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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. When should bleeding precautions be implemented?
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.
Fat - Air - DVT - or Amniotic
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

2. What is characteristic of atrial fibrillation?
Elderly - hypothyroidism - renal dysfunction - dehydration - HYPOKALEMIA - hypomagnesemia - or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

3. What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Lung disease
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

4. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
Vitamin K (aqua myphiton)
One at a time to assess the pulse amplitude and contour.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

5. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
D/C the med and call the doctor.
Chronic arteriosclerotic disease.
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

6. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
0.5-2.0 ng/ml
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.
Pulmonary edema

7. What should you teach your patient about an electrocardiogram (ECG)?
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
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
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-
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

8. How long is contrast media in the body?
Only for a few hours
This noninvasive test takes 24 hours and causes no discomfort. Electrodes are applied to your body - you need to log your activities for a 24 hour period (walking - sleeping - urinating - physical symptoms - and medications). Don't tamper with the mo
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
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

9. 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.
Lung disease
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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

10. How is angina treated?

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11. What makes the symptoms of superior vena cava syndrome better? Worse?
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
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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.

12. What should be checked in a patient on a beta blocker?
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Pulse before and after giving.

13. What is important to remember when taking care of patients with compression devices?
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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

14. What is epistaxis?
A nosebleed
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

15. What are the steps for infant 1&2 rescuer CPR?
Idiopathic
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 drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

16. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
Right sided heart failure
Only for a few hours

17. What are the nursing interventions for a patient in atrial fibrillation?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Old truck driver or someone on bed rest or with pelvic trauma.
An enlarged space indicates fluid accumulation in the pericardial sac.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

18. What is the purpose of compression devices?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
If feel more than 3 shocks in a row or develop signs of infection at the site.

19. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
One at a time to assess the pulse amplitude and contour.
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
An enlarged space indicates fluid accumulation in the pericardial sac.
Vascular - artery disease causing fluid to back up into the lungs.

20. What is CVP? Normal?
Cannot
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.

21. What is an aortic dissection?

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22. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
To inhibit thrombus and clot formation.

23. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.

24. Where is the tricuspid valve landmark on the chest?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
Lower left sternal border
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

25. What is a assessment finding with DVT?

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26. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
Air answers (open junctions)
BP is elevated or decreased depending on activity.

27. What are the nursing interventions for a patient in complete heart block?
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
D/C the med and call the doctor.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

28. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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).

29. What SE should you look for with calcium channel blocker use?
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Protamine Sulfate
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

30. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
Second right intercostal space
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.
A nosebleed

31. What is a therapeutic digoxin level?
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
Nitrates - Beta blockers - and Calcium channel blockers
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

32. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Maintain BED REST
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.

33. What is the treatment for premature ventricular contractions?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
NO because it isn't sterile so keep out.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

34. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Steroid treatment or a pregnant woman who is retaining water.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

35. What is the treatment for someone with right sided HF? How do you know working?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

36. What is the antidote for heparin?
Second right intercostal space
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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

37. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
In the first 72 hours!!!!!
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!
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

38. How should you palpate the apical pulse?
Iodine
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.)

39. What condition can cause left sided heart failure?
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.
Vitamin K (aqua myphiton)
To inhibit thrombus and clot formation.
Vascular - artery disease causing fluid to back up into the lungs.

40. What is characteristic of premature ventricular contractions?
0.5-2.0 ng/ml
Vascular - artery disease causing fluid to back up into the lungs.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.

41. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Second left intercostal space
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

42. What is the antidote for coumadin?
Must be flushed 1x/month with heparin and between treatments.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Vitamin K (aqua myphiton)

43. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
Don't interfere!
No radial artery punctures if negative
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

44. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Pulmonary edema
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

45. What should be done immediately if a pulmonary embolism is suspected?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
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

46. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.

47. What is Deep Vein Thrombosis (DVT)?
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).
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.)
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

48. What is the treatment for a pt. with ventricular tachycardia?
(S1 - S2) Third left intercostal space
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
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.
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.

49. How is the Allen's test done?
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
In fatty areas or over major muscles - large breasts - or bony prominences.
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

50. What is the goal of treatment for an MI? Treatment?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Steroid treatment or a pregnant woman who is retaining water.
Patient who are unable to tolerate exercise stress testing.
Nitrates - Beta blockers - and Calcium channel blockers

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NCLEX Cardiac

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