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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. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
Right sided heart failure
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Second left intercostal space

2. What should you teach your patient about an exercise ECG (stress test)?
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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-
NO NSAIDS or ASA.

3. What factors place you at risk for HTN?
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.
Old truck driver or someone on bed rest or with pelvic trauma.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

4. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
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.
The internal jugular veins (external are less reliable).
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.

5. What is a therapeutic digoxin level?
Steroid treatment or a pregnant woman who is retaining water.
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.
0.5-2.0 ng/ml

6. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Left sternal border
Only for a few hours
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
One large emboli (smaller=better)

7. What is an air embolism?
Before
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Second left intercostal space
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

8. What does plan of care include?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Patient who are unable to tolerate exercise stress testing.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
(S1 - S2) Third left intercostal space

9. What disease can cause right sided heart failure?
Lung disease
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
D/C the med and call the doctor.
Pulse before and after giving.

10. A femoral artery compression device ______be assigned to an NA?
Cannot
No radial artery punctures if negative
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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

11. What is a nursing diagnosis for arterial occlusion? Tx
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
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Lung disease

12. What things should you do to assess cardiovascular status?
4th left intercostal space lower sternal border
Only for a few hours
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.

13. What should you teach your patient about an electrocardiogram (ECG)?
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.

14. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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!

15. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Second left intercostal space
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

16. What is characteristic of ventricular fibrillation?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.

17. What is the treatments for hypertension?
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.
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.
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.

18. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Maintain BED REST
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

19. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
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.
Pulse before and after giving.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

20. Which type of patient shouldn't take nitrates?
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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
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

21. In What time period is the greatest risk of sudden death from an MI?
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
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
In the first 72 hours!!!!!
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

22. What is superior vena cava syndrome?
To inhibit thrombus and clot formation.
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.
Second Right intercostal space.
Old truck driver or someone on bed rest or with pelvic trauma.

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

24. What should you teach your patient about MRI?
(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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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

25. What should be checked in a patient on a beta blocker?
(S1 - S2) Third left intercostal space
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
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
Pulse before and after giving.

26. What is pulsus paradoxus?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Iodine

27. Should the tubing for a venous access port be included under the dressing site?

28. What is the treatment for someone in ventricular fibrillation?
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

29. Where is the aortic valve landmark on the chest?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
ST segment elevation (STEMI)
Second right intercostal space

30. What type of surgery is done for an aortic dissection?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Include rest periods prior to any activity.
Air answers (open junctions)
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

31. What are the proper steps to changing a central venous catheter dressing?
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
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

32. What is the hallmark clinical finding associated with pericarditis?
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.
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.

33. What are common risk factors for an MI?
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Before
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

34. What should you teach someone about iodine?
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.
Feeling warm (fire) or tin can taste is expected and will pass.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

35. What are the nursing interventions for a patient with premature ventricular contractions?
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.)
Steroid treatment or a pregnant woman who is retaining water.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

36. What should be done for someone on bleeding precautions?
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.

37. 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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
Must be flushed 1x/month with heparin and between treatments.

38. What is the correct way to insert an oropharyngeal airway?
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Pulmonary edema
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.

39. What is the most common cause of arterial insufficiency?
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.
D/C the med and call the doctor.
Chronic arteriosclerotic disease.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

40. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.)

41. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
Poorly controlled hypertension
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

42. What should be done immediately for someone with PE?
Poorly controlled hypertension
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
NO NSAIDS or ASA.
Steroid treatment or a pregnant woman who is retaining water.

43. How do you prepare a patient for Impedance cardiography monitoring?
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
Include rest periods prior to any activity.
Protamine Sulfate
The internal jugular veins (external are less reliable).

44. What is an acute peripheral arterial occlusion?
In fatty areas or over major muscles - large breasts - or bony prominences.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

45. What is impedance cardiography?
Only for a few hours
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

46. What are examples of calcium channel blockers?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Lower left sternal border
Lowers BP and makes heart beat stronger. SE: flushed face.
A nosebleed

47. What can result from left sided heart failure if left untreated?
Second Left intercostal space
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.
Pulmonary edema
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

48. What is the treatment for someone with right sided HF? How do you know working?
Iodine
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Only for a few hours

49. When would a nurse use an external femoral artery compression device?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
ST segment elevation (STEMI)
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

50. What is a chemical stress test (persantine stress test)?
If feel more than 3 shocks in a row or develop signs of infection at the site.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.)
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