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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is angina? Stable vs. unstable?

2. What should you do if you are going to ventilate someone with an ambu bag?
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
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.

3. What are the 2 types of pacemakers?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.
Second left intercostal space
Air embolism

4. How is the Allen's test done?
Steroid treatment or a pregnant woman who is retaining water.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.

5. What is the treatment for premature ventricular contractions?
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.
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Right sided heart failure

6. What is the treatment for atrial fibrillation?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Second left intercostal space
4th left intercostal space lower sternal border
Direct current cardioversion and digoxin/propranolol (inderal).

7. What type of EKG change indicates MI?
Air answers (open junctions)
ST segment elevation (STEMI)
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Protamine Sulfate

8. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
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.
Pulmonary edema
Lung disease

9. What should you tell someone about taking nitroglycerin tablets (SE)?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.

10. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
Only for a few hours
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

11. What needs to be held during the placement of a femoral artery compression device?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
Second right intercostal space
NO NSAIDS or ASA.

12. What is the nursing care associated with chemical stress tests (persantine stress test)?
Vitamin K (aqua myphiton)
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
BP is elevated or decreased depending on activity.
Second left intercostal space

13. What are the steps for adult 2 rescuer CPR?
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
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
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.
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.

14. What should be done immediately for someone with PE?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
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

15. What should you teach your patient about a holter monitor?

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

17. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
Second Right intercostal space.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

18. What is a transthoracic echocardiograph (TTE)?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
NO NSAIDS or ASA.

19. What is labile hypertension?
BP is elevated or decreased depending on activity.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
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. During an Allen's test don't compress one artery _____ the other.
Fat - Air - DVT - or Amniotic
Before
Cannot
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

21. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Air answers (open junctions)
In fatty areas or over major muscles - large breasts - or bony prominences.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

22. What does an Allen's test determine?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Whether the patients ulnar and radial arteries are patent.

23. Test ending in Gram=?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Maintain BED REST
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Iodine

24. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
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
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.

25. What body systems are affected by digoxin toxicity? S&S?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

26. What are the steps for adult/child 1 rescuer CPR?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Lowers BP and makes heart beat stronger. SE: flushed face.
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
A nosebleed

27. How should you palpate the carotid arteries?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Patient who are unable to tolerate exercise stress testing.
One at a time to assess the pulse amplitude and contour.
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

28. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
Include rest periods prior to any activity.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

29. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
No radial artery punctures if negative
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

30. 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?
Old truck driver or someone on bed rest or with pelvic trauma.
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.
Patient who are unable to tolerate exercise stress testing.

31. What is defibrillation?
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.
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
Include rest periods prior to any activity.
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.

32. What should you teach your patient about MRI?
Poorly controlled hypertension
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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

33. 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!
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.
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

34. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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.
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.
Air embolism
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

35. For which heart sounds should the diaphragm be used?
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.
Second Right intercostal space.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

36. In what locations should you not place electrodes?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

37. What is the purpose of compression devices?
One at a time to assess the pulse amplitude and contour.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.

38. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Cannot

39. Where is the tricuspid valve landmark on the chest?
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).
Lower left sternal border
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

40. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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.
The patient may suffer significant blood loss or femoral nerve compression.
Vascular - artery disease causing fluid to back up into the lungs.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

41. What should be done immediately if a pulmonary embolism is suspected?
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.
Protamine Sulfate
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
Idiopathic

42. When should you be concerned about premature ventricular contraction?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Must be flushed 1x/month with heparin and between treatments.

43. 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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
D/C the med and call the doctor.

44. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
If feel more than 3 shocks in a row or develop signs of infection at the site.
Include rest periods prior to any activity.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

45. What are the indications for a chemical stress test (persantine stress test)?
Chronic arteriosclerotic disease.
Patient who are unable to tolerate exercise stress testing.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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

46. What is a therapeutic digoxin level?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
0.5-2.0 ng/ml

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

48. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Air embolism
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 nosebleed
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

49. Where should you place your stethescope to find the mitral (apex) valve?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
Fifth left intercostal space medial to the midclavicular line.

50. What is characteristic of atrial fibrillation?
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Cannot