Test your basic knowledge |

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 the purpose of compression devices?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

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

3. What are the S&S of cardiac tamponade?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Direct current cardioversion and digoxin/propranolol (inderal).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

4. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Iodine
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.
No radial artery punctures if negative
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

5. What is an aortic dissection?

6. What are the treatments/ S&S of peripheral venous disease?
Vitamin K (aqua myphiton)
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.
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

7. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
Don't interfere!

8. What would make someone more at risk for digoxin toxicity?
Elderly - hypothyroidism - renal dysfunction - dehydration - HYPOKALEMIA - hypomagnesemia - or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.

9. What makes the symptoms of superior vena cava syndrome better? Worse?
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.
No radial artery punctures if negative
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

10. What are the nursing interventions for a patient with premature ventricular contractions?
An enlarged space indicates fluid accumulation in the pericardial sac.
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

11. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

12. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Right sided heart failure
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

13. What is superior vena cava syndrome?
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.
Vascular - artery disease causing fluid to back up into the lungs.
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!
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

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

15. In What time period is the greatest risk of sudden death from an MI?
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.
Cannot
In the first 72 hours!!!!!
An inflammation of the pericardium. It may result in MI.

16. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
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.
Fifth left intercostal space medial to the midclavicular line.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

17. Where should you place your stethescope to find the aortic valve?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
Second Right intercostal space.

18. What is a chemical stress test (persantine stress test)?
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the
One large emboli (smaller=better)
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
Iodine

19. What should you teach your patient about angiography (arteriography)?
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
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
D/C the med and call the doctor.

20. What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

21. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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
Right sided heart failure
The internal jugular veins (external are less reliable).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

22. A femoral artery compression device ______be assigned to an NA?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Cannot
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

23. How does the blood flow through the heart? (valves?)
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!
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Poorly controlled hypertension

24. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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

25. What should you do when applying a femoral artery compression device?
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
An inflammation of the pericardium. It may result in MI.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

26. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
Fat - Air - DVT - or Amniotic
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.

27. Where is the apex/mitral valve landmark on the chest?
Must be flushed 1x/month with heparin and between treatments.
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Fourth or fifth intercostal space at or medial to the midclavicular line.

28. What are the proper steps to changing a central venous catheter dressing?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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!
Fat - Air - DVT - or Amniotic
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

29. Where should you place your stethescope to find the pulmonic valve?
Pneumothorax and will end up with chest tube to help reinflate lung.
Second Left intercostal space
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.

30. What is a major complication of central line placement?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Pneumothorax and will end up with chest tube to help reinflate lung.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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

31. What disease can cause right sided heart failure?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
Lung disease
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

32. What is the antidote for coumadin?
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Vitamin K (aqua myphiton)
BP is elevated or decreased depending on activity.

33. What should you do if you are going to ventilate someone with an ambu bag?
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

34. When would a nurse use an external femoral artery compression device?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Before

35. For which heart sounds should the bell be used?
NO because it isn't sterile so keep out.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

36. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Old truck driver or someone on bed rest or with pelvic trauma.

37. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.

38. What could happen without immediate intervention for a hematoma?
0.5-2.0 ng/ml
BP is elevated or decreased depending on activity.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
The patient may suffer significant blood loss or femoral nerve compression.

39. 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.
Direct current cardioversion and digoxin/propranolol (inderal).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

40. What is intermittent claudication?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

41. What is angina? Stable vs. unstable?

42. How do you prepare a patient for Impedance cardiography monitoring?
Fat - Air - DVT - or Amniotic
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.
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.
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

43. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.
Old truck driver or someone on bed rest or with pelvic trauma.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

44. Where should you place your stethescope to find the mitral (apex) valve?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Fifth left intercostal space medial to the midclavicular line.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

45. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.

46. What does vasotec (Enalapril Maleate) do/SE?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Lower left sternal border
Lowers BP and makes heart beat stronger. SE: flushed face.
An enlarged space indicates fluid accumulation in the pericardial sac.

47. Where is the right ventricle landmark on the chest?
Maintain BED REST
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
An inflammation of the pericardium. It may result in MI.
Left sternal border

48. What does the device for impedance cardiography consist of?
Steroid treatment or a pregnant woman who is retaining water.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

49. What is pericarditis?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
An inflammation of the pericardium. It may result in MI.
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!
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.

50. What is the treatment for a patient in complete heart block?
A nosebleed
Protamine Sulfate
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.