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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 drugs are most commonly used for angina?
Lung disease
Nitrates - Beta blockers - and Calcium channel blockers
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.

2. 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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
NO NSAIDS or ASA.

3. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
D/C the med and call the doctor.
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
Pulse before and after giving.

4. What should be done immediately for someone with PE?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

5. What is an air embolism?
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.
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

6. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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 internal jugular veins (external are less reliable).
Pulmonary edema
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-

7. What should you teach a patient regarding discharge after a DVT?

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8. How should you palpate the apical pulse?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.

9. What is important to remember when removing a CVC from a patient?
No radial artery punctures if negative
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.
D/C the med and call the doctor.
One large emboli (smaller=better)

10. What condition can cause left sided heart failure?
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
Vascular - artery disease causing fluid to back up into the lungs.

11. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
NO because it isn't sterile so keep out.
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.

12. Where is the apex/mitral valve landmark on the chest?
Right sided heart failure
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Fourth or fifth intercostal space at or medial to the midclavicular line.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

13. 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
Only for a few hours
0.5-2.0 ng/ml
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

14. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
0.5-2.0 ng/ml
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

15. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Patient who are unable to tolerate exercise stress testing.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

16. What should be immediately done for a patient experiencing digoxin toxicity?
BP is elevated or decreased depending on activity.
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

17. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
One large emboli (smaller=better)
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.

18. What are the indications for a chemical stress test (persantine stress test)?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Patient who are unable to tolerate exercise stress testing.
4th left intercostal space lower sternal border
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

19. How long is contrast media in the body?
Only for a few hours
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

20. What should be done for someone on bleeding precautions?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
0.5-2.0 ng/ml
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
Only for a few hours

21. A femoral artery compression device ______be assigned to an NA?
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Second Right intercostal space.
Cannot

22. What type of surgery is done for an aortic dissection?
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.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

23. What does a swan ganz measure?
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
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

24. What are coumadin and heparin used for?
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
To inhibit thrombus and clot formation.
Before

25. How is the Allen's test done?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

26. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

27. What is a good diagnosis for someone with right sided HF?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
An inflammation of the pericardium. It may result in MI.
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.
Activity intolerance

28. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
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.

29. What is the treatments for hypertension?
Old truck driver or someone on bed rest or with pelvic trauma.
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.
NO NSAIDS or ASA.
Whether the patients ulnar and radial arteries are patent.

30. 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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Pneumothorax and will end up with chest tube to help reinflate lung.

31. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Second Left intercostal space
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

32. What is important to remember when taking care of patients with compression devices?
NO because it isn't sterile so keep out.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
Second right intercostal space

33. What is the most common cause of arterial insufficiency?
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
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
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
Chronic arteriosclerotic disease.

34. What should you do to treat pulmonary edema?
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
Vascular - artery disease causing fluid to back up into the lungs.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

35. What are the S&S of cardiac tamponade?
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Second left intercostal space

36. What should you watch for with PICC lines that have been in place for 6 months?
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-
Air answers (open junctions)
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
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

37. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

38. What is cardiac tamponade? Common causes?
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
Right sided heart failure
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Lower left sternal border

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

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40. What are the signs and symptoms of left sided HF?
No radial artery punctures if negative
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

41. What should you teach your patient about an exercise ECG (stress test)?
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-
Protamine Sulfate
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

42. What is the treatment for premature ventricular contractions?
Maintain BED REST
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.
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

43. What disease can cause right sided heart failure?
Open up blood vessels
Nitrates - Beta blockers - and Calcium channel blockers
Lung disease
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

44. What should you go when applying nitroglycerin ointment for angina?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
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

45. What are the 2 types of pacemakers?
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
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Poorly controlled hypertension

46. What is more harmful a lot of little emboli or one large emboli?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
One large emboli (smaller=better)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.

47. For what disease should you do the Allen's test?

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48. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Before
BP is elevated or decreased depending on activity.

49. What should be done immediately if a pulmonary embolism is suspected?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
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
Air answers (open junctions)

50. What makes the symptoms of superior vena cava syndrome better? Worse?
The internal jugular veins (external are less reliable).
An enlarged space indicates fluid accumulation in the pericardial sac.
Chronic arteriosclerotic disease.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

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NCLEX Cardiac

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