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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 suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
Pulse before and after giving.
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

2. What are the nursing interventions for a patient with premature ventricular contractions?
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
Don't interfere!
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

3. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
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

4. What is characteristic of complete heart block?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Before
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
One large emboli (smaller=better)

5. For which heart sounds should the bell be used?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Old truck driver or someone on bed rest or with pelvic trauma.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

6. What is a therapeutic digoxin level?
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.
0.5-2.0 ng/ml
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
4th left intercostal space lower sternal border

7. Which type of patient shouldn't take nitrates?
ST segment elevation (STEMI)
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

8. How does the blood flow through the heart? (valves?)
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.
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!
An inflammation of the pericardium. It may result in MI.
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.)

9. What is cardiac tamponade? Common causes?
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
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.
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
4th left intercostal space lower sternal border

10. 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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

11. When would a nurse use an external femoral artery compression device?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

12. What is the treatment for myocardial infarction?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

13. What should you teach someone after they have had a pacemaker placed?

14. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Second left intercostal space
An enlarged space indicates fluid accumulation in the pericardial sac.
In the first 72 hours!!!!!
The internal jugular veins (external are less reliable).

15. What should you teach your patient about an abdominal ultrasonography?
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
Right sided heart failure
An inflammation of the pericardium. It may result in MI.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

16. What is labile hypertension?
Old truck driver or someone on bed rest or with pelvic trauma.
Vitamin K (aqua myphiton)
BP is elevated or decreased depending on activity.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

17. What is defibrillation?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
In the first 72 hours!!!!!
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.
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.

18. What drugs are most commonly used for angina?
NO because it isn't sterile so keep out.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Nitrates - Beta blockers - and Calcium channel blockers
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

19. What needs to be held during the placement of a femoral artery compression device?
Steroid treatment or a pregnant woman who is retaining water.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Protamine Sulfate
NO NSAIDS or ASA.

20. What is the most common cause of arterial insufficiency?
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Chronic arteriosclerotic disease.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

21. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
No radial artery punctures if negative
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.
In fatty areas or over major muscles - large breasts - or bony prominences.

22. When should bleeding precautions be implemented?
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.
Second right intercostal space
An inflammation of the pericardium. It may result in MI.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

23. What is an acute peripheral arterial occlusion?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Cannot
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

24. What is an aortic dissection?

25. What are the S&S of pulmonary embolism?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Steroid treatment or a pregnant woman who is retaining water.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

26. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
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.
Right sided heart failure

27. 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.
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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

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

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

30. What is important to remember when removing a CVC from a patient?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

31. What are the S&S of superior vena cava syndrome?
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.
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

32. A femoral artery compression device ______be assigned to an NA?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Cannot

33. What is an air embolism?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

34. What are common risk factors for an MI?
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.

35. What is the antidote for heparin?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Protamine Sulfate
Lung disease
D/C the med and call the doctor.

36. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
ST segment elevation (STEMI)
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

37. What is CVP? Normal?
Fifth left intercostal space medial to the midclavicular line.
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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).

38. What type of surgery is done for an aortic dissection?
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Left sternal border

39. What is a nursing diagnosis for arterial occlusion? Tx
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

40. What type of EKG change indicates MI?
ST segment elevation (STEMI)
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.
Idiopathic
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

41. What are the signs and symptoms of left sided HF?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Old truck driver or someone on bed rest or with pelvic trauma.

42. What should be done immediately for someone with PE?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.

43. Where should you place your stethescope to find the mitral (apex) valve?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Fifth left intercostal space medial to the midclavicular line.
(S1 - S2) Third 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.

44. What should you observe for in someone on bleeding precautions?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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).

45. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

46. What should you do when applying a femoral artery compression device?
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
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
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

47. What is the treatment for a pt. with ventricular tachycardia?
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.
One large emboli (smaller=better)
Include rest periods prior to any activity.
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.

48. What condition can cause left sided heart failure?
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.
Vascular - artery disease causing fluid to back up into the lungs.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.

49. What should you do immediately if you suspect someone of developing a hematoma?
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
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.
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.
Maintain BED REST

50. What is characteristic of ventricular tachycardia?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Direct current cardioversion and digoxin/propranolol (inderal).