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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 factors place you at risk for HTN?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
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.

2. What would make someone more at risk for digoxin toxicity?
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.
Maintain BED REST
Lung disease
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

3. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

4. 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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
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

5. Where is the tricuspid valve landmark on the chest?
Old truck driver or someone on bed rest or with pelvic trauma.
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.
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.
Lower left sternal border

6. 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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
4th left intercostal space lower sternal border

7. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.

8. What should you do if the PT value is 45 sec?
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
D/C the med and call the doctor.
Feeling warm (fire) or tin can taste is expected and will pass.

9. What are the S&S of aortic dissection?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Air answers (open junctions)
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

10. 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
Use sterile gloves and aseptic technique - clean skin over port with alcohol or iodine - insert a 21 or 22 gauge HUBER needle (noncoring - won't break apart) attached to syringe or tubing into the middle of the port until rigid back of port is palpab
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

11. What are examples of calcium channel blockers?
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
Steroid treatment or a pregnant woman who is retaining water.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

12. 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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
An inflammation of the pericardium. It may result in MI.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

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

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14. What is the maintenance for venous access port that isn't being regularly used?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Must be flushed 1x/month with heparin and between treatments.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

15. What is a chemical stress test (persantine stress test)?
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
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
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.
Second Right intercostal space.

16. What are common risk factors for an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Idiopathic
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

17. What is pericarditis?
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
An inflammation of the pericardium. It may result in MI.
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-
If feel more than 3 shocks in a row or develop signs of infection at the site.

18. What is an aortic dissection?

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19. What should you go when applying nitroglycerin ointment for angina?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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
To inhibit thrombus and clot formation.
Fourth or fifth intercostal space at or medial to the midclavicular line.

20. What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
NO because it isn't sterile so keep out.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
NO NSAIDS or ASA.

21. How long is contrast media in the body?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Only for a few hours
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

22. What are the treatments/ S&S of peripheral venous disease?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Old truck driver or someone on bed rest or with pelvic trauma.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

23. What should you do immediately if you suspect someone of developing a hematoma?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Lung disease
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.

24. What should you teach your patient about an electrocardiogram (ECG)?
Don't interfere!
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
One at a time to assess the pulse amplitude and contour.
Activity intolerance

25. What causes secondary hypertension?
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.
Steroid treatment or a pregnant woman who is retaining water.
Vitamin K (aqua myphiton)
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

26. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Old truck driver or someone on bed rest or with pelvic trauma.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.
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.

27. What is pulsus paradoxus?
Open up blood vessels
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

28. What is the hallmark clinical finding associated with pericarditis?
NO NSAIDS or ASA.
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.
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.
Open up blood vessels

29. What is the treatment for someone with right sided HF? How do you know working?
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
Must be flushed 1x/month with heparin and between treatments.
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

30. What is the purpose of compression devices?
Right sided heart failure
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
4th left intercostal space lower sternal border

31. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
Fifth left intercostal space medial to the midclavicular line.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.

32. What is the treatment for a patient in complete heart block?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Open up blood vessels
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

33. What is cardioversion?

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34. Where is the apex/mitral valve landmark on the chest?
An inflammation of the pericardium. It may result in MI.
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Fourth or fifth intercostal space at or medial to the midclavicular line.

35. What is labile hypertension?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Second Left intercostal space
BP is elevated or decreased depending on activity.
Left sternal border

36. What does the device for impedance cardiography consist of?
NO NSAIDS or ASA.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.

37. What should you explain to the patient about an impedance cardiography test?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

38. What is the treatment for myocardial infarction?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
The patient may suffer significant blood loss or femoral nerve compression.
NO because it isn't sterile so keep out.

39. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
An enlarged space indicates fluid accumulation in the pericardial sac.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

40. What are the S&S of air embolism?
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.
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

41. What can result from left sided heart failure if left untreated?
Pulmonary edema
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.)
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

42. What does plan of care include?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.
The patient may suffer significant blood loss or femoral nerve compression.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

43. What should you remember while taking care of someone with a peripheral arterial occlusion?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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-
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).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

44. What are the steps for adult/child 1 rescuer CPR?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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
Maintain BED REST
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

45. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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).

46. What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
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-
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
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.

47. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
They may feel a slight stinging under there tongue when they are dissolving - and they should get a HA (if no HA may not be good bc the pills only last for 6 months). Keep with you at all times.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.

48. How does the blood flow through the heart? (valves?)
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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 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.

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

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50. What is a good diagnosis for someone with 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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
Activity intolerance