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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 body systems are affected by digoxin toxicity? S&S?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Steroid treatment or a pregnant woman who is retaining water.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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

2. Where should you place your stethescope to find the aortic valve?
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
Left sternal border
Second Right intercostal space.
Feeling warm (fire) or tin can taste is expected and will pass.

3. What landmarks should you be looking for on someone's chest?
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
NO NSAIDS or ASA.

4. What type of surgery is done for an aortic dissection?
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
Pulmonary edema
Second Left intercostal space
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

5. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Feeling warm (fire) or tin can taste is expected and will pass.
Second Right intercostal space.
NO NSAIDS or ASA.
Maintain BED REST

6. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Second Right intercostal space.
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.
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

7. For which heart sounds should the bell be used?
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.

8. What should you do if the PT value is 45 sec?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
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.
D/C the med and call the doctor.

9. What factors place you at risk for HTN?
Poorly controlled hypertension
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

10. What are the nursing interventions for a patient in atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Left sternal border
No radial artery punctures if negative
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

11. What should you remember while taking care of someone with a peripheral arterial occlusion?
Only for a few hours
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

12. During an Allen's test don't compress one artery _____ the other.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
Before
Protamine Sulfate

13. What are the signs and symptoms of left sided HF?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
One large emboli (smaller=better)
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
In fatty areas or over major muscles - large breasts - or bony prominences.

14. What should you teach someone about iodine?
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.
Old truck driver or someone on bed rest or with pelvic trauma.
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
Feeling warm (fire) or tin can taste is expected and will pass.

15. What are the S&S of superior vena cava syndrome?
Second right intercostal space
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.
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
Pulmonary edema

16. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
One at a time to assess the pulse amplitude and contour.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

17. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Pulse before and after giving.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

18. What should be done immediately if a pulmonary embolism is suspected?
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.
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).
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
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

19. What usually triggers angina pain?
Nitrates - Beta blockers - and Calcium channel blockers
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

20. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.

21. How does the blood flow through the heart? (valves?)
The internal jugular veins (external are less reliable).
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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!
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.

22. What are the nursing interventions for a patient with premature ventricular contractions?
Air embolism
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

23. What is the most common cause of arterial insufficiency?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Chronic arteriosclerotic disease.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
One large emboli (smaller=better)

24. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.

25. How is angina treated?

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26. What is characteristic of ventricular tachycardia?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Maintain BED REST
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

27. How should you palpate the carotid arteries?
No radial artery punctures if negative
ST segment elevation (STEMI)
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
One at a time to assess the pulse amplitude and contour.

28. What should you watch for with PICC lines that have been in place for 6 months?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Air answers (open junctions)
Lower left sternal border
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.

29. What are the 2 types of pacemakers?
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.
Pulse before and after giving.
Open up blood vessels
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

30. What is Raynauds disease? Tx?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
NO NSAIDS or ASA.
Must be flushed 1x/month with heparin and between treatments.

31. What should you do if you are going to ventilate someone with an ambu bag?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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

32. What is an air embolism?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
One at a time to assess the pulse amplitude and contour.

33. 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
To inhibit thrombus and clot formation.
In fatty areas or over major muscles - large breasts - or bony prominences.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

34. How is the Allen's test done?
Direct current cardioversion and digoxin/propranolol (inderal).
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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

35. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Lower left sternal border
Include rest periods prior to any activity.
NO because it isn't sterile so keep out.
Pulse before and after giving.

36. What is an aortic dissection?

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37. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
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.
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
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

38. What is the treatment for myocardial infarction?
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
NO because it isn't sterile so keep out.

39. What signals an elevated venous pressure based on the internal jugular veins?
Air embolism
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.
Fifth left intercostal space medial to the midclavicular line.

40. What is the antidote for heparin?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Air embolism
0.5-2.0 ng/ml
Protamine Sulfate

41. What causes essential/primary hypertension?
Idiopathic
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Must be flushed 1x/month with heparin and between treatments.
Fat - Air - DVT - or Amniotic

42. What are the S&S of pulmonary embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

43. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Patient who are unable to tolerate exercise stress testing.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.

44. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Patient who are unable to tolerate exercise stress testing.
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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.

45. What is the treatment for premature ventricular contractions?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

46. What are examples of calcium channel blockers?
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.
Chronic arteriosclerotic disease.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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

47. What makes the symptoms of superior vena cava syndrome better? Worse?
(S1 - S2) Third left intercostal space
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.
Pulmonary edema
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

48. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Maintain BED REST
D/C the med and call the doctor.

49. What causes secondary hypertension?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Steroid treatment or a pregnant woman who is retaining water.
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.

50. When should bleeding precautions be implemented?
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.
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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