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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What are the S&S of aortic dissection?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Right atrium - TRICUSPID VALVE (tissue) - right ventricle - PULMONIC VALVE (paper) - lungs - left atrium - MITRAL VALVE (My) - left ventricle - AORTIC VALVE (Assets). Tissue PAPER MY ASSETS!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

2. 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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

3. What SE should you look for with calcium channel blocker use?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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!
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

4. Where is the aortic valve landmark on the chest?
Second right intercostal space
Poorly controlled hypertension
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

5. What should you do when applying a femoral artery compression device?
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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

6. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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).
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.

7. How is angina treated?

8. What is characteristic of complete heart block?
If feel more than 3 shocks in a row or develop signs of infection at the site.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Lung disease
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

9. What should you teach your patient about angiography (arteriography)?
Second Left intercostal space
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
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

10. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
Iodine
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.
Fat - Air - DVT - or Amniotic

11. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
(S1 - S2) Third left intercostal space

12. What is the treatment for premature ventricular contractions?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Fat - Air - DVT - or Amniotic
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.

13. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
In the first 72 hours!!!!!
One large emboli (smaller=better)

14. What does an Allen's test determine?
Lower left sternal border
Whether the patients ulnar and radial arteries are patent.
Pulmonary edema
Second right intercostal space

15. Should the tubing for a venous access port be included under the dressing site?

16. What do calcium channel blockers do?
Open up blood vessels
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.
Pulmonary edema
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

17. What things should you do to assess cardiovascular status?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
(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).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

18. What type of surgery is done for an aortic dissection?
Pulse before and after giving.
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.
Before
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

19. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
An inflammation of the pericardium. It may result in MI.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

20. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.

21. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
Second right intercostal space
Poorly controlled hypertension
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.

22. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
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.
Lung disease
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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

23. 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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
Fourth or fifth intercostal space at or medial to the midclavicular line.

24. What could happen without immediate intervention for a hematoma?
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.
NO because it isn't sterile so keep out.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
The patient may suffer significant blood loss or femoral nerve compression.

25. What is pulsus paradoxus?
Iodine
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Second Left intercostal space
Fourth or fifth intercostal space at or medial to the midclavicular line.

26. What is angina? Stable vs. unstable?

27. What are the S&S of cardiac tamponade?
Vascular - artery disease causing fluid to back up into the lungs.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Pulmonary edema

28. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
An enlarged space indicates fluid accumulation in the pericardial sac.
In fatty areas or over major muscles - large breasts - or bony prominences.

29. What will a leg with arterial insufficiency look like?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

30. How should you palpate the apical pulse?
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

31. What should you go when applying nitroglycerin ointment for angina?
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
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
A monitor with four dual electrodes that are applied to the patients neck and thorax.

32. What is CVP? Normal?
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.
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

33. What drugs are most commonly used for angina?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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
Nitrates - Beta blockers - and Calcium channel blockers
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

34. What are the nursing interventions for a patient with premature ventricular contractions?
A nosebleed
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

35. What should you explain to the patient about an impedance cardiography test?
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.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Only for a few hours
Patient who are unable to tolerate exercise stress testing.

36. When would a nurse use an external femoral artery compression device?
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
Second left intercostal space
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

37. What is characteristic of atrial fibrillation?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

38. What is a assessment finding with DVT?

39. Where do the internal jugular veins lie?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Patient who are unable to tolerate exercise stress testing.
Fifth left intercostal space medial to the midclavicular line.

40. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
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.

41. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Steroid treatment or a pregnant woman who is retaining water.
File toe nails - if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
Include rest periods prior to any activity.
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).

42. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
ST segment elevation (STEMI)
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

43. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Fifth left intercostal space medial to the midclavicular line.
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.)

44. When should you be concerned about premature ventricular contraction?
Cannot
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Activity intolerance

45. What are the steps for adult/child 1 rescuer CPR?
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
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
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

46. What is the antidote for heparin?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Protamine Sulfate
Old truck driver or someone on bed rest or with pelvic trauma.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

47. What condition can cause left sided heart failure?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Vascular - artery disease causing fluid to back up into the lungs.
Left sternal border
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.

48. What should you watch for with PICC lines that have been in place for 6 months?
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
Air answers (open junctions)
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.

49. What should you teach your patient about an exercise ECG (stress test)?
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
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-
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

50. What is the hallmark clinical finding associated with pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.