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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 patient in complete heart block?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Include rest periods prior to any activity.

2. What SE should you look for with calcium channel blocker use?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
One at a time to assess the pulse amplitude and contour.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

3. What is epistaxis?
In fatty areas or over major muscles - large breasts - or bony prominences.
A nosebleed
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

4. What is characteristic of atrial fibrillation?
The internal jugular veins (external are less reliable).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

5. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Open up blood vessels
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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

6. What are the nursing interventions for a patient in complete heart block?
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD

7. What is defibrillation?
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
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
Chronic arteriosclerotic disease.

8. What are the S&S of air embolism?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

9. What is important to remember when taking care of patients with compression devices?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.

10. What is angina? Stable vs. unstable?

11. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Feeling warm (fire) or tin can taste is expected and will pass.
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.)

12. What should you do if you are going to ventilate someone with an ambu bag?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
A nosebleed

13. For what disease should you do the Allen's test?

14. 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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

15. What should you teach your patient about MRI?
An enlarged space indicates fluid accumulation in the pericardial sac.
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
Lower left sternal border
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.

16. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Air embolism
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.

17. What should you teach someone with arterial insufficiency?

18. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
The internal jugular veins (external are less reliable).

19. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Pulse before and after giving.

20. Where should you place your stethescope to find the aortic valve?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
NO NSAIDS or ASA.
Second Right intercostal space.

21. What is a good diagnosis for someone with right sided HF?
Activity intolerance
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
ST segment elevation (STEMI)

22. How is angina treated?

23. What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
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.
Air answers (open junctions)
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.

24. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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.
NO NSAIDS or ASA.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

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

26. 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.
BP is elevated or decreased depending on activity.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
NO NSAIDS or ASA.

27. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

28. What is important to remember when removing a CVC from a patient?
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.
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
0.5-2.0 ng/ml
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

29. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
4th left intercostal space lower sternal border
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

30. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
One at a time to assess the pulse amplitude and contour.
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.
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.

31. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.
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.
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

32. What are the signs and symptoms of left sided HF?
Second Left intercostal space
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
Vascular - artery disease causing fluid to back up into the lungs.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

33. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.

34. How does the blood flow through the heart? (valves?)
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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!
NO because it isn't sterile so keep out.
(S1 - S2) Third left intercostal space

35. What is characteristic of ventricular fibrillation?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Open up blood vessels
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

36. When would a nurse use an external femoral artery compression device?
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).
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

37. 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).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Pneumothorax and will end up with chest tube to help reinflate lung.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

38. What condition can cause left sided heart failure?
Protamine Sulfate
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Vascular - artery disease causing fluid to back up into the lungs.
Pneumothorax and will end up with chest tube to help reinflate lung.

39. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
D/C the med and call the doctor.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Include rest periods prior to any activity.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

40. For which heart sounds should the diaphragm be used?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Direct current cardioversion and digoxin/propranolol (inderal).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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

41. What does plan of care include?
Vascular - artery disease causing fluid to back up into the lungs.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Patient who are unable to tolerate exercise stress testing.
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

42. What should you teach your patient about an exercise ECG (stress test)?
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.)
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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-
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

43. Where should you place your stethescope to find the mitral (apex) valve?
Fifth left intercostal space medial to the midclavicular line.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
NO NSAIDS or ASA.

44. Where is the tricuspid valve landmark on the chest?
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.
Lower left sternal border
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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

45. What is labile hypertension?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
BP is elevated or decreased depending on activity.
Don't interfere!
Lower left sternal border

46. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

47. What should you teach your patient about a cardiac catheterization?
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.
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

48. Who would most likely have peripheral venous disease?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
(S1 - S2) Third left intercostal space

49. What is the purpose of compression devices?
Second right intercostal space
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Fourth or fifth intercostal space at or medial to the midclavicular line.

50. What are the steps for infant 1&2 rescuer CPR?
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.
In fatty areas or over major muscles - large breasts - or bony prominences.