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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 causes essential/primary hypertension?
Idiopathic
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
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

2. Where is the tricuspid valve landmark on the chest?
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
Lower left sternal border
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

3. What is a good diagnosis for someone with right sided HF?
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
Activity intolerance
0.5-2.0 ng/ml
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

4. What should you do immediately if you suspect someone of developing a hematoma?
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
Air embolism
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.

5. What would make someone more at risk for digoxin toxicity?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

6. What should you teach your patient about an exercise ECG (stress test)?
No radial artery punctures if negative
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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-
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

7. What needs to be held during the placement of a femoral artery compression device?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Steroid treatment or a pregnant woman who is retaining water.
NO NSAIDS or ASA.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

8. What is the treatment for atrial fibrillation?
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
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.
Direct current cardioversion and digoxin/propranolol (inderal).
ST segment elevation (STEMI)

9. For which heart sounds should the diaphragm be used?
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
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.

10. What is an air embolism?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

11. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Right sided heart failure
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

12. 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?
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.
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

13. How do you prepare a patient for Impedance cardiography monitoring?
Before
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

14. How is angina treated?

15. What is a nursing diagnosis for arterial occlusion? Tx
Iodine
NO NSAIDS or ASA.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Second right intercostal space

16. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
The internal jugular veins (external are less reliable).
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.
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

17. What are the S&S of air embolism?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Second Left intercostal space
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

18. What should you watch for with PICC lines that have been in place for 6 months?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Cannot
In fatty areas or over major muscles - large breasts - or bony prominences.
Air answers (open junctions)

19. Where should you place your stethescope to find the ERB's Point?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
(S1 - S2) Third left intercostal space
Pulse before and after giving.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

20. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Include rest periods prior to any activity.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
ST segment elevation (STEMI)

21. What should you not allow if a patient has a negative Allen's test?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
No radial artery punctures if negative
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.)

22. Test ending in Gram=?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Iodine
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

23. Where should you place your stethescope to find the mitral (apex) valve?
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
Fat - Air - DVT - or Amniotic
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Fifth left intercostal space medial to the midclavicular line.

24. What factors place you at risk for HTN?
0.5-2.0 ng/ml
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.
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.
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

25. What is angina? Stable vs. unstable?

26. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
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 they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

27. What is CVP? Normal?
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

28. What SE should you look for with calcium channel blocker use?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Left sternal border

29. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Chronic arteriosclerotic disease.
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

30. What should you do if the PT value is 45 sec?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
D/C the med and call the doctor.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.

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

32. What is defibrillation?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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
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.
Second Left intercostal space

33. What are the nursing interventions for a patient in complete heart block?
Include rest periods prior to any activity.
D/C the med and call the doctor.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

34. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Before
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).
Cannot
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.

35. What is a transthoracic echocardiograph (TTE)?
NO because it isn't sterile so keep out.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

36. When should bleeding precautions be implemented?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Pulse before and after giving.
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.

37. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
One large emboli (smaller=better)
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.

38. What are the steps to perform the heimlich maneuver?
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.

39. How does the blood flow through the heart? (valves?)
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.
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!
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

40. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Vascular - artery disease causing fluid to back up into the lungs.

41. 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.
An inflammation of the pericardium. It may result in MI.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

42. What should you teach your patient about an abdominal ultrasonography?
Right sided heart failure
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Only for a few hours

43. What can result from left sided heart failure if left untreated?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
Pulmonary edema
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

44. What should you explain to the patient about an impedance cardiography test?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

45. What should be done immediately for someone with PE?
ST segment elevation (STEMI)
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.

46. Where should you place your stethescope to find the aortic valve?
Whether the patients ulnar and radial arteries are patent.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Second Right intercostal space.
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

47. What should a patient do if they feel chest pain or discomfort?
NO NSAIDS or ASA.
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.

48. During an Allen's test don't compress one artery _____ the other.
One at a time to assess the pulse amplitude and contour.
Activity intolerance
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
Before

49. What are the S&S of cardiac tamponade?
4th left intercostal space lower sternal border
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.

50. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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.
Vitamin K (aqua myphiton)
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
4th left intercostal space lower sternal border