NCLEX Cardiac

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?
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).


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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


3. What would make someone more at risk for digoxin toxicity?
Only for a few hours
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.
Patient who are unable to tolerate exercise stress testing.


4. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Pneumothorax and will end up with chest tube to help reinflate lung.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Air embolism
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.


5. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Fifth left intercostal space medial to the midclavicular line.


6. What should be immediately done for a patient experiencing digoxin toxicity?
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
Right sided heart failure
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!


7. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Right sided heart failure
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


8. What should you do if you are going to ventilate someone with an ambu bag?
An enlarged space indicates fluid accumulation in the pericardial sac.
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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


9. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
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).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)


10. What is a transthoracic echocardiograph (TTE)?
(S1 - S2) Third left intercostal space
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
No radial artery punctures if negative


11. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
Only for a few hours
(S1 - S2) Third left intercostal space


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).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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 TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


13. For which heart sounds should the bell be used?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L


14. What are the treatments/ S&S of peripheral venous disease?
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
4th left intercostal space lower sternal border
Patient who are unable to tolerate exercise stress testing.


15. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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. What should you teach your patient about an abdominal ultrasonography?
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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
BP is elevated or decreased depending on activity.


17. How is the Allen's test done?
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
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 patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.


18. What type of surgery is done for an aortic dissection?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


19. What should you go when applying nitroglycerin ointment for angina?
Patient who are unable to tolerate exercise stress testing.
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
Fifth left intercostal space medial to the midclavicular line.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


20. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
In fatty areas or over major muscles - large breasts - or bony prominences.
An enlarged space indicates fluid accumulation in the pericardial sac.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).


21. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Right sided heart failure
If feel more than 3 shocks in a row or develop signs of infection at the site.


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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


23. What is cardiac tamponade? Common causes?
Lowers BP and makes heart beat stronger. SE: flushed face.
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
One at a time to assess the pulse amplitude and contour.


24. What should a patient do if they feel chest pain or discomfort?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
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
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.


25. What places someone at risk for an aortic dissection?
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.
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.
Poorly controlled hypertension
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.


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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


27. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
Air embolism
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Protamine Sulfate


28. What signals an elevated venous pressure based on the internal jugular veins?
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.
NO because it isn't sterile so keep out.
To inhibit thrombus and clot formation.
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


29. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.


30. What is intermittent claudication?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.


31. What are the steps for infant 1&2 rescuer CPR?
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-
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
One at a time to assess the pulse amplitude and contour.
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


32. What are the proper steps to changing a central venous catheter dressing?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


34. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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
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.
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.


35. What things should you do to assess cardiovascular status?
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.


36. How should you palpate the apical pulse?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
To inhibit thrombus and clot formation.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.


37. Test ending in Gram=?
D/C the med and call the doctor.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Iodine


38. What does the device for impedance cardiography consist of?
Right sided heart failure
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
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.


39. What will be the treatment for an acute episode of life threatening tamponade?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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


40. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Maintain BED REST
Poorly controlled hypertension
One at a time to assess the pulse amplitude and contour.
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.


41. Where should you place your stethescope to find the tricuspid valve?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
4th left intercostal space lower sternal border
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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


42. In What time period is the greatest risk of sudden death from an MI?
Pneumothorax and will end up with chest tube to help reinflate lung.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
In the first 72 hours!!!!!
BP is elevated or decreased depending on activity.


43. What are common risk factors for an MI?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
In fatty areas or over major muscles - large breasts - or bony prominences.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.


44. What are the two common complications of pericarditis?
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Lower left sternal border


45. What should you teach someone with arterial insufficiency?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


46. What landmarks should you be looking for on someone's chest?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
The patient may suffer significant blood loss or femoral nerve compression.
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


47. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Idiopathic
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-
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.


48. What are the S&S of air embolism?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.


49. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
Patient who are unable to tolerate exercise stress testing.
An inflammation of the pericardium. It may result in MI.
Fourth or fifth intercostal space at or medial to the midclavicular line.


50. What is characteristic of ventricular tachycardia?
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.
One large emboli (smaller=better)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.