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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 type of EKG change indicates MI?
ST segment elevation (STEMI)
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
In fatty areas or over major muscles - large breasts - or bony prominences.

2. What is pulsus paradoxus?
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
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
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.

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

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4. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

5. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Vascular - artery disease causing fluid to back up into the lungs.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Iodine

6. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

7. What does vasotec (Enalapril Maleate) do/SE?
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.
Lowers BP and makes heart beat stronger. SE: flushed face.
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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.

8. What are the S&S of air embolism?
An inflammation of the pericardium. It may result in MI.
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

9. What should you not allow if a patient has a negative Allen's test?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
No radial artery punctures if negative
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

10. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Before
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

11. What should you do to treat pulmonary edema?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Before
Second right 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

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

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13. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
Right sided heart failure
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

14. What places someone at risk for an aortic dissection?
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
Poorly controlled hypertension
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.

15. What is the treatment for premature ventricular contractions?
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

16. What could happen without immediate intervention for a hematoma?
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.
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
The patient may suffer significant blood loss or femoral nerve compression.
Must be flushed 1x/month with heparin and between treatments.

17. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
0.5-2.0 ng/ml
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
Lung disease

18. What is CVP? Normal?
In fatty areas or over major muscles - large breasts - or bony prominences.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Second left intercostal space
Vascular - artery disease causing fluid to back up into the lungs.

19. What is the antidote for heparin?
Protamine Sulfate
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

20. What does plan of care include?
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.
Open up blood vessels
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.

21. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
No radial artery punctures if negative
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.
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.

22. What are the nursing interventions for a pt. with ventricular tachycardia?
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
In the first 72 hours!!!!!

23. How long is contrast media in the body?
Only for a few hours
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
Pulmonary edema
Air embolism

24. What is a nursing diagnosis for arterial occlusion? Tx
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Only for a few hours

25. What are the signs and symptoms of left sided HF?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

26. What will be the treatment for an acute episode of life threatening tamponade?
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Lowers BP and makes heart beat stronger. SE: flushed face.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

27. What should you teach someone about iodine?
Air answers (open junctions)
Patient who are unable to tolerate exercise stress testing.
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.
Feeling warm (fire) or tin can taste is expected and will pass.

28. What things should you do to assess cardiovascular status?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Air answers (open junctions)

29. What are the two common complications of pericarditis?
Cannot
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

30. What is labile hypertension?
BP is elevated or decreased depending on activity.
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-
Chronic arteriosclerotic disease.
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).

31. Where is the tricuspid valve landmark on the chest?
Lower left sternal border
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.
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

32. What drugs are most commonly used for angina?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Nitrates - Beta blockers - and Calcium channel blockers
Second Right intercostal space.

33. A femoral artery compression device ______be assigned to an NA?
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.
Lung disease
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Cannot

34. What is the treatment for someone in ventricular fibrillation?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

35. What are all the S&S of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Nitrates - Beta blockers - and Calcium channel blockers
Only for a few hours

36. What should you go when applying nitroglycerin ointment for angina?
Lower left sternal border
Activity intolerance
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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

37. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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.
Air embolism
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.
No radial artery punctures if negative

38. What is characteristic of premature ventricular contractions?
Only for a few hours
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.
NO NSAIDS or ASA.
(S1 - S2) Third left intercostal space

39. What should you do if you are going to ventilate someone with an ambu bag?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
One large emboli (smaller=better)

40. What should you teach your patient about a cardiac catheterization?
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.
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
Vitamin K (aqua myphiton)
Protamine Sulfate

41. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
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
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.
Steroid treatment or a pregnant woman who is retaining water.

42. Where should you place your stethescope to find the pulmonic valve?
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
Second Left intercostal space
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

43. What does the device for impedance cardiography consist of?
Must be flushed 1x/month with heparin and between treatments.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
ST segment elevation (STEMI)
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

44. During an Allen's test don't compress one artery _____ the other.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Before
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.

45. What body systems are affected by digoxin toxicity? S&S?
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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

46. How should you palpate the carotid arteries?
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.
One at a time to assess the pulse amplitude and contour.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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

47. What is an acute peripheral arterial occlusion?
Right sided heart failure
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
4th left intercostal space lower sternal border

48. What condition can cause left sided heart failure?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
Vascular - artery disease causing fluid to back up into the lungs.
Maintain BED REST

49. Where is the aortic valve landmark on the chest?
Pulmonary edema
Second right intercostal space
One large emboli (smaller=better)
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

50. What are examples of calcium channel blockers?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Old truck driver or someone on bed rest or with pelvic trauma.