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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 is a transthoracic echocardiograph (TTE)?
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.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

2. What should you go when applying nitroglycerin ointment for angina?
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

3. What should be done immediately if a pulmonary embolism is suspected?
BP is elevated or decreased depending on activity.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

4. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

5. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Whether the patients ulnar and radial arteries are patent.
Direct current cardioversion and digoxin/propranolol (inderal).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

6. What should you do if the PT value is 45 sec?
Air answers (open junctions)
D/C the med and call the doctor.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

7. What is impedance cardiography?
The internal jugular veins (external are less reliable).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

8. What is an air embolism?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
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.

9. What landmarks should you be looking for on someone's chest?
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
The patient may suffer significant blood loss or femoral nerve compression.

10. What type of surgery is done for an aortic dissection?
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 because it isn't sterile so keep out.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.

11. What are the S&S of 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.
To inhibit thrombus and clot formation.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
In fatty areas or over major muscles - large breasts - or bony prominences.

12. What are the indications for a chemical stress test (persantine stress test)?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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
Patient who are unable to tolerate exercise stress testing.

13. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Second left intercostal space
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

14. What should you teach someone with arterial insufficiency?

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15. How should you palpate the carotid arteries?
An enlarged space indicates fluid accumulation in the pericardial sac.
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
One at a time to assess the pulse amplitude and contour.
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.

16. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Second Left intercostal space
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
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

17. What is more harmful a lot of little emboli or one large emboli?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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
One large emboli (smaller=better)
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

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

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19. What are the steps for adult/child 1 rescuer CPR?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
One at a time to assess the pulse amplitude and contour.
NO because it isn't sterile so keep out.
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

20. What are the signs and symptoms of left sided HF?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.
Open up blood vessels
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

21. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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).
Whether the patients ulnar and radial arteries are patent.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

22. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
A monitor with four dual electrodes that are applied to the patients neck and thorax.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Direct current cardioversion and digoxin/propranolol (inderal).

23. What is a major complication of central line placement?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Nitrates - Beta blockers - and Calcium channel blockers
Fat - Air - DVT - or Amniotic
Pneumothorax and will end up with chest tube to help reinflate lung.

24. What should you watch for with PICC lines that have been in place for 6 months?
Fifth left intercostal space medial to the midclavicular line.
Air answers (open junctions)
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

25. What is a chemical stress test (persantine stress test)?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
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

26. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

27. What can result from left sided heart failure if left untreated?
Pulmonary edema
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

28. What are common risk factors for an MI?
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
No radial artery punctures if negative

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

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30. What are the S&S of aortic dissection?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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

31. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
Cannot
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
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.

32. What needs to be held during the placement of a femoral artery compression device?
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
NO NSAIDS or ASA.

33. What is the most common cause of arterial insufficiency?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Chronic arteriosclerotic disease.
One at a time to assess the pulse amplitude and contour.

34. What is cardiac tamponade? Common causes?
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
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
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
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

35. What should you teach your patient about an electrocardiogram (ECG)?
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.
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
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.
An enlarged space indicates fluid accumulation in the pericardial sac.

36. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Protamine Sulfate
Chronic arteriosclerotic disease.
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

37. What should you teach your patient about a cardiac catheterization?
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.
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

38. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
In fatty areas or over major muscles - large breasts - or bony prominences.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.

39. Where should you place your stethescope to find the mitral (apex) valve?
Iodine
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
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.
Fifth left intercostal space medial to the midclavicular line.

40. What should you remember while taking care of someone with a peripheral arterial occlusion?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

41. What could happen without immediate intervention for a hematoma?
Vascular - artery disease causing fluid to back up into the lungs.
The patient may suffer significant blood loss or femoral nerve compression.
Air embolism
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

42. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Include rest periods prior to any activity.
Lowers BP and makes heart beat stronger. SE: flushed face.
Activity intolerance
One large emboli (smaller=better)

43. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Right sided heart failure
An enlarged space indicates fluid accumulation in the pericardial sac.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

44. What is important to remember when removing a CVC from a patient?
Steroid treatment or a pregnant woman who is retaining water.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
An inflammation of the pericardium. It may result in MI.

45. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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 right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
No radial artery punctures if negative
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

46. What type of EKG change indicates MI?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.
ST segment elevation (STEMI)
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

47. What is cardioversion?

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48. What is the treatment for a pt. with ventricular tachycardia?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Open up blood vessels

49. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
D/C the med and call the doctor.

50. What is the purpose of compression devices?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.