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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 the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Direct current cardioversion and digoxin/propranolol (inderal).
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Chronic arteriosclerotic disease.

2. 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?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
4th left intercostal space lower sternal border
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

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

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4. What are the S&S of cardiac tamponade?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

5. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
Pulmonary edema
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

6. For what disease should you do the Allen's test?

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7. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Only for a few hours

8. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
ST segment elevation (STEMI)
Activity intolerance
A monitor with four dual electrodes that are applied to the patients neck and thorax.

9. What is important to remember when removing a CVC from a patient?
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.
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.
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
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.

10. What are the S&S of pulmonary embolism?
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

11. What is an air embolism?
Iodine
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
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.

12. What is the treatments for hypertension?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Second left intercostal space
Maintain BED REST
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.

13. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Maintain BED REST
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
NO because it isn't sterile so keep out.

14. What should be done immediately for someone with PE?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Vitamin K (aqua myphiton)
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

15. What is the treatment for myocardial infarction?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

16. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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!
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.

17. What are the four types of pulmonary emboli?
Feeling warm (fire) or tin can taste is expected and will pass.
Old truck driver or someone on bed rest or with pelvic trauma.
Vitamin K (aqua myphiton)
Fat - Air - DVT - or Amniotic

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

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19. What is an acute peripheral arterial occlusion?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Vascular - artery disease causing fluid to back up into the lungs.
BP is elevated or decreased depending on activity.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

20. What are the treatments/ S&S of peripheral venous disease?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Before
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

21. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
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.
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

22. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Pulmonary edema
Direct current cardioversion and digoxin/propranolol (inderal).
The internal jugular veins (external are less reliable).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

23. Where should you place your stethescope to find the tricuspid valve?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
4th left intercostal space lower sternal border

24. What needs to be held during the placement of a femoral artery compression device?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
NO NSAIDS or ASA.
Fat - Air - DVT - or Amniotic
Don't interfere!

25. How long is contrast media in the body?
A nosebleed
Only for a few hours
Left sternal border
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

26. What is a major complication of central line placement?
Pneumothorax and will end up with chest tube to help reinflate lung.
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
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.
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.

27. What are signs and symptoms of an MI?
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.
Second left intercostal space
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
The patient may suffer significant blood loss or femoral nerve compression.

28. What are examples of calcium channel blockers?
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.)
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
(S1 - S2) Third left intercostal space

29. Where should you place your stethescope to find the aortic valve?
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.)
Direct current cardioversion and digoxin/propranolol (inderal).
Second Right intercostal space.
4th left intercostal space lower sternal border

30. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Second right intercostal space
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

31. What is characteristic of premature ventricular contractions?
ST segment elevation (STEMI)
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.

32. What should you explain to the patient about an impedance cardiography test?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

33. In What time period is the greatest risk of sudden death from an MI?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
In fatty areas or over major muscles - large breasts - or bony prominences.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
In the first 72 hours!!!!!

34. 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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Feeling warm (fire) or tin can taste is expected and will pass.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

35. Which type of patient shouldn't take nitrates?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
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 patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

36. What are the S&S of aortic dissection?
Nitrates - Beta blockers - and Calcium channel blockers
Old truck driver or someone on bed rest or with pelvic trauma.
One large emboli (smaller=better)
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

37. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

38. Where is the aortic valve landmark on the chest?
Second right intercostal space
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Left sternal border

39. What are the S&S associated with right sided heart failure?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

40. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
If feel more than 3 shocks in a row or develop signs of infection at the site.
One at a time to assess the pulse amplitude and contour.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

41. What does vasotec (Enalapril Maleate) do/SE?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Lowers BP and makes heart beat stronger. SE: flushed face.

42. What is impedance cardiography?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
An inflammation of the pericardium. It may result in MI.
Left sternal border
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

43. What are the nursing interventions for a patient in atrial fibrillation?
D/C the med and call the doctor.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

44. What disease can cause right sided heart failure?
Pulmonary edema
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Lung disease
A monitor with four dual electrodes that are applied to the patients neck and thorax.

45. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
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

46. What do calcium channel blockers do?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
D/C the med and call the doctor.
Open up blood vessels
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

47. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
ST segment elevation (STEMI)
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.)

48. What causes essential/primary hypertension?
Idiopathic
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
In the first 72 hours!!!!!
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

49. Test ending in Gram=?
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
Iodine
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.
Air embolism

50. 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?
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
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Vitamin K (aqua myphiton)