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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 is a therapeutic digoxin level?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
0.5-2.0 ng/ml

2. What are the treatments/ S&S of peripheral venous disease?
0.5-2.0 ng/ml
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

3. Where is the aortic valve landmark on the chest?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
Second right intercostal space

4. What should you teach your patient about MRI?
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
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

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

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6. What are the proper steps to changing a central venous catheter dressing?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
No radial artery punctures if negative
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

7. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Right sided heart failure

8. What causes essential/primary hypertension?
Right sided heart failure
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Idiopathic
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

9. What should you do if you are going to ventilate someone with an ambu bag?
Patient who are unable to tolerate exercise stress testing.
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
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

10. What is the treatment for a patient in complete heart block?
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

11. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

12. What is an acute peripheral arterial occlusion?
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
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!
Only for a few hours
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

13. What are the steps for infant 1&2 rescuer CPR?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The internal jugular veins (external are less reliable).
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

14. What should you teach your patient about a cardiac catheterization?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Second Left intercostal space
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
Iodine

15. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
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 reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
One at a time to assess the pulse amplitude and contour.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

16. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
The internal jugular veins (external are less reliable).
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

17. What could happen without immediate intervention for a hematoma?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The patient may suffer significant blood loss or femoral nerve compression.
Pulmonary edema

18. What are common risk factors for an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches

19. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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
Vascular - artery disease causing fluid to back up into the lungs.

20. What can result from left sided heart failure if left untreated?
An enlarged space indicates fluid accumulation in the pericardial sac.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Pulmonary edema

21. What is pulsus paradoxus?
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

22. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
Lower left sternal border
Air embolism
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

23. Who would most likely have peripheral venous disease?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Old truck driver or someone on bed rest or with pelvic trauma.
Feeling warm (fire) or tin can taste is expected and will pass.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

24. What is characteristic of ventricular tachycardia?
In fatty areas or over major muscles - large breasts - or bony prominences.
Air embolism
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.

25. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
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.

26. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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 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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

27. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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.
ST segment elevation (STEMI)
An enlarged space indicates fluid accumulation in the pericardial sac.

28. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Whether the patients ulnar and radial arteries are patent.
Fifth left intercostal space medial to the midclavicular line.
Air embolism
Vitamin K (aqua myphiton)

29. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
In fatty areas or over major muscles - large breasts - or bony prominences.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

30. What is characteristic of premature ventricular contractions?
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.
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.
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
Second Left intercostal space

31. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
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.
ST segment elevation (STEMI)
In the first 72 hours!!!!!

32. What is important to remember when taking care of patients with compression devices?
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

33. What is an aortic dissection?

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34. What drugs are most commonly used for angina?
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.
Nitrates - Beta blockers - and Calcium channel blockers
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.
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.

35. Where do the internal jugular veins lie?
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Include rest periods prior to any activity.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

36. 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.
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
D/C the med and call the doctor.

37. What type of EKG change indicates MI?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
D/C the med and call the doctor.
ST segment elevation (STEMI)

38. What are the S&S of air embolism?
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

39. In what locations should you not place electrodes?
Pulse before and after giving.
In fatty areas or over major muscles - large breasts - or bony prominences.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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

40. What is cardioversion?

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41. What are the signs and symptoms of left sided HF?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

42. 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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
0.5-2.0 ng/ml
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

43. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.)
Air embolism

44. A femoral artery compression device ______be assigned to an NA?
Include rest periods prior to any activity.
An inflammation of the pericardium. It may result in MI.
Must be flushed 1x/month with heparin and between treatments.
Cannot

45. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
Second Right intercostal space.
NO because it isn't sterile so keep out.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

46. What do calcium channel blockers do?
Open up blood vessels
NO NSAIDS or ASA.
Maintain BED REST
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.

47. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Don't interfere!

48. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Maintain BED REST

49. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

50. What is characteristic of ventricular fibrillation?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Steroid treatment or a pregnant woman who is retaining water.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.