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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 does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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

2. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Must be flushed 1x/month with heparin and between treatments.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

3. What is labile hypertension?
BP is elevated or decreased depending on activity.
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
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
Don't interfere!

4. What needs to be held during the placement of a femoral artery compression device?
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
NO NSAIDS or ASA.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

5. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Right sided heart failure
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

6. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

7. What things should you do to assess cardiovascular status?
In fatty areas or over major muscles - large breasts - or bony prominences.
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.

8. What condition can cause left sided heart failure?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Vascular - artery disease causing fluid to back up into the lungs.
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
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.

9. 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?
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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!

10. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

11. What is impedance cardiography?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

12. What is characteristic of complete heart block?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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-
Pulse before and after giving.

13. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
The internal jugular veins (external are less reliable).
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.
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

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

15. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
NO because it isn't sterile so keep out.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
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.

16. How is the Allen's test done?
BP is elevated or decreased depending on activity.
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

17. Without prompt surgery for an aortic dissection What is someone at risk for developing?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.

18. Where should you place your stethescope to find the tricuspid valve?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.
4th left intercostal space lower sternal border
A nosebleed

19. What SE should you look for with calcium channel blocker use?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Iodine
Lowers BP and makes heart beat stronger. SE: flushed face.

20. What is INR?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

21. What is a assessment finding with DVT?

22. What does vasotec (Enalapril Maleate) do/SE?
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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

23. How do you prepare a patient for Impedance cardiography monitoring?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
An inflammation of the pericardium. It may result in MI.
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

24. What type of surgery is done for an aortic dissection?
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.
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.
(S1 - S2) Third left intercostal space
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

25. What are the nursing interventions for a patient in complete heart block?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
ST segment elevation (STEMI)
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

26. What is a therapeutic digoxin level?
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
Left sternal border
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
0.5-2.0 ng/ml

27. What could happen without immediate intervention for a hematoma?
Fat - Air - DVT - or Amniotic
To inhibit thrombus and clot formation.
The patient may suffer significant blood loss or femoral nerve compression.
Before

28. How should you palpate the carotid arteries?
Air answers (open junctions)
One at a time to assess the pulse amplitude and contour.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

29. What should you observe for in someone on bleeding precautions?
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.
Poorly controlled hypertension
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).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

30. What are the steps for adult/child 1 rescuer CPR?
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
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 nosebleed
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

31. What is the purpose of compression devices?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Idiopathic
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

32. What is an acute peripheral arterial occlusion?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Lower left sternal border

33. What should you go when applying nitroglycerin ointment for angina?
Second Right intercostal space.
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
Activity intolerance
Open up blood vessels

34. What should you do when applying a femoral artery compression device?
NO because it isn't sterile so keep out.
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

35. What are the proper steps to changing a central venous catheter dressing?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
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

36. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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
An inflammation of the pericardium. It may result in MI.
Don't interfere!
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

37. What is characteristic of ventricular fibrillation?
Air embolism
Second Right intercostal space.
In fatty areas or over major muscles - large breasts - or bony prominences.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

38. When should bleeding precautions be implemented?
The internal jugular veins (external are less reliable).
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

39. What are the S&S of cardiac tamponade?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.
Activity intolerance

40. What are the nursing interventions for a pt. with ventricular tachycardia?
Don't interfere!
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

41. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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).
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

42. What are the four types of pulmonary emboli?
ST segment elevation (STEMI)
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Fat - Air - DVT - or Amniotic
Air answers (open junctions)

43. What causes secondary hypertension?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Steroid treatment or a pregnant woman who is retaining water.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

44. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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!
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

45. Where do the internal jugular veins lie?
One large emboli (smaller=better)
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

46. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
The internal jugular veins (external are less reliable).
Protamine Sulfate
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

47. What should you teach your patient about a holter monitor?

48. What should you teach a patient regarding discharge after a DVT?

49. What should you teach someone about iodine?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
If feel more than 3 shocks in a row or develop signs of infection at the site.
Feeling warm (fire) or tin can taste is expected and will pass.
Pulmonary edema

50. What is Deep Vein Thrombosis (DVT)?
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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Second left intercostal space
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.