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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. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Iodine
Cannot
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

2. Where should you place your stethescope to find the mitral (apex) valve?
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.
Fifth left intercostal space medial to the midclavicular line.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Patient who are unable to tolerate exercise stress testing.

3. What could happen without immediate intervention for a hematoma?
The internal jugular veins (external are less reliable).
The patient may suffer significant blood loss or femoral nerve compression.
Protamine Sulfate
Must be flushed 1x/month with heparin and between treatments.

4. What is the antidote for heparin?
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
Protamine Sulfate
A nosebleed
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.

5. What makes the symptoms of superior vena cava syndrome better? Worse?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Nitrates - Beta blockers - and Calcium channel blockers
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

6. What can result from left sided heart failure if left untreated?
Pulmonary edema
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.
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
Second Left intercostal space

7. What is the antidote for coumadin?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
D/C the med and call the doctor.
Fat - Air - DVT - or Amniotic
Vitamin K (aqua myphiton)

8. Where should you place your stethescope to find the pulmonic valve?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
One large emboli (smaller=better)
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Second Left intercostal space

9. What should you teach your patient about an electrocardiogram (ECG)?
Only for a few hours
Pulmonary edema
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
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

10. What is important to remember when taking care of patients with compression devices?
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.
Protamine Sulfate
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

11. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Air embolism
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

12. What is the treatment for myocardial infarction?
An inflammation of the pericardium. It may result in MI.
Fat - Air - DVT - or Amniotic
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

13. What signals an elevated venous pressure based on the internal jugular veins?
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.
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
Old truck driver or someone on bed rest or with pelvic trauma.
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.

14. What is the nursing care associated with chemical stress tests (persantine stress test)?
Only for a few hours
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!
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
Patient who are unable to tolerate exercise stress testing.

15. For which heart sounds should the bell be used?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

16. What are the steps for infant 1&2 rescuer CPR?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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

17. What is CVP? Normal?
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Direct current cardioversion and digoxin/propranolol (inderal).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

18. What should you teach someone after they have had a pacemaker placed?

19. Where is the apex/mitral valve landmark on the chest?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Second left intercostal space
Fourth or fifth intercostal space at or medial to the midclavicular line.

20. What should you explain to the patient about an impedance cardiography test?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Open up blood vessels

21. How long is contrast media in the body?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
Air answers (open junctions)
Only for a few hours

22. What is superior vena cava syndrome?
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.

23. Where should you place your stethescope to find the tricuspid valve?
Second Right intercostal space.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
4th left intercostal space lower sternal border
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

24. What should you remember while taking care of someone with a peripheral arterial occlusion?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
An enlarged space indicates fluid accumulation in the pericardial sac.
No radial artery punctures if negative
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

25. What are the steps to perform the heimlich maneuver?
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
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.
Old truck driver or someone on bed rest or with pelvic trauma.
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.

26. Where should you place your stethescope to find the aortic valve?
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
Second Right intercostal space.
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.
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. Which type of patient shouldn't take nitrates?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

28. What is intermittent claudication?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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 nosebleed
An inflammation of the pericardium. It may result in MI.

29. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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

30. What is characteristic of ventricular fibrillation?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
To inhibit thrombus and clot formation.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

31. What landmarks should you be looking for on someone's chest?
Lowers BP and makes heart beat stronger. SE: flushed face.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Left sternal border

32. 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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Second Right intercostal space.

33. What is epistaxis?
Lung disease
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
A nosebleed
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

34. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
Direct current cardioversion and digoxin/propranolol (inderal).

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

36. What is the hallmark clinical finding associated with pericarditis?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(S1 - S2) Third left intercostal space

37. A femoral artery compression device ______be assigned to an NA?
Second left intercostal space
Whether the patients ulnar and radial arteries are patent.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Cannot

38. What is characteristic of premature ventricular contractions?
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.)
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.
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.

39. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

40. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

41. What should you do if the PTT value is 80 for someone on heparin?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
D/C the med and call the doctor.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

42. What does a swan ganz measure?
No radial artery punctures if negative
Air answers (open junctions)
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

43. 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?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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

44. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
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.
Lower left sternal border
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

45. What is labile hypertension?
BP is elevated or decreased depending on activity.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

46. What should a patient do if they feel chest pain or discomfort?
D/C the med and call the doctor.
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
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

47. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
0.5-2.0 ng/ml
Chronic arteriosclerotic disease.

48. What does an Allen's test determine?
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Whether the patients ulnar and radial arteries are patent.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

49. 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).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

50. What are the nursing interventions for a patient with premature ventricular contractions?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Activity intolerance