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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 are the S&S of superior vena cava syndrome?
A nosebleed
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!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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

2. What causes essential/primary hypertension?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
(S1 - S2) Third left intercostal space
Idiopathic
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

3. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
A nosebleed
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.

4. What signals an elevated venous pressure based on the internal jugular veins?
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
If feel more than 3 shocks in a row or develop signs of infection at the 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

5. What is the treatment for a pt. with ventricular tachycardia?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Must be flushed 1x/month with heparin and between treatments.
Awake and alert: IV lidocaine bolus and drip Unconscious - hypotensive - or S&S of angina/CHF: Direct current cardioversion and IV Lidocaine bolus and drip.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

6. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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

7. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
BP is elevated or decreased depending on activity.
Patient who are unable to tolerate exercise stress testing.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

8. What should you teach your patient about MRI?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

9. What is the nursing care associated with chemical stress tests (persantine stress test)?
Fifth left intercostal space medial to the midclavicular line.
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
0.5-2.0 ng/ml

10. What is the treatment for atrial fibrillation?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Fat - Air - DVT - or Amniotic
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.
Direct current cardioversion and digoxin/propranolol (inderal).

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

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

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13. What drugs are most commonly used for angina?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
Nitrates - Beta blockers - and Calcium channel blockers
Old truck driver or someone on bed rest or with pelvic trauma.

14. What is INR?
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.
Right sided heart failure
Chronic arteriosclerotic disease.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

15. What is intermittent claudication?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

16. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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

17. What does the device for impedance cardiography consist of?
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 monitor with four dual electrodes that are applied to the patients neck and thorax.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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

18. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.

19. For what disease should you do the Allen's test?

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20. What does an Allen's test determine?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
(S1 - S2) Third left intercostal space
Whether the patients ulnar and radial arteries are patent.

21. What should be checked in a patient on a beta blocker?
Lung disease
Pneumothorax and will end up with chest tube to help reinflate lung.
Pulse before and after giving.
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

22. What does plan of care include?
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!
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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
D/C the med and call the doctor.

23. What can result from left sided heart failure if left untreated?
No radial artery punctures if negative
Pulmonary edema
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
Vascular - artery disease causing fluid to back up into the lungs.

24. In what locations should you not place electrodes?
Direct current cardioversion and digoxin/propranolol (inderal).
In fatty areas or over major muscles - large breasts - or bony prominences.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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

25. What will be the treatment for an acute episode of life threatening tamponade?
Vitamin K (aqua myphiton)
In the first 72 hours!!!!!
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

26. What is an aortic dissection?

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27. What is a nursing diagnosis for arterial occlusion? Tx
D/C the med and call the doctor.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

28. What is characteristic of atrial fibrillation?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Right sided heart failure
(S1 - S2) Third left intercostal space
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

29. What are the S&S associated with right sided heart failure?
In the first 72 hours!!!!!
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Iodine

30. Where should you place your stethescope to find the tricuspid valve?
NO because it isn't sterile so keep out.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
One large emboli (smaller=better)
4th left intercostal space lower sternal border

31. How should you palpate the carotid arteries?
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
One at a time to assess the pulse amplitude and contour.
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

32. What does a swan ganz measure?
Lung disease
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

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

34. What is the purpose of compression devices?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
In the first 72 hours!!!!!

35. What are the steps for adult 2 rescuer CPR?
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
(S1 - S2) Third left intercostal space
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

36. What are examples of calcium channel blockers?
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.
Steroid treatment or a pregnant woman who is retaining water.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

37. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
ST segment elevation (STEMI)
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
No radial artery punctures if negative
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

38. What is defibrillation?
One at a time to assess the pulse amplitude and contour.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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 monitor with four dual electrodes that are applied to the patients neck and thorax.

39. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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.
Protamine Sulfate
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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

40. What are the steps for infant 1&2 rescuer CPR?
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.
Idiopathic
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
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

41. What are the indications for a chemical stress test (persantine stress test)?
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
Before
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.)
Patient who are unable to tolerate exercise stress testing.

42. What is cardiac tamponade? Common causes?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
BP is elevated or decreased depending on activity.
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

43. What is characteristic of ventricular fibrillation?
Nitrates - Beta blockers - and Calcium channel blockers
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.
Patient who are unable to tolerate exercise stress testing.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

44. What is the treatment for premature ventricular contractions?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
The internal jugular veins (external are less reliable).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Nitrates - Beta blockers - and Calcium channel blockers

45. During an Allen's test don't compress one artery _____ the other.
Before
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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
Feeling warm (fire) or tin can taste is expected and will pass.

46. 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
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.)
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.

47. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Air answers (open junctions)
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
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

48. What could happen without immediate intervention for a hematoma?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
The patient may suffer significant blood loss or femoral nerve compression.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

49. What should be done immediately if a pulmonary embolism is suspected?
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.
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

50. Where is the apex/mitral valve landmark on the chest?
Pulse before and after giving.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Cannot
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.