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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 are the S&S of air embolism?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
To inhibit thrombus and clot formation.

2. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Chronic arteriosclerotic disease.
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

3. What are the nursing interventions for a patient in complete heart block?
One large emboli (smaller=better)
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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).

4. What is pulsus paradoxus?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
NO NSAIDS or ASA.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.

5. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
Pneumothorax and will end up with chest tube to help reinflate lung.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

6. What landmarks should you be looking for on someone's chest?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

7. What are the S&S of pulmonary embolism?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
To inhibit thrombus and clot formation.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

8. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Second left intercostal space
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

9. What lab value is used to evaluate a patient on coumadin? What is the normal value?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.
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.
Left sternal border

10. What is the treatment for a pt. with ventricular tachycardia?
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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

11. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
To inhibit thrombus and clot formation.
Feeling warm (fire) or tin can taste is expected and will pass.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

12. Test ending in Gram=?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Chronic arteriosclerotic disease.
Iodine
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

13. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Iodine
In the first 72 hours!!!!!
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

14. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.

15. What does an Allen's test determine?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
An inflammation of the pericardium. It may result in MI.
Whether the patients ulnar and radial arteries are patent.

16. What is epistaxis?
4th left intercostal space lower sternal border
Chronic arteriosclerotic disease.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A nosebleed

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

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18. Where should you place your stethescope to find the mitral (apex) valve?
Patient who are unable to tolerate exercise stress testing.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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
Fifth left intercostal space medial to the midclavicular line.

19. What are the steps for adult 2 rescuer CPR?
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.
One large emboli (smaller=better)
Rescuer arrives with AED - turn AED on - select proper pads and apply - clear victim to analyze - clear victim to shock/press shock - resume chest compressions after 1 shock - delivers cycle of compressions at correct rate - pause to allow other resc
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

20. What is the treatment for a patient in complete heart block?
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.
One at a time to assess the pulse amplitude and contour.
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

21. When should you be concerned about premature ventricular contraction?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Whether the patients ulnar and radial arteries are patent.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

22. In what locations should you not place electrodes?
To inhibit thrombus and clot formation.
In fatty areas or over major muscles - large breasts - or bony prominences.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

23. What are the S&S of superior vena cava syndrome?
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
Second left intercostal space

24. What are common risk factors for an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

25. What should you go when applying nitroglycerin ointment for angina?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Pneumothorax and will end up with chest tube to help reinflate lung.
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

26. What should be done for someone on bleeding precautions?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
An enlarged space indicates fluid accumulation in the pericardial sac.

27. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

28. What drugs are most commonly used for angina?
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.
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.
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.)
Nitrates - Beta blockers - and Calcium channel blockers

29. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
Lung disease
BP is elevated or decreased depending on activity.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

30. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Idiopathic
D/C the med and call the doctor.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.

31. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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.
Cannot
Air embolism
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

32. What will a leg with arterial insufficiency look like?
Chronic arteriosclerotic disease.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
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!

33. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
BP is elevated or decreased depending on activity.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

34. What are the steps for adult/child 1 rescuer CPR?
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.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Lower left sternal border

35. What is cardioversion?

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36. What is a therapeutic digoxin level?
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.
0.5-2.0 ng/ml
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.

37. What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
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.
Fat - Air - DVT - or Amniotic

38. What is defibrillation?
Poorly controlled hypertension
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.
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.
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

39. A femoral artery compression device ______be assigned to an NA?
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.
Cannot
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
BP is elevated or decreased depending on activity.

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

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41. What are the nursing interventions for a patient with premature ventricular contractions?
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Feeling warm (fire) or tin can taste is expected and will pass.

42. 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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

43. What does a swan ganz measure?
Poorly controlled hypertension
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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

44. Where is the pulmonic valve landmark on the chest?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Air answers (open junctions)
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
Second left intercostal space

45. Without prompt surgery for an aortic dissection What is someone at risk for developing?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

46. Where is the aortic valve landmark on the chest?
Second right intercostal space
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

47. What should be done immediately if a pulmonary embolism is suspected?
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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

48. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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49. What should you observe for in someone on bleeding precautions?
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.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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).

50. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Open up blood vessels
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.
Don't interfere!
An enlarged space indicates fluid accumulation in the pericardial sac.

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NCLEX Cardiac

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