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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 be checked in a patient on a beta blocker?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pulse before and after giving.
Only for a few hours
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

2. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
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.

3. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Cannot
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

4. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
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
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
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.

5. What is a therapeutic digoxin level?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
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
0.5-2.0 ng/ml

6. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Poorly controlled hypertension
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.

7. What is important to remember when taking care of patients with compression devices?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

8. What should you do when applying a femoral artery compression device?
Chronic arteriosclerotic disease.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Only for a few hours
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

9. What is the antidote for heparin?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Protamine Sulfate
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

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

11. What is important to remember when removing a CVC from a patient?
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
BP is elevated or decreased depending on activity.
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.
To inhibit thrombus and clot formation.

12. What should be done for someone on bleeding precautions?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
The internal jugular veins (external are less reliable).
D/C the med and call the doctor.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

13. What are the 2 types of pacemakers?
Air answers (open junctions)
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
Lung disease

14. What is the treatment for myocardial infarction?
Second Left intercostal space
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.

15. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause
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
In the first 72 hours!!!!!
Second right intercostal space

16. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
Old truck driver or someone on bed rest or with pelvic trauma.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

17. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
The patient may suffer significant blood loss or femoral nerve compression.
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
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

18. What are the steps to perform the heimlich maneuver?
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Vitamin K (aqua myphiton)
Steroid treatment or a pregnant woman who is retaining water.

19. Test ending in Gram=?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Iodine
Air embolism
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

20. What are the steps for adult/child 1 rescuer CPR?
Check for response - activate ERS and AED - open airway with head tilt chin lift - checking breathing (5-10 sec) - give 2 breaths (1 sec each) - check carotid pulse (5-10 sec) - locate CPR hand position - deliver first cycle of compressions (30 compr
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Activity intolerance
Idiopathic

21. What should a patient do if they feel chest pain or discomfort?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

22. What are common risk factors for an MI?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

23. In what locations should you not place electrodes?
Fifth left intercostal space medial to the midclavicular line.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Pneumothorax and will end up with chest tube to help reinflate lung.
In fatty areas or over major muscles - large breasts - or bony prominences.

24. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
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.
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
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

25. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
D/C the med and call the doctor.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

26. What is characteristic of complete heart block?
No radial artery punctures if negative
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Fourth or fifth intercostal space at or medial to the midclavicular line.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

27. What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
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.

28. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
Vitamin K (aqua myphiton)
Second left intercostal space

29. Where is the tricuspid valve landmark on the chest?
Lower left sternal border
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Open up blood vessels
Fifth left intercostal space medial to the midclavicular line.

30. What is the purpose of compression devices?
Must be flushed 1x/month with heparin and between treatments.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

31. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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
Must be flushed 1x/month with heparin and between treatments.
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.
A nosebleed

32. What should you do to treat pulmonary edema?
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.
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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

33. 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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Pulmonary edema
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.

34. Where should you place your stethescope to find the pulmonic valve?
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
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.
One large emboli (smaller=better)
Second Left intercostal space

35. What is superior vena cava syndrome?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.
NO because it isn't sterile so keep out.
A complication from a venous access device or port. It is a blockage of the superior vena cava preventing superior blood flow from reaching the heart.

36. Where should you place your stethescope to find the tricuspid valve?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
4th left intercostal space lower sternal border
In the first 72 hours!!!!!
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.

37. What are the steps for infant 1&2 rescuer CPR?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
(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.

38. What is characteristic of ventricular tachycardia?
Vitamin K (aqua myphiton)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
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).

39. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
Lung disease
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.
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.

40. What should you explain to the patient about an impedance cardiography test?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Must be flushed 1x/month with heparin and between treatments.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
If feel more than 3 shocks in a row or develop signs of infection at the site.

41. What are the four types of pulmonary emboli?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
In the first 72 hours!!!!!
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Fat - Air - DVT - or Amniotic

42. When would a nurse use an external femoral artery compression device?
Lowers BP and makes heart beat stronger. SE: flushed face.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

43. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Maintain BED REST

44. What is the treatment for a pt. with ventricular tachycardia?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
Patient who are unable to tolerate exercise stress testing.
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.

45. What is epistaxis?
A nosebleed
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.
Lower left sternal border
Fifth left intercostal space medial to the midclavicular line.

46. What causes secondary hypertension?
Protamine Sulfate
Left sternal border
Steroid treatment or a pregnant woman who is retaining water.
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.

47. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

48. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause

49. What should you not allow if a patient has a negative Allen's test?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
No radial artery punctures if negative
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

50. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Left sternal border
Right sided heart failure
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