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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 things should you do to assess cardiovascular status?
D/C the med and call the doctor.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
In the first 72 hours!!!!!
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

2. Where is the tricuspid valve landmark on the chest?
Before
Maintain BED REST
Lower left sternal border
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

3. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.

4. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.

5. What is intermittent claudication?
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.
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
Pneumothorax and will end up with chest tube to help reinflate lung.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

6. What does plan of care include?
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
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

7. What is CVP? Normal?
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.
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
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 central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

8. What will be the treatment for an acute episode of life threatening tamponade?
Air embolism
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

9. How should you palpate the apical pulse?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

10. What needs to be held during the placement of a femoral artery compression device?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
NO NSAIDS or ASA.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

11. What should be immediately done for a patient experiencing digoxin toxicity?
Second left intercostal space
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

12. What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Fat - Air - DVT - or Amniotic
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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

13. What are the steps for adult/child 1 rescuer CPR?
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
Feeling warm (fire) or tin can taste is expected and will pass.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

14. What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Open up blood vessels
Steroid treatment or a pregnant woman who is retaining water.
Second Right intercostal space.

15. What is the treatment for myocardial infarction?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Lowers BP and makes heart beat stronger. SE: flushed face.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

16. What is characteristic of complete heart block?
One at a time to assess the pulse amplitude and contour.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

17. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
Include rest periods prior to any activity.

18. What should you teach your patient about a holter monitor?

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19. What are the four types of pulmonary emboli?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Fat - Air - DVT - or Amniotic

20. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
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
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

21. What should you do to treat pulmonary edema?
Idiopathic
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

22. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
Pulse before and after giving.

23. What should you tell someone about taking nitroglycerin tablets (SE)?
0.5-2.0 ng/ml
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.

24. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

25. What should you teach your patient about MRI?
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

26. During an Allen's test don't compress one artery _____ the other.
Before
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
Vitamin K (aqua myphiton)
NO because it isn't sterile so keep out.

27. What are the steps for infant 1&2 rescuer CPR?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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
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

28. How do you prepare a patient for Impedance cardiography monitoring?
Open up blood vessels
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
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.
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

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

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30. What would make someone more at risk for digoxin toxicity?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
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).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

31. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
Pneumothorax and will end up with chest tube to help reinflate lung.
D/C the med and call the doctor.
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.

32. What is the treatment for premature ventricular contractions?
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.
Chronic arteriosclerotic disease.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Vascular - artery disease causing fluid to back up into the lungs.

33. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Lung disease
Protamine Sulfate
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

34. What does vasotec (Enalapril Maleate) do/SE?
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.
Before
Lowers BP and makes heart beat stronger. SE: flushed face.

35. What are examples of calcium channel blockers?
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

36. What are the S&S associated with right sided heart failure?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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).

37. What are the S&S of aortic dissection?
Second left intercostal space
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

38. What does an Allen's test determine?
If feel more than 3 shocks in a row or develop signs of infection at the site.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Whether the patients ulnar and radial arteries are patent.
Vitamin K (aqua myphiton)

39. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
NO because it isn't sterile so keep out.

40. 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
Fat - Air - DVT - or Amniotic
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
One at a time to assess the pulse amplitude and contour.

41. What is labile hypertension?
ST segment elevation (STEMI)
An enlarged space indicates fluid accumulation in the pericardial sac.
An inflammation of the pericardium. It may result in MI.
BP is elevated or decreased depending on activity.

42. What are the S&S of cardiac tamponade?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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 is characteristic of atrial fibrillation?
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
Open up blood vessels
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

44. What is the treatment for someone with right sided HF? How do you know working?
To inhibit thrombus and clot formation.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Maintain BED REST
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

45. Where should you place your stethescope to find the pulmonic valve?
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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
Second Left intercostal space

46. What should you teach someone about iodine?
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
Feeling warm (fire) or tin can taste is expected and will pass.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

47. What should be done for someone on bleeding precautions?
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
Chronic arteriosclerotic disease.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

48. What are the S&S of air embolism?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
An enlarged space indicates fluid accumulation in the pericardial sac.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

49. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

50. Test ending in Gram=?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Steroid treatment or a pregnant woman who is retaining water.
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
Iodine