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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 the nursing interventions for a patient in complete heart block?
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

2. What are the nursing interventions for a patient in atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Direct current cardioversion and digoxin/propranolol (inderal).
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.

3. Who would most likely have peripheral venous disease?
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
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
Old truck driver or someone on bed rest or with pelvic trauma.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

4. What is the goal of treatment for an MI? Treatment?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Lung disease
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

5. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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

6. What should be done immediately for someone with PE?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
No radial artery punctures if negative
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

7. What can result from left sided heart failure if left untreated?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Pulmonary edema
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Fifth left intercostal space medial to the midclavicular line.

8. What is a assessment finding with DVT?

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9. How should you palpate the apical pulse?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Vitamin K (aqua myphiton)
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

10. What is characteristic of ventricular fibrillation?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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

11. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
In fatty areas or over major muscles - large breasts - or bony prominences.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Include rest periods prior to any activity.

12. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

13. What should you teach someone with arterial insufficiency?

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14. What could happen without immediate intervention for a hematoma?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
The patient may suffer significant blood loss or femoral nerve compression.

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

16. What should you teach your patient about an exercise ECG (stress test)?
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-
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
Lower left sternal border

17. What are the S&S of aortic dissection?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Iodine

18. What is pulsus paradoxus?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Left sternal border
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

19. What type of surgery is done for an aortic dissection?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

20. What is Raynauds disease? Tx?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

21. What should you do immediately if you suspect someone of developing a hematoma?
Patient who are unable to tolerate exercise stress testing.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

22. What is defibrillation?
Lower left sternal border
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
D/C the med and call the doctor.
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.

23. 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?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
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.
Patient who are unable to tolerate exercise stress testing.

24. Where is the aortic valve landmark on the chest?
Pneumothorax and will end up with chest tube to help reinflate lung.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Second right intercostal space
Iodine

25. What is a good diagnosis for someone with right sided HF?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Activity intolerance
Fat - Air - DVT - or Amniotic
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

26. What should be checked in a patient on a beta blocker?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Pulse before and after giving.
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

27. What is CVP? Normal?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Old truck driver or someone on bed rest or with pelvic trauma.
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.

28. What is the antidote for heparin?
Protamine Sulfate
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Vascular - artery disease causing fluid to back up into the lungs.

29. What does an Allen's test determine?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Lower left sternal border
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Whether the patients ulnar and radial arteries are patent.

30. How should you palpate the carotid arteries?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
One at a time to assess the pulse amplitude and contour.

31. What is cardiac tamponade? Common causes?
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
Right sided heart failure
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.
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

32. A femoral artery compression device ______be assigned to an NA?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Poorly controlled hypertension
Cannot
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

33. What is the treatment for premature ventricular contractions?
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
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
In the first 72 hours!!!!!

34. How long is contrast media in the body?
4th left intercostal space lower sternal border
Feeling warm (fire) or tin can taste is expected and will pass.
Only for a few hours
Poorly controlled hypertension

35. What is more harmful a lot of little emboli or one large emboli?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
One large emboli (smaller=better)
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

36. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Direct current cardioversion and digoxin/propranolol (inderal).
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

37. What are the S&S of cardiac tamponade?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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

38. What should you teach your patient about MRI?
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
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

39. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.

40. What should you do if you are going to ventilate someone with an ambu bag?
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
Left sternal border
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
Don't interfere!

41. What are examples of calcium channel blockers?
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
Pneumothorax and will end up with chest tube to help reinflate lung.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Fat - Air - DVT - or Amniotic

42. What should you teach your patient about an abdominal ultrasonography?
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
One at a time to assess the pulse amplitude and contour.
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.

43. Where is the pulmonic valve landmark on the chest?
In the first 72 hours!!!!!
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
Second left intercostal space

44. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
A nosebleed
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
Second Right intercostal space.
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

45. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Must be flushed 1x/month with heparin and between treatments.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Right sided heart failure

46. What should you do if the PT value is 45 sec?
4th left intercostal space lower sternal border
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.
D/C the med and call the doctor.
To inhibit thrombus and clot formation.

47. What is the hallmark clinical finding associated with pericarditis?
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
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Include rest periods prior to any activity.

48. What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Vitamin K (aqua myphiton)
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.

49. How is the Allen's test done?
Open up blood vessels
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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

50. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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