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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 are coumadin and heparin used for?
Second left intercostal space
To inhibit thrombus and clot formation.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Idiopathic

2. How does the blood flow through the heart? (valves?)
Second Left intercostal space
One at a time to assess the pulse amplitude and contour.
Right sided heart failure
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!

3. What should you do immediately if you suspect someone of developing a hematoma?
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
Idiopathic
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.
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

4. What is the antidote for coumadin?
Air answers (open junctions)
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Vitamin K (aqua myphiton)

5. What makes the symptoms of superior vena cava syndrome better? Worse?
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
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

6. Which type of patient shouldn't take nitrates?
Fat - Air - DVT - or Amniotic
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
One large emboli (smaller=better)

7. What should you do if you are going to ventilate someone with an ambu bag?
Vitamin K (aqua myphiton)
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.
Direct current cardioversion and digoxin/propranolol (inderal).
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

8. What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

9. If a victim is choking but can cough - speak - or breath what should you do?

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10. What should a patient do if they feel chest pain or discomfort?
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.
Vascular - artery disease causing fluid to back up into the lungs.
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

11. What does an Allen's test determine?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Whether the patients ulnar and radial arteries are patent.
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.
Old truck driver or someone on bed rest or with pelvic trauma.

12. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Second left intercostal space
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

13. What is angina? Stable vs. unstable?

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14. What should you teach your patient about an exercise ECG (stress test)?
Close the open catheter lumen with the clamp - and place the pt on their left side in trendelenburg to move the air embolus away from the pulmonic valve. If you hear a churning sound in his chest (a classic sign of air embolus) and the patient starts
It 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-
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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

15. What should be done immediately for someone with PE?
Nitrates - Beta blockers - and Calcium channel blockers
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
0.5-2.0 ng/ml

16. For which heart sounds should the diaphragm be used?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

17. 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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
Old truck driver or someone on bed rest or with pelvic trauma.

18. What should be checked in a patient on a beta blocker?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Pulse before and after giving.
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

19. During an Allen's test don't compress one artery _____ the other.
Vascular - artery disease causing fluid to back up into the lungs.
Patient who are unable to tolerate exercise stress testing.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Before

20. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

21. What is intermittent claudication?
Air embolism
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.
Second right intercostal space
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

22. What should you teach someone about iodine?
Air answers (open junctions)
Feeling warm (fire) or tin can taste is expected and will pass.
An inflammation of the pericardium. It may result in MI.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

23. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

24. What are the two common complications of pericarditis?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
Idiopathic

25. What is characteristic of atrial fibrillation?
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Air answers (open junctions)
Before

26. What is superior vena cava syndrome?
Whether the patients ulnar and radial arteries are patent.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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.
Nitrates - Beta blockers - and Calcium channel blockers

27. What is a assessment finding with DVT?

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28. For which heart sounds should the bell be used?
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.
Must be flushed 1x/month with heparin and between treatments.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Protamine Sulfate

29. What is CVP? Normal?
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Must be flushed 1x/month with heparin and between treatments.

30. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

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

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32. What is epistaxis?
Chronic arteriosclerotic disease.
A nosebleed
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.
An enlarged space indicates fluid accumulation in the pericardial sac.

33. What factors place you at risk for HTN?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.

34. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

35. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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.
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Include rest periods prior to any activity.

36. What is Deep Vein Thrombosis (DVT)?
Whether the patients ulnar and radial arteries are patent.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
To inhibit thrombus and clot formation.
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

37. What are the S&S of aortic dissection?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

38. What is the hallmark clinical finding associated with pericarditis?
Lung disease
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.
Only for a few hours
Iodine

39. What would make someone more at risk for digoxin toxicity?
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.
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Lower left sternal border

40. What is the correct way to insert an oropharyngeal airway?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

41. What body systems are affected by digoxin toxicity? S&S?
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
Second Left intercostal space
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Pulmonary edema

42. What needs to be held during the placement of a femoral artery compression device?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
NO NSAIDS or ASA.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

43. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.)
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Right sided heart failure

44. What type of EKG change indicates MI?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Don't interfere!
Old truck driver or someone on bed rest or with pelvic trauma.
ST segment elevation (STEMI)

45. What should be done for someone on bleeding precautions?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

46. In what locations should you not place electrodes?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
In fatty areas or over major muscles - large breasts - or bony prominences.
If feel more than 3 shocks in a row or develop signs of infection at the site.
To inhibit thrombus and clot formation.

47. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Before
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

48. Where should you place your stethescope to find the aortic valve?
Fat - Air - DVT - or Amniotic
Second Right intercostal space.
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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

49. What are signs and symptoms of an MI?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Activity intolerance
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

50. What is a good diagnosis for someone with right sided HF?
BP is elevated or decreased depending on activity.
Second Right intercostal space.
Activity intolerance
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-