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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 should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Iodine
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

2. What SE should you look for with calcium channel blocker use?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Pulse before and after giving.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

3. What are the S&S of aortic dissection?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

4. What are all the S&S of pericarditis?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

5. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

6. What should you teach your patient about angiography (arteriography)?
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
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
NO because it isn't sterile so keep out.
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

7. How do you prepare a patient for Impedance cardiography monitoring?
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea
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
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.
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

8. What should you teach your patient about an exercise ECG (stress test)?
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
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-
Fat - Air - DVT - or Amniotic

9. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
Elderly - hypothyroidism - renal dysfunction - dehydration - HYPOKALEMIA - hypomagnesemia - or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

10. What are the steps for infant 1&2 rescuer CPR?
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!
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
The internal jugular veins (external are less reliable).

11. What is a good diagnosis for someone with right sided HF?
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
Activity intolerance
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Direct current cardioversion and digoxin/propranolol (inderal).

12. What should you do if you are going to ventilate someone with an ambu bag?
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
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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

13. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Protamine Sulfate
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.

14. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
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.
Steroid treatment or a pregnant woman who is retaining water.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

15. What is the treatment for atrial fibrillation?
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.
Direct current cardioversion and digoxin/propranolol (inderal).
No radial artery punctures if negative
Second Left intercostal space

16. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Left sternal border
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

17. 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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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

18. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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
Maintain BED REST
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

19. How should you palpate the carotid arteries?
Old truck driver or someone on bed rest or with pelvic trauma.
The internal jugular veins (external are less reliable).
One at a time to assess the pulse amplitude and contour.
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.

20. What is more harmful a lot of little emboli or one large emboli?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Nitrates - Beta blockers - and Calcium channel blockers
One large emboli (smaller=better)
No radial artery punctures if negative

21. 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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

22. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
One at a time to assess the pulse amplitude and contour.
Include rest periods prior to any activity.
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.
Don't interfere!

23. What are the nursing interventions for a pt. with ventricular tachycardia?
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

24. In what locations should you not place electrodes?
Elderly - hypothyroidism - renal dysfunction - dehydration - HYPOKALEMIA - hypomagnesemia - or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.
Air answers (open junctions)
In fatty areas or over major muscles - large breasts - or bony prominences.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

25. What should you teach someone with arterial insufficiency?

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26. When should you be concerned about premature ventricular contraction?
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
ST segment elevation (STEMI)

27. Where is the aortic valve landmark on the chest?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Second right intercostal space
The internal jugular veins (external are less reliable).

28. What does the device for impedance cardiography consist of?
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Include rest periods prior to any activity.

29. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

30. Should the tubing for a venous access port be included under the dressing site?

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31. What are the 2 types of pacemakers?
Poorly controlled hypertension
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.
The internal jugular veins (external are less reliable).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

32. What should a patient do if they feel chest pain or discomfort?
Air embolism
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
Second Right intercostal space.
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.

33. Where is the pulmonic valve landmark on the chest?
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.
Second left intercostal space
Second Right intercostal space.
Idiopathic

34. What landmarks should you be looking for on someone's chest?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

35. What are the nursing interventions for a patient with premature ventricular contractions?
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 will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Protamine Sulfate

36. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Second left intercostal space
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

37. What should happen if someone converts to asystole/flatline?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Steroid treatment or a pregnant woman who is retaining water.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

38. Where should you place your stethescope to find the mitral (apex) valve?
A nosebleed
Fifth left intercostal space medial to the midclavicular line.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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

39. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
A nosebleed
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!
Chronic arteriosclerotic disease.

40. What makes the symptoms of superior vena cava syndrome better? Worse?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
If feel more than 3 shocks in a row or develop signs of infection at the site.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
(S1 - S2) Third left intercostal space

41. For which heart sounds should the bell be used?
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
Before
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

42. What factors place you at risk for HTN?
Activity intolerance
Patient who are unable to tolerate exercise stress testing.
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

43. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.

44. During an Allen's test don't compress one artery _____ the other.
Patient who are unable to tolerate exercise stress testing.
Lower left sternal border
Before
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

45. What is a nursing diagnosis for arterial occlusion? Tx
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Lower left sternal border
(S1 - S2) Third left intercostal space

46. What should be checked in a patient on a beta blocker?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Pulse before and after giving.

47. What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

48. What should be done immediately if a pulmonary embolism is suspected?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

49. What things should you do to assess cardiovascular status?
Pulmonary edema
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

50. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
Whether the patients ulnar and radial arteries are patent.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.