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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 cardioversion?

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2. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Second Right intercostal space.

3. What is a assessment finding with DVT?

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4. What are the five areas for listening to the heart?

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5. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
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
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

6. In What time period is the greatest risk of sudden death from an MI?
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.
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
In the first 72 hours!!!!!
Cannot

7. 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?
Feeling warm (fire) or tin can taste is expected and will pass.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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!
Must be flushed 1x/month with heparin and between treatments.

8. What are the nursing interventions for a patient in complete heart block?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

9. What is superior vena cava syndrome?
Left sternal border
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.
The internal jugular veins (external are less reliable).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

10. What should you watch for with PICC lines that have been in place for 6 months?
Activity intolerance
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
One at a time to assess the pulse amplitude and contour.
Air answers (open junctions)

11. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.

12. What should you observe for in someone on bleeding precautions?
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).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
An enlarged space indicates fluid accumulation in the pericardial sac.
NO because it isn't sterile so keep out.

13. What does a swan ganz measure?
Fat - Air - DVT - or Amniotic
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

14. What is the treatment for someone with right sided HF? How do you know working?
Poorly controlled hypertension
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

15. What usually triggers angina pain?
Open up blood vessels
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Steroid treatment or a pregnant woman who is retaining water.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

16. What are the S&S of aortic dissection?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Activity intolerance
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

17. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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.
Air answers (open junctions)
Maintain BED REST
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.

18. What should you teach your patient about an electrocardiogram (ECG)?
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
If feel more than 3 shocks in a row or develop signs of infection at the site.
D/C the med and call the doctor.

19. What is intermittent claudication?
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
(S1 - S2) Third left intercostal space
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 should a patient do if they feel chest pain or discomfort?
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
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

21. Where is the pulmonic valve landmark on the chest?
Direct current cardioversion and digoxin/propranolol (inderal).
If feel more than 3 shocks in a row or develop signs of infection at the site.
Second left intercostal space
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.

22. 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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Only for a few hours
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

23. For which heart sounds should the bell be used?
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
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.

24. What is the hallmark clinical finding associated with pericarditis?
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
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.
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.
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

25. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Fifth left intercostal space medial to the midclavicular line.
If feel more than 3 shocks in a row or develop signs of infection at the site.

26. When would a nurse use an external femoral artery compression device?
4th left intercostal space lower sternal border
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Chronic arteriosclerotic disease.

27. What is an air embolism?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

28. What are all the S&S of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
To inhibit thrombus and clot formation.
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
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

29. What does an Allen's test determine?
Protamine Sulfate
BP is elevated or decreased depending on activity.
Don't interfere!
Whether the patients ulnar and radial arteries are patent.

30. What should be done immediately for someone with PE?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

31. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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32. What is the treatment for myocardial infarction?
No radial artery punctures if negative
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

33. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

34. What is a nursing diagnosis for arterial occlusion? Tx
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.

35. What are examples of calcium channel blockers?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

36. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
In fatty areas or over major muscles - large breasts - or bony prominences.
NO NSAIDS or ASA.
The internal jugular veins (external are less reliable).
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

37. When should you be concerned about premature ventricular contraction?
To inhibit thrombus and clot formation.
Air embolism
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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

38. What is Raynauds disease? Tx?
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.
Only for a few hours
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!
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

39. What should you do when applying a femoral artery compression device?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Old truck driver or someone on bed rest or with pelvic trauma.
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
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

40. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Open up blood vessels

41. What should you teach someone about iodine?
D/C the med and call the doctor.
Include rest periods prior to any activity.
Second left intercostal space
Feeling warm (fire) or tin can taste is expected and will pass.

42. Where is the aortic valve landmark on the chest?
Second right intercostal space
Protamine Sulfate
Exercise and use graduated compression devices as directed - don't stand for long period of time - to avoid dislodging blood clots don't rub or massage your legs.
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

43. What are the indications for a chemical stress test (persantine stress test)?
0.5-2.0 ng/ml
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Patient who are unable to tolerate exercise stress testing.

44. What do calcium channel blockers do?
NO because it isn't sterile so keep out.
To inhibit thrombus and clot formation.
Open up blood vessels
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

45. What is a good diagnosis for someone with right sided HF?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Activity intolerance
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

46. For which heart sounds should the diaphragm be used?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
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.

47. What should you teach your patient about an abdominal ultrasonography?
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
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
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.
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!

48. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
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.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

49. What is defibrillation?
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.
Air answers (open junctions)
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

50. During an Allen's test don't compress one artery _____ the other.
0.5-2.0 ng/ml
Before
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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-