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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

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

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

1. What should 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
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
D/C the med and call the doctor.
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

2. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
D/C the med and call the doctor.
Open up blood vessels
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Fifth left intercostal space medial to the midclavicular line.

3. A femoral artery compression device ______be assigned to an NA?
Vascular - artery disease causing fluid to back up into the lungs.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Cannot

4. What should you explain to the patient about an impedance cardiography test?
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.
ST segment elevation (STEMI)
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

5. Where should you place your stethescope to find the tricuspid valve?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
Feeling warm (fire) or tin can taste is expected and will pass.
4th left intercostal space lower sternal border

6. What is an air embolism?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Activity intolerance
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

7. When should bleeding precautions be implemented?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
BP is elevated or decreased depending on activity.
One at a time to assess the pulse amplitude and contour.

8. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
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.
Protamine Sulfate
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).

9. What is the nursing care associated with chemical stress tests (persantine stress test)?
Activity intolerance
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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. How does the blood flow through the heart? (valves?)
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
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!
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.

11. What makes the symptoms of superior vena cava syndrome better? Worse?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
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.

12. What is the treatment for premature ventricular contractions?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.

13. When should you be concerned about premature ventricular contraction?
Pneumothorax and will end up with chest tube to help reinflate lung.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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 S&S of decreased cardiac output and Notify physician (2nd).

14. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
Right sided heart failure
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Activity intolerance

15. Where should you place your stethescope to find the aortic valve?
Lung disease
Second Right intercostal space.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Open up blood vessels

16. What is CVP? Normal?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.

17. What is important to remember when taking care of patients with compression devices?
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-
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

18. What is pericarditis?
D/C the med and call the doctor.
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.
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.
An inflammation of the pericardium. It may result in MI.

19. What is an acute peripheral arterial occlusion?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
4th left intercostal space lower sternal border
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 arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

20. What are coumadin and heparin used for?
Must be flushed 1x/month with heparin and between treatments.
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.
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.
To inhibit thrombus and clot formation.

21. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Lung disease

22. What should a patient do if they feel chest pain or discomfort?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Vascular - artery disease causing fluid to back up into the lungs.
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

23. What are the steps for adult/child 1 rescuer CPR?
Check for response - activate ERS and AED - open airway with head tilt chin lift - checking breathing (5-10 sec) - give 2 breaths (1 sec each) - check carotid pulse (5-10 sec) - locate CPR hand position - deliver first cycle of compressions (30 compr
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).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Activity intolerance

24. What are the S&S of cardiac tamponade?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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 feel more than 3 shocks in a row or develop signs of infection at the site.

25. What should you do if the PT value is 45 sec?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
D/C the med and call the doctor.
Second right intercostal space
(S1 - S2) Third left intercostal space

26. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
One at a time to assess the pulse amplitude and contour.
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
Protamine Sulfate
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

27. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
In the first 72 hours!!!!!
The internal jugular veins (external are less reliable).

28. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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

29. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Fifth left intercostal space medial to the midclavicular line.
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
NO because it isn't sterile so keep out.

30. What is labile hypertension?
BP is elevated or decreased depending on activity.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
D/C the med and call the doctor.

31. What should you teach someone about iodine?
Second left intercostal space
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Feeling warm (fire) or tin can taste is expected and will pass.
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg - wash hands and put on sterile gloves - gown - and mask - position device - check circulation and make sure good pedal pulse is present - IMMEDIATELY REPO

32. What should you teach your patient about an abdominal ultrasonography?
Fat - Air - DVT - or Amniotic
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
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.
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.

33. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Cannot
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

34. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

35. 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.
Vascular - artery disease causing fluid to back up into the lungs.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Don't interfere!

36. What is an aortic dissection?

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37. What factors place you at risk for HTN?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
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.
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

38. In what locations should you not place electrodes?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
Only for a few hours
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

39. When would a nurse use an external femoral artery compression device?
Nitrates - Beta blockers - and Calcium channel blockers
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Steroid treatment or a pregnant woman who is retaining water.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

40. What are common risk factors for an MI?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

41. What is the goal of treatment for an MI? Treatment?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
ST segment elevation (STEMI)

42. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
0.5-2.0 ng/ml
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).
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.

43. How is the Allen's test done?
One at a time to assess the pulse amplitude and contour.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
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

44. What should be done immediately if a pulmonary embolism is suspected?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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
An enlarged space indicates fluid accumulation in the pericardial sac.

45. What is the correct way to insert an oropharyngeal airway?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Second Right intercostal space.
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.
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

46. What are examples of calcium channel blockers?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
An inflammation of the pericardium. It may result in MI.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

47. What should you observe for in someone on bleeding precautions?
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.
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).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

48. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
Second Right intercostal space.

49. During an Allen's test don't compress one artery _____ the other.
Before
Nitrates - Beta blockers - and Calcium channel blockers
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

50. What is cardioversion?

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NCLEX Cardiac

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