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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 should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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

2. What is pulsus paradoxus?
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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
Open up blood vessels

3. How is angina treated?

4. What disease can cause right sided heart failure?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Pulse before and after giving.
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
Lung disease

5. What should you do to treat pulmonary edema?
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
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
Must be flushed 1x/month with heparin and between treatments.
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

6. For which heart sounds should the diaphragm be used?
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
Poorly controlled hypertension
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.

7. When should you be concerned about premature ventricular contraction?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
4th left intercostal space lower sternal border
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

8. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
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.
Direct current cardioversion and digoxin/propranolol (inderal).
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

9. Where is the apex/mitral valve landmark on the chest?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.

10. What are the signs and symptoms of left sided HF?
Pulse before and after giving.
A nosebleed
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Protamine Sulfate

11. Where should you place your stethescope to find the mitral (apex) valve?
Second left intercostal space
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Fifth left intercostal space medial to the midclavicular line.
NO NSAIDS or ASA.

12. Where do the internal jugular veins lie?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Vitamin K (aqua myphiton)
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD

13. What is the treatment for premature ventricular contractions?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Before
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

14. What are the steps for adult/child 1 rescuer CPR?
Pulmonary edema
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Poorly controlled hypertension

15. What is Raynauds disease? Tx?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A nosebleed
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.
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

16. What is cardioversion?

17. What should you teach your patient about angiography (arteriography)?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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

18. What should you do if the PTT value is 80 for someone on heparin?
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
Include rest periods prior to any activity.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
D/C the med and call the doctor.

19. What is the correct way to insert an oropharyngeal airway?
Chronic arteriosclerotic disease.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
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

20. What should you teach someone with arterial insufficiency?

21. What does the device for impedance cardiography consist of?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
Right sided heart failure

22. What should you teach someone about iodine?
If feel more than 3 shocks in a row or develop signs of infection at the site.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Feeling warm (fire) or tin can taste is expected and will pass.
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.

23. What drugs are most commonly used for angina?
NO NSAIDS or ASA.
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.
Nitrates - Beta blockers - and Calcium channel blockers
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.

24. What is important to remember when removing a CVC from a patient?
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.
0.5-2.0 ng/ml
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Second Right intercostal space.

25. What is the antidote for heparin?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.
Protamine Sulfate
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

26. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Include rest periods prior to any activity.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
Feeling warm (fire) or tin can taste is expected and will pass.

27. What are the S&S of air embolism?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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-

28. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Vascular - artery disease causing fluid to back up into the lungs.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
(S1 - S2) Third left intercostal space

29. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.

30. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

31. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

32. What is Deep Vein Thrombosis (DVT)?
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Iodine

33. What condition can cause left sided heart failure?
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
Whether the patients ulnar and radial arteries are patent.
Vascular - artery disease causing fluid to back up into the lungs.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

34. What should you explain to the patient about an impedance cardiography test?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Air answers (open junctions)

35. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Lung disease
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
4th left intercostal space lower sternal border
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

36. What is characteristic of complete heart block?
ST segment elevation (STEMI)
Pulse before and after giving.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

37. Where is the pulmonic valve landmark on the chest?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Stand behind the victim - wrap arms around waist (IF PREGNANT WRAP ABOVE The BABy) - make a fist with one had and place thumb against abdomen midline - grasp fist with other hand - press into victims abdomen with quick upward thrusts.
Second left intercostal space

38. What causes secondary hypertension?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Steroid treatment or a pregnant woman who is retaining water.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
The internal jugular veins (external are less reliable).

39. What do calcium channel blockers do?
Pulmonary edema
Open up blood vessels
Activity intolerance
A monitor with four dual electrodes that are applied to the patients neck and thorax.

40. Where should you place your stethescope to find the aortic valve?
Second Right intercostal space.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Fat - Air - DVT - or Amniotic
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

41. How is the Allen's test done?
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
0.5-2.0 ng/ml

42. What is intermittent claudication?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
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.
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.

43. What is the maintenance for venous access port that isn't being regularly used?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Must be flushed 1x/month with heparin and between treatments.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

44. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Second left intercostal space
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

45. What are the S&S of superior vena cava syndrome?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.)
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

46. What is epistaxis?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
ST segment elevation (STEMI)
A nosebleed
Maintain BED REST

47. What is the treatments for hypertension?
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.
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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

48. What are the indications for a chemical stress test (persantine stress test)?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
An enlarged space indicates fluid accumulation in the pericardial sac.
Patient who are unable to tolerate exercise stress testing.
ST segment elevation (STEMI)

49. 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
Demand: Works PRN (when HR goes below predetermined rate) or Fixed: beats constantly at predetermined rate so no matter what heart does still beats at same rate.
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
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 are coumadin and heparin used for?
D/C the med and call the doctor.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
To inhibit thrombus and clot formation.
No radial artery punctures if negative