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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 should you tell a patient who developed a hematoma in the hospital and is being discharged?
Must be flushed 1x/month with heparin and between treatments.
Nitrates - Beta blockers - and Calcium channel blockers
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.
Steroid treatment or a pregnant woman who is retaining water.

2. 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?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
If feel more than 3 shocks in a row or develop signs of infection at the site.

3. Test ending in Gram=?
Second Right intercostal space.
Iodine
One at a time to assess the pulse amplitude and contour.
Cannot

4. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
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) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
Lower left sternal border

5. What does the device for impedance cardiography consist of?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
A monitor with four dual electrodes that are applied to the patients neck and thorax.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Cannot

6. 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?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.

7. What is the treatment for atrial fibrillation?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
Direct current cardioversion and digoxin/propranolol (inderal).
Lower left sternal border

8. What should you do if you are going to ventilate someone with an ambu bag?
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
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.
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.
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.

9. What are the nursing interventions for a pt. with ventricular tachycardia?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

10. What is superior vena cava syndrome?
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 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 NSAIDS or ASA.
An inflammation of the pericardium. It may result in MI.

11. What usually triggers angina pain?
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
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.
Air answers (open junctions)
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

12. What are the steps for adult 2 rescuer CPR?
To inhibit thrombus and clot formation.
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
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
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.

13. What is the treatment for someone in ventricular fibrillation?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Right sided heart failure
0.5-2.0 ng/ml
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

14. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

15. Where is the right ventricle landmark on the chest?
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
Second right intercostal space
Left sternal border
Air embolism

16. What things should you do to assess cardiovascular status?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Must be flushed 1x/month with heparin and between treatments.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

17. What are the S&S of aortic dissection?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
An inflammation of the pericardium. It may result in MI.
Second right intercostal space

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

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19. What are the signs and symptoms of left sided HF?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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

20. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Lowers BP and makes heart beat stronger. SE: flushed face.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

21. What is a transthoracic echocardiograph (TTE)?
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
Maintain BED REST
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

22. What is the most common cause of arterial insufficiency?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Cannot
Nitrates - Beta blockers - and Calcium channel blockers
Chronic arteriosclerotic disease.

23. Where should you place your stethescope to find the pulmonic valve?
Cannot
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.
Second Left intercostal space
Lower left sternal border

24. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
Poorly controlled hypertension
Include rest periods prior to any activity.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

25. What is the correct way to insert an oropharyngeal airway?
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!
Pneumothorax and will end up with chest tube to help reinflate lung.
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
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the

26. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Maintain BED REST
Lung disease
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.

27. What should you do immediately if you suspect someone of developing a hematoma?
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.
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.
4th left intercostal space lower sternal border
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

28. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
An inflammation of the pericardium. It may result in MI.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
(S1 - S2) Third left intercostal space
Right sided heart failure

29. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Vascular - artery disease causing fluid to back up into the lungs.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

30. Where is the pulmonic valve landmark on the chest?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Second left intercostal space
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

31. What are the S&S of cardiac tamponade?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

32. What should you teach your patient about angiography (arteriography)?
The patient may suffer significant blood loss or femoral nerve compression.
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
Vitamin K (aqua myphiton)
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

33. What is the antidote for coumadin?
D/C the med and call the doctor.
Pulmonary edema
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Vitamin K (aqua myphiton)

34. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
Include rest periods prior to any activity.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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

35. What makes the symptoms of superior vena cava syndrome better? Worse?
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!
Second Left intercostal space
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

36. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

37. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Right sided heart failure
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
Lower left sternal border

38. What places someone at risk for an aortic dissection?
Whether the patients ulnar and radial arteries are patent.
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.
Poorly controlled hypertension
Activity intolerance

39. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Only for a few hours
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

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

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41. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Second right intercostal space
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

42. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
4th left intercostal space lower sternal border

43. What is characteristic of complete heart block?
Air embolism
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-
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

44. What should you do if the PTT value is 80 for someone on heparin?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
No radial artery punctures if negative
D/C the med and call the doctor.

45. Where is the aortic valve landmark on the chest?
Second right intercostal space
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

46. What should you teach your patient about MRI?
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
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.
Pulse before and after giving.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

47. What could happen without immediate intervention for a hematoma?
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 patient may suffer significant blood loss or femoral nerve compression.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.

48. What should you do if the PT value is 45 sec?
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.
D/C the med and call the doctor.
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!
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

49. What SE should you look for with calcium channel blocker use?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Lowers BP and makes heart beat stronger. SE: flushed face.

50. What is an acute peripheral arterial occlusion?
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).