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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 CVP? Normal?
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!
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

2. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Pneumothorax and will end up with chest tube to help reinflate lung.
Second right intercostal space
Whether the patients ulnar and radial arteries are patent.

3. Which type of patient shouldn't take nitrates?
Direct current cardioversion and digoxin/propranolol (inderal).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Idiopathic
An enlarged space indicates fluid accumulation in the pericardial sac.

4. What is pericarditis?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
An inflammation of the pericardium. It may result in MI.
In fatty areas or over major muscles - large breasts - or bony prominences.

5. What are the steps for infant 1&2 rescuer CPR?
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
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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

6. What is characteristic of complete heart block?
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
Only for a few hours
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

7. Where do the internal jugular veins lie?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Direct current cardioversion and digoxin/propranolol (inderal).

8. Where should you place your stethescope to find the aortic valve?
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.
Second Right intercostal space.
Pulmonary edema
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

9. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
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.
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

10. What is more harmful a lot of little emboli or one large emboli?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
One large emboli (smaller=better)
Lung disease
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

11. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Protamine Sulfate
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD

12. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Lowers BP and makes heart beat stronger. SE: flushed face.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.

13. What is INR?
To inhibit thrombus and clot formation.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

14. What is the antidote for heparin?
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.
Protamine Sulfate
No radial artery punctures if negative
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

15. What is angina? Stable vs. unstable?

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16. What are common risk factors for an MI?
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.)
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Activity intolerance

17. In What time period is the greatest risk of sudden death from an MI?
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.
In the first 72 hours!!!!!
Before
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

18. What do calcium channel blockers do?
Second right intercostal space
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Open up blood vessels
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

19. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
To inhibit thrombus and clot formation.
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.

20. What should you teach your patient about an electrocardiogram (ECG)?
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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-
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 a major complication of central line placement?
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

22. What landmarks should you be looking for on someone's chest?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
One large emboli (smaller=better)
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

23. What are the indications for a chemical stress test (persantine stress test)?
Second left intercostal space
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Patient who are unable to tolerate exercise stress testing.
Must be flushed 1x/month with heparin and between treatments.

24. What is cardioversion?

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25. 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.
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.
Right sided heart failure
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

26. What can result from left sided heart failure if left untreated?
Pulmonary edema
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
Don't interfere!

27. What are the nursing interventions for a pt. with ventricular tachycardia?
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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
Lower left sternal border

28. What is characteristic of atrial fibrillation?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Lung disease
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

29. What should you do if the PTT value is 80 for someone on heparin?
In fatty areas or over major muscles - large breasts - or bony prominences.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
D/C the med and call the doctor.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

30. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
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.
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.
Left sternal border

31. 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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
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
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.

32. For which heart sounds should the bell be used?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Nitrates - Beta blockers - and Calcium channel blockers

33. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

34. What should be done immediately if a pulmonary embolism is suspected?
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
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.
Activity intolerance
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

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

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36. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
One large emboli (smaller=better)
Must be flushed 1x/month with heparin and between treatments.

37. What is the treatment for someone in ventricular fibrillation?
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).
Don't interfere!
Feeling warm (fire) or tin can taste is expected and will pass.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

38. What disease can cause right sided heart failure?
Only for a few hours
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
Lung disease

39. What are the steps for adult 2 rescuer CPR?
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
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.
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

40. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Patient who are unable to tolerate exercise stress testing.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

41. What is the treatment for premature ventricular contractions?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

42. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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.
Activity intolerance
Maintain BED REST
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

43. What are signs and symptoms of an MI?
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!
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

44. How is angina treated?

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45. What is Deep Vein Thrombosis (DVT)?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

46. What should you do if the PT value is 45 sec?
Lung disease
D/C the med and call the doctor.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Second Right intercostal space.

47. What are examples of calcium channel blockers?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

48. What are coumadin and heparin used for?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
To inhibit thrombus and clot formation.

49. What is pulsus paradoxus?
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.

50. What will a leg with arterial insufficiency look like?
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.
Steroid treatment or a pregnant woman who is retaining water.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
NO NSAIDS or ASA.