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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. What should you watch for with PICC lines that have been in place for 6 months?
Second right intercostal space
Air answers (open junctions)
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.
BP is elevated or decreased depending on activity.

3. What are the nursing interventions for a patient in atrial fibrillation?
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Left sternal border
The internal jugular veins (external are less reliable).

4. What should you do to treat pulmonary edema?
Second Left intercostal space
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
(S1 - S2) Third left intercostal space
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

5. What should you do if the PT value is 45 sec?
Lung disease
D/C the med and call the doctor.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
BP is elevated or decreased depending on activity.

6. What can result from left sided heart failure if left untreated?
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
Pulmonary edema
Cannot

7. What is the maintenance for venous access port that isn't being regularly used?
The patient may suffer significant blood loss or femoral nerve compression.
ST segment elevation (STEMI)
Must be flushed 1x/month with heparin and between treatments.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

8. What does an Allen's test determine?
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.)
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Whether the patients ulnar and radial arteries are patent.

9. What is a transthoracic echocardiograph (TTE)?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Air answers (open junctions)
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

10. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Fifth left intercostal space medial to the midclavicular line.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.

11. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.

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

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13. What is an aortic dissection?

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14. What should you teach your patient about angiography (arteriography)?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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

15. What is labile hypertension?
Chronic arteriosclerotic disease.
In fatty areas or over major muscles - large breasts - or bony prominences.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
BP is elevated or decreased depending on activity.

16. 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.
Cannot
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

17. What is pulsus paradoxus?
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.
One large emboli (smaller=better)
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
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

18. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Include rest periods prior to any activity.

19. 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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Before

20. What is the nursing care associated with chemical stress tests (persantine stress test)?
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
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

21. What should you tell someone about taking nitroglycerin tablets (SE)?
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-
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
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

22. During an Allen's test don't compress one artery _____ the other.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Before
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

23. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Must be flushed 1x/month with heparin and between treatments.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

24. For which heart sounds should the bell be used?
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
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

25. What is pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
An inflammation of the pericardium. It may result in MI.

26. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Pneumothorax and will end up with chest tube to help reinflate lung.
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

27. 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
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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

28. What is characteristic of premature ventricular contractions?
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.
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
Steroid treatment or a pregnant woman who is retaining water.

29. What is the treatment for myocardial infarction?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

30. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
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
Cannot
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

31. How do you prepare a patient for Impedance cardiography monitoring?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
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
To inhibit thrombus and clot formation.

32. What is an acute peripheral arterial occlusion?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Must be flushed 1x/month with heparin and between treatments.

33. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
BP is elevated or decreased depending on activity.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

34. What is Raynauds disease? Tx?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
No radial artery punctures if negative

35. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
Vascular - artery disease causing fluid to back up into the lungs.
Iodine
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.

36. What is intermittent claudication?
NO because it isn't sterile so keep out.
Fifth left intercostal space medial to the midclavicular line.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.

37. What should be done immediately for someone with PE?
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Fifth left intercostal space medial to the midclavicular line.

38. What are the proper steps to changing a central venous catheter dressing?
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

39. What is a good diagnosis for someone with right sided HF?
Activity intolerance
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.
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
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.

40. What is the treatment for atrial fibrillation?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Direct current cardioversion and digoxin/propranolol (inderal).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
An enlarged space indicates fluid accumulation in the pericardial sac.

41. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Right sided heart failure
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

42. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Lung disease
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
If feel more than 3 shocks in a row or develop signs of infection at the site.

43. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
An inflammation of the pericardium. It may result in MI.
4th left intercostal space lower sternal border
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

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

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45. What should you do if you are going to ventilate someone with an ambu bag?
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
Include rest periods prior to any activity.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

46. What are the four types of pulmonary emboli?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Fat - Air - DVT - or Amniotic
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

47. In What time period is the greatest risk of sudden death from an MI?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
4th left intercostal space lower sternal border
In the first 72 hours!!!!!

48. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Idiopathic
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

49. When would a nurse use an external femoral artery compression device?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Fourth or fifth intercostal space at or medial to the midclavicular line.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

50. Where is the apex/mitral valve landmark on the chest?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.