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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. Where should you place your stethescope to find the pulmonic valve?
Whether the patients ulnar and radial arteries are patent.
Second Left intercostal space
An enlarged space indicates fluid accumulation in the pericardial sac.
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.

2. What should you always assume with a patient who has a central line placed and is experiencing SOB?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Air embolism
Vascular - artery disease causing fluid to back up into the lungs.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

3. What are the proper steps to changing a central venous catheter dressing?
Lower left sternal border
NO because it isn't sterile so keep out.
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

4. What are the nursing interventions for a patient in complete heart block?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Iodine
Second Right intercostal space.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

5. 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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

6. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Second Left intercostal space
Lowers BP and makes heart beat stronger. SE: flushed face.
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

7. What signals an elevated venous pressure based on the internal jugular veins?
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.
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.

8. Where should you place your stethescope to find the ERB's Point?
4th left intercostal space lower sternal border
(S1 - S2) Third left intercostal space
No radial artery punctures if negative
If feel more than 3 shocks in a row or develop signs of infection at the site.

9. 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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.

10. What is pulsus paradoxus?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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 drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

11. What causes essential/primary hypertension?
Idiopathic
Pneumothorax and will end up with chest tube to help reinflate lung.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

12. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

13. A femoral artery compression device ______be assigned to an NA?
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Iodine
Cannot

14. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

15. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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
Second left intercostal space
Right sided heart failure
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.

16. What are all the S&S of pericarditis?
ST segment elevation (STEMI)
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

17. 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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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
Chronic arteriosclerotic disease.

18. In what locations should you not place electrodes?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
In fatty areas or over major muscles - large breasts - or bony prominences.
Iodine

19. 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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.

20. What SE should you look for with calcium channel blocker use?
Iodine
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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

21. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

22. What should be done for someone on bleeding precautions?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Right sided heart failure
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

23. What should happen if someone converts to asystole/flatline?
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

24. What are the S&S of pulmonary embolism?
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

25. How is the Allen's test done?
An enlarged space indicates fluid accumulation in the pericardial sac.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

26. What body systems are affected by digoxin toxicity? S&S?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Pulse before and after giving.
Right sided heart failure
D/C the med and call the doctor.

27. What should you teach someone with arterial insufficiency?

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28. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
Before
NO NSAIDS or ASA.
Air answers (open junctions)

29. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Air embolism
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

30. What type of EKG change indicates MI?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
ST segment elevation (STEMI)
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 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

31. What are the steps for adult/child 1 rescuer CPR?
Check for response - activate ERS and AED - open airway with head tilt chin lift - checking breathing (5-10 sec) - give 2 breaths (1 sec each) - check carotid pulse (5-10 sec) - locate CPR hand position - deliver first cycle of compressions (30 compr
Vitamin K (aqua myphiton)
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.
Right sided heart failure

32. What is the correct way to insert an oropharyngeal airway?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
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.
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.

33. What will be the treatment for an acute episode of life threatening tamponade?
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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
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

34. What are the indications for a chemical stress test (persantine stress test)?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Patient who are unable to tolerate exercise stress testing.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

35. What should you explain to the patient about an impedance cardiography test?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
Protamine Sulfate
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

36. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Second Left intercostal space
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

37. What do calcium channel blockers do?
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.)
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Open up blood vessels
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

38. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Vascular - artery disease causing fluid to back up into the lungs.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

39. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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
In fatty areas or over major muscles - large breasts - or bony prominences.
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.

40. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
Lower left sternal border
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

41. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Lung disease
The internal jugular veins (external are less reliable).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Open up blood vessels

42. Where should you place your stethescope to find the tricuspid valve?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
BP is elevated or decreased depending on activity.
Air embolism
4th left intercostal space lower sternal border

43. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Maintain BED REST

44. What could happen without immediate intervention for a hematoma?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
The patient may suffer significant blood loss or femoral nerve compression.
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

45. What should you teach a patient regarding discharge after a DVT?

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46. What should you teach your patient about angiography (arteriography)?
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

47. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Patient who are unable to tolerate exercise stress testing.

48. What is the antidote for heparin?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Protamine Sulfate
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.
Include rest periods prior to any activity.

49. What can result from left sided heart failure if left untreated?
Awake and alert: IV lidocaine bolus and drip Unconscious - hypotensive - or S&S of angina/CHF: Direct current cardioversion and IV Lidocaine bolus and drip.
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Pulmonary edema

50. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Pneumothorax and will end up with chest tube to help reinflate lung.
In the first 72 hours!!!!!
No radial artery punctures if negative