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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 do if the PT value is 45 sec?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Chronic arteriosclerotic disease.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
D/C the med and call the doctor.

2. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.
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.
The internal jugular veins (external are less reliable).

3. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
D/C the med and call the doctor.

4. What is the treatment for a patient in complete heart block?
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.
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
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

5. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

6. Where is the aortic valve landmark on the chest?
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
Second right intercostal space
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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

7. What condition can cause left sided heart failure?
Pulmonary edema
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Vascular - artery disease causing fluid to back up into the lungs.
Lung disease

8. Where is the apex/mitral valve landmark on the chest?
The patient may suffer significant blood loss or femoral nerve compression.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Fourth or fifth intercostal space at or medial to the midclavicular line.
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

9. What are the steps for infant 1&2 rescuer CPR?
D/C the med and call the doctor.
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
Second right intercostal space
The internal jugular veins (external are less reliable).

10. 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
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
Only for a few hours
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

11. What should you explain to the patient about an impedance cardiography test?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

12. Where is the pulmonic valve landmark on the chest?
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.
Second left intercostal space
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.

13. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Fifth left intercostal space medial to the midclavicular line.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

14. What is an acute peripheral arterial occlusion?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
ST segment elevation (STEMI)
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

15. What is the treatment for a pt. with ventricular tachycardia?
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.
The patient may suffer significant blood loss or femoral nerve compression.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
0.5-2.0 ng/ml

16. What is pericarditis?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
An inflammation of the pericardium. It may result in MI.
No radial artery punctures if negative

17. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Pulmonary edema
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.
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.
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

18. How should you palpate the carotid arteries?
Don't interfere!
The patient may suffer significant blood loss or femoral nerve compression.
Maintain BED REST
One at a time to assess the pulse amplitude and contour.

19. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
If feel more than 3 shocks in a row or develop signs of infection at the site.
One at a time to assess the pulse amplitude and contour.
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-
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

20. What is the goal of treatment for an MI? Treatment?
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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
To inhibit thrombus and clot formation.

21. During an Allen's test don't compress one artery _____ the other.
Lower left sternal border
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Before

22. How do you prepare a patient for Impedance cardiography monitoring?
Lung disease
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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
One large emboli (smaller=better)

23. What disease can cause right sided heart failure?
Only for a few hours
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.
Fifth left intercostal space medial to the midclavicular line.
Lung disease

24. What is epistaxis?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A nosebleed
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

25. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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

26. What are the two common complications of pericarditis?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
Cannot
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

27. How is angina treated?

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28. What should you teach your patient about a cardiac catheterization?
Poorly controlled hypertension
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
The 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 is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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

30. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
One large emboli (smaller=better)
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
ST segment elevation (STEMI)

31. What should you teach your patient about an abdominal ultrasonography?
An inflammation of the pericardium. It may result in MI.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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 Left intercostal space

33. What should you teach your patient about angiography (arteriography)?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
The patient may suffer significant blood loss or femoral nerve compression.
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

34. What should you teach someone after they have had a pacemaker placed?

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

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36. What is defibrillation?
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 clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

37. Where is the right ventricle landmark on the chest?
Left sternal border
Second Left intercostal space
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

38. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
To inhibit thrombus and clot formation.
Pneumothorax and will end up with chest tube to help reinflate lung.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

39. What is an aortic dissection?

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40. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
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
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Lung disease

41. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
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.
Steroid treatment or a pregnant woman who is retaining water.
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

42. Where should you place your stethescope to find the aortic valve?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Second Right intercostal space.
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

43. When should you be concerned about premature ventricular contraction?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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 TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

44. What usually triggers angina pain?
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
The internal jugular veins (external are less reliable).
The patient may suffer significant blood loss or femoral nerve compression.

45. What are the nursing interventions for a pt. with ventricular tachycardia?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Patient who are unable to tolerate exercise stress testing.
Before

46. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Don't interfere!
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.

47. What type of EKG change indicates MI?
ST segment elevation (STEMI)
The patient may suffer significant blood loss or femoral nerve compression.
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

48. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Activity intolerance
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

49. 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?
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
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

50. What drugs are most commonly used for angina?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Nitrates - Beta blockers - and Calcium channel blockers
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

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NCLEX Cardiac

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