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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 will be the treatment for an acute episode of life threatening tamponade?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
D/C the med and call the doctor.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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

2. What is labile hypertension?
Open up blood vessels
BP is elevated or decreased depending on activity.
Protamine Sulfate
Activity intolerance

3. What should you remember while taking care of someone with a peripheral arterial occlusion?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

4. What should you watch for with PICC lines that have been in place for 6 months?
Chronic arteriosclerotic disease.
Air answers (open junctions)
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
NO because it isn't sterile so keep out.

5. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Cannot
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

6. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

7. What are the indications for a chemical stress test (persantine stress test)?
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Patient who are unable to tolerate exercise stress testing.
Protamine Sulfate

8. Where is the aortic valve landmark on the chest?
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
Second right intercostal space
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

9. What should you teach your patient about an abdominal ultrasonography?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

10. What should be checked in a patient on a beta blocker?
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
Pneumothorax and will end up with chest tube to help reinflate lung.
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
Pulse before and after giving.

11. What are the nursing interventions for a patient in atrial fibrillation?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.

12. What should you teach your patient about an exercise ECG (stress test)?
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
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-
Pneumothorax and will end up with chest tube to help reinflate lung.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

13. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
Must be flushed 1x/month with heparin and between treatments.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.

14. What is superior vena cava syndrome?
NO NSAIDS or ASA.
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

15. What is Deep Vein Thrombosis (DVT)?
Iodine
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Maintain BED REST
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.

16. How should you palpate the apical pulse?
Fifth left intercostal space medial to the midclavicular line.
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

17. For which heart sounds should the diaphragm be used?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

18. What is an air embolism?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

19. What should be immediately done for a patient experiencing digoxin toxicity?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

20. What are the S&S of aortic dissection?
Include rest periods prior to any activity.
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Must be flushed 1x/month with heparin and between treatments.

21. What are signs and symptoms of an MI?
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-
Old truck driver or someone on bed rest or with pelvic trauma.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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

22. What is the treatment for someone in ventricular fibrillation?
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Must be flushed 1x/month with heparin and between treatments.
An inflammation of the pericardium. It may result in MI.

23. What are coumadin and heparin used for?
Iodine
To inhibit thrombus and clot formation.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

24. How is angina treated?

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25. What causes essential/primary hypertension?
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!
Fifth left intercostal space medial to the midclavicular line.
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.
Idiopathic

26. What things should you do to assess cardiovascular status?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
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

27. Where should you place your stethescope to find the mitral (apex) valve?
Second left intercostal space
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).
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
Fifth left intercostal space medial to the midclavicular line.

28. What is a major complication of central line placement?
The patient may suffer significant blood loss or femoral nerve compression.
Pneumothorax and will end up with chest tube to help reinflate lung.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Idiopathic

29. Where is the tricuspid valve landmark on the chest?
Don't interfere!
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
Lower left sternal border

30. When would a nurse use an external femoral artery compression device?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

31. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
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-
Pulmonary edema
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

32. What are common risk factors for an MI?
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
Whether the patients ulnar and radial arteries are patent.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

33. What type of EKG change indicates MI?
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
ST segment elevation (STEMI)
Only for a few hours

34. How do you prepare a patient for Impedance cardiography monitoring?
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
Lowers BP and makes heart beat stronger. SE: flushed face.
Nitrates - Beta blockers - and Calcium channel blockers
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.

35. What drugs are most commonly used for angina?
Maintain BED REST
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Nitrates - Beta blockers - and Calcium channel blockers
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

36. What are the S&S of air embolism?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

37. What are the S&S of superior vena cava syndrome?
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
In the first 72 hours!!!!!
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

38. What should you teach your patient about angiography (arteriography)?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
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

39. A femoral artery compression device ______be assigned to an NA?
Cannot
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
D/C the med and call the doctor.
Direct current cardioversion and digoxin/propranolol (inderal).

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

41. What are the 2 types of pacemakers?
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
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.
NO because it isn't sterile so keep out.
Iodine

42. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Right sided heart failure
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Don't interfere!
Air answers (open junctions)

43. Who would most likely have peripheral venous disease?
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Old truck driver or someone on bed rest or with pelvic trauma.
To inhibit thrombus and clot formation.

44. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Feeling warm (fire) or tin can taste is expected and will pass.
Fifth left intercostal space medial to the midclavicular line.
The internal jugular veins (external are less reliable).
Include rest periods prior to any activity.

45. What is the maintenance for venous access port that isn't being regularly used?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Must be flushed 1x/month with heparin and between treatments.
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
Second left intercostal space

46. What is the treatment for myocardial infarction?
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.
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

47. What needs to be held during the placement of a femoral artery compression device?
Activity intolerance
Vitamin K (aqua myphiton)
NO NSAIDS or ASA.
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

48. Where should you place your stethescope to find the tricuspid valve?
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
4th left intercostal space lower sternal border
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

49. What are the nursing interventions for a pt. with ventricular tachycardia?
An enlarged space indicates fluid accumulation in the pericardial sac.
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).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

50. What is cardioversion?

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NCLEX Cardiac

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