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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?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

2. What is epistaxis?
Chronic arteriosclerotic 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
A nosebleed
Lower left sternal border

3. What factors place you at risk for HTN?
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
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

4. How does the blood flow through the heart? (valves?)
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!
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.
Don't interfere!
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

5. What are the steps to perform the heimlich maneuver?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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
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.

6. What is the nursing care associated with chemical stress tests (persantine stress test)?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Direct current cardioversion and digoxin/propranolol (inderal).
Right atrium - TRICUSPID VALVE (tissue) - right ventricle - PULMONIC VALVE (paper) - lungs - left atrium - MITRAL VALVE (My) - left ventricle - AORTIC VALVE (Assets). Tissue PAPER MY ASSETS!
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va

7. How should you palpate the carotid arteries?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
One at a time to assess the pulse amplitude and contour.

8. What is the treatment for myocardial infarction?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Fifth left intercostal space medial to the midclavicular line.

9. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
Before
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Only for a few hours

10. What are the S&S of aortic dissection?
Poorly controlled hypertension
4th left intercostal space lower sternal border
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
No radial artery punctures if negative

11. What is Raynauds disease? Tx?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
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.
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.

12. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
In the first 72 hours!!!!!

13. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

14. What is superior vena cava syndrome?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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).
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.
An enlarged space indicates fluid accumulation in the pericardial sac.

15. Where is the right ventricle landmark on the chest?
Left sternal border
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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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

16. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Chronic arteriosclerotic disease.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

17. What is a chemical stress test (persantine stress test)?
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
D/C the med and call the doctor.
D/C the med and call the doctor.

18. What can result from left sided heart failure if left untreated?
Second left intercostal space
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Fifth left intercostal space medial to the midclavicular line.
Pulmonary edema

19. What is the hallmark clinical finding associated with pericarditis?
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.

20. What is the treatment for atrial fibrillation?
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Direct current cardioversion and digoxin/propranolol (inderal).
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.

21. What would make someone more at risk for digoxin toxicity?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Don't interfere!
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

22. When should bleeding precautions be implemented?
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
D/C the med and call the doctor.

23. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
File toe nails - if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

24. During an Allen's test don't compress one artery _____ the other.
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
Before
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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

25. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Before
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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

26. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Don't interfere!
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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

27. How do you prepare a patient for Impedance cardiography monitoring?
4th left intercostal space lower sternal border
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
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.

28. What will be the treatment for an acute episode of life threatening tamponade?
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Pulmonary edema

29. What are common risk factors for an MI?
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

30. What does the device for impedance cardiography consist of?
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
Steroid treatment or a pregnant woman who is retaining water.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

31. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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).
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.
Lower left sternal border
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

32. 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.
A nosebleed
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

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

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34. What type of EKG change indicates MI?
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)
Feeling warm (fire) or tin can taste is expected and will pass.
Idiopathic

35. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
An inflammation of the pericardium. It may result in MI.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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

36. What should you tell someone about taking nitroglycerin tablets (SE)?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

37. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Feeling warm (fire) or tin can taste is expected and will pass.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
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.

38. What should you teach your patient about MRI?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
Feeling warm (fire) or tin can taste is expected and will pass.
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

39. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
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.

40. What type of surgery is done for an aortic dissection?
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 damaged portion of the aorta is removed and is repaired with a synthetic graft.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

41. Should the tubing for a venous access port be included under the dressing site?

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42. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
ST segment elevation (STEMI)
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

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

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44. Where is the aortic valve landmark on the chest?
Second right intercostal space
No radial artery punctures if negative
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

45. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Second Right intercostal space.

46. Where should you place your stethescope to find the ERB's Point?
BP is elevated or decreased depending on activity.
No radial artery punctures if negative
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
(S1 - S2) Third left intercostal space

47. What is the antidote for heparin?
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.
Protamine Sulfate
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

48. What are the 2 types of pacemakers?
Feeling warm (fire) or tin can taste is expected and will pass.
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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-

49. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Second left intercostal space
Chronic arteriosclerotic disease.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

50. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.