal border
Pneumothorax and will end up with chest tube to help reinflate lung.
A nosebleed

10. What is the correct way to insert an oropharyngeal airway?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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.

11. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
Vascular - artery disease causing fluid to back up into the lungs.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

12. What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Maintain BED REST
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.)
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

13. What are the S&S of pulmonary embolism?
Only for a few hours
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Lower left sternal border

14. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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.
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.
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.
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

15. What is cardiac tamponade? Common causes?
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.
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.

16. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

17. What are the treatments/ S&S of peripheral venous disease?
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
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.

18. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
(S1 - S2) Third left intercostal space
Fat - Air - DVT - or Amniotic
Direct current cardioversion and digoxin/propranolol (inderal).

19. What are the S&S associated with right sided heart failure?
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Maintain BED REST
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

20. What is a good diagnosis for someone with right sided HF?
Activity intolerance
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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

21. Where is the pulmonic valve landmark on the chest?
Left sternal border
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
Second left intercostal space
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.

22. What should be done for someone on bleeding precautions?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Pneumothorax and will end up with chest tube to help reinflate lung.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

23. What is superior vena cava syndrome?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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 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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

24. What should you watch for with PICC lines that have been in place for 6 months?
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
Air answers (open junctions)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.

25. What is the treatment for premature ventricular contractions?
4th left intercostal space lower sternal border
Vitamin K (aqua myphiton)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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

26. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
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.
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.

27. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

28. What is the hallmark clinical finding associated with pericarditis?
In fatty areas or over major muscles - large breasts - or bony prominences.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
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.

29. Where do the internal jugular veins lie?
Second right intercostal space
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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!
0.5-2.0 ng/ml

30. What should you do when applying a femoral artery compression device?
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.
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.)
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
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.

31. What do calcium channel blockers do?
Second right intercostal space
4th left intercostal space lower sternal border
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
Open up blood vessels

32. What is a transthoracic echocardiograph (TTE)?
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Activity intolerance
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

33. What are common risk factors for an MI?
Second right intercostal space
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
An enlarged space indicates fluid accumulation in the pericardial sac.
To inhibit thrombus and clot formation.

34. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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
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.
Pulmonary edema
Steroid treatment or a pregnant woman who is retaining water.

35. What drugs are most commonly used for angina?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Nitrates - Beta blockers - and Calcium channel blockers

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

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37. Who would most likely have peripheral venous disease?
BP is elevated or decreased depending on activity.
Old truck driver or someone on bed rest or with pelvic trauma.
Lung disease
Patient who are unable to tolerate exercise stress testing.

38. Where should you place your stethescope to find the aortic valve?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
Second Right intercostal space.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

39. What is cardioversion?

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40. What is the treatments for hypertension?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
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.
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.

41. What should you teach a patient regarding discharge after a DVT?

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42. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

43. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Maintain BED REST

44. What should you teach your patient about angiography (arteriography)?
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.
Fifth left intercostal space medial to the midclavicular line.
Lowers BP and makes heart beat stronger. SE: flushed face.
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

45. When would a nurse use an external femoral artery compression device?
D/C the med and call the doctor.
No radial artery punctures if negative
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

46. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.

47. What are coumadin and heparin used for?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Cannot
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
To inhibit thrombus and clot formation.

48. What should you teach your patient about a cardiac catheterization?
D/C the med and call the doctor.
ST segment elevation (STEMI)
Idiopathic
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

49. What is labile hypertension?
Before
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
BP is elevated or decreased depending on activity.
Pneumothorax and will end up with chest tube to help reinflate lung.

50. What makes the symptoms of superior vena cava syndrome better? Worse?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

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NCLEX Cardiac

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