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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 a patient do if they feel chest pain or discomfort?
Lower left sternal border
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
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

2. What is the nursing care associated with chemical stress tests (persantine stress test)?
In the first 72 hours!!!!!
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
(S1 - S2) Third left intercostal space
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

3. What is labile hypertension?
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
BP is elevated or decreased depending on activity.
Pneumothorax and will end up with chest tube to help reinflate lung.
Nitrates - Beta blockers - and Calcium channel blockers

4. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
The internal jugular veins (external are less reliable).
Second Right intercostal space.
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

5. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Before
D/C the med and call the doctor.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

6. What is the most common cause of arterial insufficiency?
Fourth or fifth intercostal space at or medial to the midclavicular line.
ST segment elevation (STEMI)
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Chronic arteriosclerotic disease.

7. What should you go when applying nitroglycerin ointment for angina?
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
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
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

8. Test ending in Gram=?
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unu
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Iodine
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

9. What would make someone more at risk for digoxin toxicity?
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.
(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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

10. What should you tell someone about taking nitroglycerin tablets (SE)?
Iodine
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

11. What is characteristic of ventricular tachycardia?
Idiopathic
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Lowers BP and makes heart beat stronger. SE: flushed face.
NO NSAIDS or ASA.

12. What is the treatment for myocardial infarction?
Old truck driver or someone on bed rest or with pelvic trauma.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

13. What is the treatment for a patient in complete heart block?
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
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
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

14. What should you teach your patient about MRI?
Must be flushed 1x/month with heparin and between treatments.
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
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

15. What should you teach someone with arterial insufficiency?

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16. What do calcium channel blockers do?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
Open up blood vessels
Old truck driver or someone on bed rest or with pelvic trauma.

17. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
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.
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
D/C the med and call the doctor.

18. 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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

19. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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.
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

20. What is characteristic of premature ventricular contractions?
Second Left intercostal space
Premature beats that are not preceded by a P- wave - QRS is wide and bizarre - and the T wave of the premature beat is generally large and in the opposite direction of the QRS.
Chronic arteriosclerotic disease.
Right sided heart failure

21. What is an aortic dissection?

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22. What are the S&S of air embolism?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Left sternal border
Cannot

23. What is pulsus paradoxus?
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 drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
To inhibit thrombus and clot formation.
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

24. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Only for a few hours
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.
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.

25. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Second left intercostal space
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
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

26. How long is contrast media in the body?
Only for a few hours
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.)
Fat - Air - DVT - or Amniotic
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

27. What is epistaxis?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
A nosebleed

28. A femoral artery compression device ______be assigned to an NA?
Include rest periods prior to any activity.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Cannot

29. When would a nurse use an external femoral artery compression device?
Activity intolerance
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

30. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

31. What is intermittent claudication?
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
Nitrates - Beta blockers - and Calcium channel blockers
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.
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.

32. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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

33. What are the indications for a chemical stress test (persantine stress test)?
D/C the med and call the doctor.
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
Patient who are unable to tolerate exercise stress testing.
Air embolism

34. What will be the treatment for an acute episode of life threatening tamponade?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.

35. Where is the right ventricle landmark on the chest?
Air embolism
Left sternal border
NO because it isn't sterile so keep out.
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.

36. What should you teach your patient about an abdominal ultrasonography?
Premature beats that are not preceded by a P- wave - QRS is wide and bizarre - and the T wave of the premature beat is generally large and in the opposite direction of the QRS.
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.
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

37. What are the steps to perform the heimlich maneuver?
Lower left sternal border
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Feeling warm (fire) or tin can taste is expected and will pass.
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.

38. What is cardioversion?

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39. Which type of patient shouldn't take nitrates?
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 patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

40. What landmarks should you be looking for on someone's chest?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

41. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Don't interfere!
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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

42. What is important to remember when taking care of patients with compression devices?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

43. What should you explain to the patient about an impedance cardiography test?
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unu
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

44. How is the Allen's test done?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

45. What is an acute peripheral arterial occlusion?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Vitamin K (aqua myphiton)
Idiopathic

46. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Patient who are unable to tolerate exercise stress testing.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

47. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Second Right intercostal space.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

48. What should you teach your patient about an exercise ECG (stress test)?
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-
Only for a few hours
Air embolism
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

49. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
An inflammation of the pericardium. It may result in MI.

50. 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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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