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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 is the treatment for a pt. with ventricular tachycardia?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

2. What is characteristic of ventricular fibrillation?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Second right intercostal space
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

3. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
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
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.

4. Where should you place your stethescope to find the tricuspid valve?
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.
Include rest periods prior to any activity.
4th left intercostal space lower sternal border
BP is elevated or decreased depending on activity.

5. What is the maintenance for venous access port that isn't being regularly used?
NO NSAIDS or ASA.
Must be flushed 1x/month with heparin and between treatments.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
One at a time to assess the pulse amplitude and contour.

6. Where do the internal jugular veins lie?
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

7. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Poorly controlled hypertension

8. What is the goal of treatment for an MI? Treatment?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Cannot

9. What is a major complication of central line placement?
Pneumothorax and will end up with chest tube to help reinflate lung.
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-
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Activity intolerance

10. What can result from left sided heart failure if left untreated?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Pulmonary edema
In the first 72 hours!!!!!
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

11. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
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.

12. What is the purpose of compression devices?
Cannot
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
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

13. What are the two common complications of pericarditis?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

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

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15. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
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
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.

16. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Nitrates - Beta blockers - and Calcium channel blockers
Fifth left intercostal space medial to the midclavicular line.
NO NSAIDS or ASA.

17. What does the device for impedance cardiography consist of?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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 monitor with four dual electrodes that are applied to the patients neck and thorax.
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

18. What is the treatments for hypertension?
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.
No radial artery punctures if negative
Feeling warm (fire) or tin can taste is expected and will pass.
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.

19. What is the treatment for a patient in complete heart block?
Maintain BED REST
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

20. What is a assessment finding with DVT?

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21. What are the steps for adult 2 rescuer CPR?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
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
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

22. What does an Allen's test determine?
One large emboli (smaller=better)
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
Whether the patients ulnar and radial arteries are patent.
The patient may suffer significant blood loss or femoral nerve compression.

23. What drugs are most commonly used for angina?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Nitrates - Beta blockers - and Calcium channel blockers
Left sternal border

24. What should you watch for with PICC lines that have been in place for 6 months?
Patient who are unable to tolerate exercise stress testing.
Lowers BP and makes heart beat stronger. SE: flushed face.
Air answers (open junctions)
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

25. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
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).
In the first 72 hours!!!!!
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-

26. What is a good diagnosis for someone with right sided HF?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Activity intolerance
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

27. What is a chemical stress test (persantine stress test)?
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
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

28. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
ST segment elevation (STEMI)

29. What does vasotec (Enalapril Maleate) do/SE?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

30. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.

31. What should be done for someone on bleeding precautions?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

32. What should you observe for in someone on bleeding precautions?
Cannot
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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).

33. What landmarks should you be looking for on someone's chest?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

34. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Patient who are unable to tolerate exercise stress testing.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

35. What things should you do to assess cardiovascular status?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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).
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

36. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
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.

37. What are the nursing interventions for a patient in atrial fibrillation?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

38. What will be the treatment for an acute episode of life threatening tamponade?
Lower left sternal border
A monitor with four dual electrodes that are applied to the patients neck and thorax.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

39. What should happen if someone converts to asystole/flatline?
Lowers BP and makes heart beat stronger. SE: flushed face.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

40. What should you explain to the patient about an impedance cardiography 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-
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

41. What is pulsus paradoxus?
No radial artery punctures if negative
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
A nosebleed
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

42. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
NO NSAIDS or ASA.
An enlarged space indicates fluid accumulation in the pericardial sac.
Second right intercostal space
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

43. What type of surgery is done for an aortic dissection?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
D/C the med and call the doctor.

44. What is labile hypertension?
Pneumothorax and will end up with chest tube to help reinflate lung.
BP is elevated or decreased depending on activity.
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
Feeling warm (fire) or tin can taste is expected and will pass.

45. What is angina? Stable vs. unstable?

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46. What is Raynauds disease? Tx?
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.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

47. What is Deep Vein Thrombosis (DVT)?
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
0.5-2.0 ng/ml
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

48. What is cardiac tamponade? Common causes?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
NO because it isn't sterile so keep out.

49. What should be done immediately if a pulmonary embolism is suspected?
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
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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
Lower left sternal border

50. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
ST segment elevation (STEMI)
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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