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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 can result from left sided heart failure if left untreated?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Pulmonary edema
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.

2. How do you prepare a patient for Impedance cardiography monitoring?
Nitrates - Beta blockers - and Calcium channel blockers
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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

3. What SE should you look for with calcium channel blocker use?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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

4. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Air answers (open junctions)
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Cannot

5. Where is the aortic valve landmark on the chest?
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.
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
Second right intercostal space
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

6. What things should you do to assess cardiovascular status?
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

7. Where is the right ventricle landmark on the chest?
Left sternal border
To inhibit thrombus and clot formation.
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.
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.

8. What is the nursing care associated with chemical stress tests (persantine 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
Don't interfere!
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
ST segment elevation (STEMI)

9. What is the goal of treatment for an MI? Treatment?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.

10. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

11. What are common risk factors for an MI?
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.
Open up blood vessels
Second left intercostal space
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

12. What is the antidote for coumadin?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Vitamin K (aqua myphiton)
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

13. What are the signs and symptoms of left sided HF?
Chronic arteriosclerotic disease.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

14. What is the antidote for heparin?
D/C the med and call the doctor.
Protamine Sulfate
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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

15. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Second right intercostal space
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

16. What is angina? Stable vs. unstable?

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17. Where is the tricuspid valve landmark on the chest?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
In the first 72 hours!!!!!
Lower left sternal border
To inhibit thrombus and clot formation.

18. What is characteristic of premature ventricular contractions?
Steroid treatment or a pregnant woman who is retaining water.
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
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

19. What is a nursing diagnosis for arterial occlusion? Tx
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.
Activity intolerance
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

20. What should you do immediately if you suspect someone of developing a hematoma?
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.
The internal jugular veins (external are less reliable).
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.
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

21. What is a therapeutic digoxin level?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Open up blood vessels
0.5-2.0 ng/ml

22. What is the purpose of compression devices?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
BP is elevated or decreased depending on activity.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

23. What are the five areas for listening to the heart?

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24. What is the treatment for someone in ventricular fibrillation?
Second left intercostal space
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

25. What body systems are affected by digoxin toxicity? S&S?
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
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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!

26. What should you remember while taking care of someone with a peripheral arterial occlusion?
Second Left intercostal space
Poorly controlled hypertension
Fifth left intercostal space medial to the midclavicular line.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

27. When should bleeding precautions be implemented?
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.
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
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.
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.

28. What disease can cause right sided heart failure?
Lung disease
4th left intercostal space lower sternal border
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

29. What should be immediately done for a patient experiencing digoxin toxicity?
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 clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
NO NSAIDS or ASA.

30. What usually triggers angina pain?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

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

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32. A femoral artery compression device ______be assigned to an NA?
Cannot
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
No radial artery punctures if negative
(S1 - S2) Third left intercostal space

33. What should happen if someone converts to asystole/flatline?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Only for a few hours
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

34. What is labile hypertension?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Old truck driver or someone on bed rest or with pelvic trauma.
BP is elevated or decreased depending on activity.

35. What are examples of calcium channel blockers?
Lower left sternal border
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

36. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Second Right intercostal space.
Don't interfere!

37. What should be done for someone on bleeding precautions?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
One at a time to assess the pulse amplitude and contour.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

38. What is characteristic of atrial fibrillation?
No radial artery punctures if negative
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
NO NSAIDS or ASA.

39. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
An inflammation of the pericardium. It may result in MI.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Whether the patients ulnar and radial arteries are patent.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

40. What is the treatment for premature ventricular contractions?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
Steroid treatment or a pregnant woman who is retaining water.

41. What is defibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Used in an emergency (Vfib/defib) - used with Vfib or Vtach - NO CARDIAC OUTPUT - client is unconscious - EKG monitor - NO CONSENT NEEDED - begin with 200 Joules and up to 360.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

42. What should you teach your patient about an electrocardiogram (ECG)?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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

43. What are the S&S of air embolism?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Fifth left intercostal space medial to the midclavicular line.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

44. What should you tell someone about taking nitroglycerin tablets (SE)?
NO NSAIDS or ASA.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
One large emboli (smaller=better)

45. What is the treatment for atrial fibrillation?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Direct current cardioversion and digoxin/propranolol (inderal).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

46. 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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
BP is elevated or decreased depending on activity.
Fourth or fifth intercostal space at or medial to the midclavicular line.

47. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

48. Where should you place your stethescope to find the ERB's Point?
Left sternal border
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
(S1 - S2) Third left intercostal space
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

49. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Pulse before and after giving.
Direct current cardioversion and digoxin/propranolol (inderal).
BP is elevated or decreased depending on activity.

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