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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 a assessment finding with DVT?

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2. For which heart sounds should the bell be used?
Old truck driver or someone on bed rest or with pelvic trauma.
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
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

3. What is superior vena cava syndrome?
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.
D/C the med and call the doctor.
Whether the patients ulnar and radial arteries are patent.
In fatty areas or over major muscles - large breasts - or bony prominences.

4. What should you teach your patient about an electrocardiogram (ECG)?
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
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Lung disease

5. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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
Feeling warm (fire) or tin can taste is expected and will pass.
Protamine Sulfate

6. What should you do when applying a femoral artery compression device?
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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

7. What disease can cause right sided heart failure?
(S1 - S2) Third left intercostal space
Lung disease
One large emboli (smaller=better)
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.

8. What is Deep Vein Thrombosis (DVT)?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
One large emboli (smaller=better)

9. When should you be concerned about premature ventricular contraction?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Whether the patients ulnar and radial arteries are patent.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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

10. Where should you place your stethescope to find the aortic valve?
Second Right intercostal space.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Idiopathic
The patient may suffer significant blood loss or femoral nerve compression.

11. How is the Allen's test done?
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.
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.
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
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

12. What is defibrillation?
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
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.

13. What are examples of calcium channel blockers?
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!
Pulmonary edema
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

14. What should you do if the PT value is 45 sec?
Steroid treatment or a pregnant woman who is retaining water.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
BP is elevated or decreased depending on activity.
D/C the med and call the doctor.

15. What is labile hypertension?
In fatty areas or over major muscles - large breasts - or bony prominences.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
BP is elevated or decreased depending on activity.

16. How long is contrast media in the body?
Only for a few hours
One large emboli (smaller=better)
Old truck driver or someone on bed rest or with pelvic trauma.
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 is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Pneumothorax and will end up with chest tube to help reinflate lung.
One at a time to assess the pulse amplitude and contour.
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.
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.

18. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
Pulmonary edema
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

19. Where is the right ventricle landmark on the chest?
Left sternal border
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.

20. Where do the internal jugular veins lie?
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Old truck driver or someone on bed rest or with pelvic trauma.

21. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
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
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.
0.5-2.0 ng/ml

22. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
4th left intercostal space lower sternal border
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

23. What are the four types of pulmonary emboli?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
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.

24. What should you go when applying nitroglycerin ointment for angina?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Second Right intercostal space.
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

25. What are the nursing interventions for a patient in atrial fibrillation?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Chronic arteriosclerotic disease.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

26. What is pericarditis?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
An inflammation of the pericardium. It may result in MI.
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

27. When should bleeding precautions be implemented?
When: using anticoagulants - liver disease - decrease in platelets (less than 150 -000) - hemophilia - using thrombolytic meds - DIC - CA - HIV - chemo - bone marrow problems - and ASA/NSAIDS.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

28. What should you teach someone with arterial insufficiency?

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29. What is the nursing care associated with chemical stress tests (persantine stress test)?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
D/C the med and call the doctor.
To inhibit thrombus and clot formation.
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

30. What drugs are most commonly used for angina?
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
Nitrates - Beta blockers - and Calcium channel blockers
Don't interfere!
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

31. What should you observe for in someone on bleeding precautions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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).
Fat - Air - DVT - or Amniotic

32. What are the nursing interventions for a pt. with ventricular tachycardia?
Air answers (open junctions)
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

33. What is INR?
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.
In the first 72 hours!!!!!
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
0.5-2.0 ng/ml

34. What are the steps for adult/child 1 rescuer CPR?
Second right intercostal space
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

35. What is the goal of treatment for an MI? Treatment?
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Include rest periods prior to any activity.

36. What are the nursing interventions for a patient with premature ventricular contractions?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
(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).
One at a time to assess the pulse amplitude and contour.

37. What landmarks should you be looking for on someone's chest?
Must be flushed 1x/month with heparin and between treatments.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
ST segment elevation (STEMI)
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

38. What is the correct way to insert an oropharyngeal airway?
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.
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.

39. What is the treatment for myocardial infarction?
The internal jugular veins (external are less reliable).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.)
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

40. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (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.
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.
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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

41. What should you do immediately if you suspect someone of developing a hematoma?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
Open up blood vessels
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

42. What usually triggers angina pain?
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.
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).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

43. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.

44. What does the device for impedance cardiography consist of?
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.
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
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!
A monitor with four dual electrodes that are applied to the patients neck and thorax.

45. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

46. What should you teach your patient about an abdominal ultrasonography?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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-
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

47. What is the hallmark clinical finding associated with pericarditis?
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Fourth or fifth intercostal space at or medial to the midclavicular line.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

48. Where should you place your stethescope to find the pulmonic valve?
When: using anticoagulants - liver disease - decrease in platelets (less than 150 -000) - hemophilia - using thrombolytic meds - DIC - CA - HIV - chemo - bone marrow problems - and ASA/NSAIDS.
Second Left intercostal space
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Pneumothorax and will end up with chest tube to help reinflate lung.

49. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
D/C the med and call the doctor.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

50. What should be done immediately if a pulmonary embolism is suspected?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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
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
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