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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. Where do the internal jugular veins lie?
Patient who are unable to tolerate exercise stress testing.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
To inhibit thrombus and clot formation.

2. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
4th left intercostal space lower sternal border
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.

3. How should you palpate the apical pulse?
Vitamin K (aqua myphiton)
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

4. What is the treatments for hypertension?
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.

5. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
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.
Open up blood vessels
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

6. What are the S&S of pulmonary embolism?
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Nitrates - Beta blockers - and Calcium channel blockers

7. What should you do immediately if you suspect someone of developing a hematoma?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Second left intercostal space
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.

8. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Second right intercostal space
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

9. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
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

10. What should you do when applying a femoral artery compression device?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

11. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
Second right intercostal space
A monitor with four dual electrodes that are applied to the patients neck and thorax.

12. What is the antidote for heparin?
Pulmonary edema
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Protamine Sulfate

13. What are the steps for adult 2 rescuer CPR?
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Vascular - artery disease causing fluid to back up into the lungs.
The patient may suffer significant blood loss or femoral nerve compression.

14. What are the steps for adult/child 1 rescuer CPR?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Don't interfere!
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

15. What landmarks should you be looking for on someone's chest?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Second Left intercostal space
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

16. What are coumadin and heparin used for?
NO NSAIDS or ASA.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Before
To inhibit thrombus and clot formation.

17. 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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Protamine Sulfate
D/C the med and call the doctor.

18. How do you prepare a patient for Impedance cardiography monitoring?
Vitamin K (aqua myphiton)
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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
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

19. What is CVP? Normal?
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.
Poorly controlled hypertension
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

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

21. How is angina treated?

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22. What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

23. What is important to remember when taking care of patients with compression devices?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

24. What causes secondary hypertension?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
Steroid treatment or a pregnant woman who is retaining water.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

25. What is the treatment for a patient in complete heart block?
Second Right intercostal space.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

26. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
4th left intercostal space lower sternal border
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

27. Where is the right ventricle landmark on the chest?
An inflammation of the pericardium. It may result in MI.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Left sternal border
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

28. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Feeling warm (fire) or tin can taste is expected and will pass.
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
Pulmonary edema

29. 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.
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.
Protamine Sulfate

30. How long is contrast media in the body?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Only for a few hours
Lowers BP and makes heart beat stronger. SE: flushed face.

31. What are the nursing interventions for a patient in complete heart block?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
One at a time to assess the pulse amplitude and contour.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

32. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Old truck driver or someone on bed rest or with pelvic trauma.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

33. What should you teach someone about iodine?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Feeling warm (fire) or tin can taste is expected and will pass.
Nitrates - Beta blockers - and Calcium channel blockers

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

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35. What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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 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
NO NSAIDS or ASA.

36. What are examples of calcium channel blockers?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
One at a time to assess the pulse amplitude and contour.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

37. What should you teach your patient about an abdominal ultrasonography?
NO because it isn't sterile so keep out.
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
To inhibit thrombus and clot formation.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

38. What is the treatment for someone with right sided HF? How do you know working?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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

39. What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
0.5-2.0 ng/ml
(S1 - S2) Third left intercostal space

40. What is a good diagnosis for someone with right sided HF?
Activity intolerance
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.
Pulse before and after giving.

41. Test ending in Gram=?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Iodine
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
(S1 - S2) Third left intercostal space

42. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Open up blood vessels
Cannot
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.

43. What is a therapeutic digoxin level?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
0.5-2.0 ng/ml
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

44. What things should you do to assess cardiovascular status?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

45. What signals an elevated venous pressure based on the internal jugular veins?
Maintain BED REST
In fatty areas or over major muscles - large breasts - or bony prominences.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.

46. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
The patient may suffer significant blood loss or femoral nerve compression.
D/C the med and call the doctor.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.

47. What should you do to treat pulmonary edema?
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-
Vascular - artery disease causing fluid to back up into the lungs.
Lower left sternal border
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

48. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Feeling warm (fire) or tin can taste is expected and will pass.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

49. What are the nursing interventions for a pt. with ventricular tachycardia?
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.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

50. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Poorly controlled hypertension
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).