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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 the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Include rest periods prior to any activity.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

2. What should you observe for in someone on bleeding precautions?
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.
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.)
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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).

3. What is the antidote for coumadin?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.
Vitamin K (aqua myphiton)

4. What should you do if you are going to ventilate someone with an ambu bag?
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Iodine
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

5. What is impedance cardiography?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

6. What should you do immediately if you suspect someone of developing a hematoma?
0.5-2.0 ng/ml
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.
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-
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.

7. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
D/C the med and call the doctor.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

8. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Nitrates - Beta blockers - and Calcium channel blockers
D/C the med and call the doctor.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

9. What is a good diagnosis for someone with right sided HF?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Activity intolerance

10. When should you be concerned about premature ventricular contraction?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Pulse before and after giving.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

11. What is the treatment for myocardial infarction?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Second Right intercostal space.
Maintain BED REST
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. Where is the tricuspid valve landmark on the chest?
Lower left sternal border
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

13. What does vasotec (Enalapril Maleate) do/SE?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Lowers BP and makes heart beat stronger. SE: flushed face.

14. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

15. What is CVP? Normal?
Poorly controlled hypertension
D/C the med and call the doctor.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

16. What places someone at risk for an aortic dissection?
Lower left sternal border
The internal jugular veins (external are less reliable).
Poorly controlled hypertension
Second left intercostal space

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

18. How long is contrast media in the body?
NO because it isn't sterile so keep out.
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.
Only for a few hours
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

19. What usually triggers angina pain?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

20. When should bleeding precautions be implemented?
Second left intercostal space
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.

21. What is characteristic of atrial fibrillation?
To inhibit thrombus and clot formation.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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

22. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Protamine Sulfate
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Right sided heart failure

23. What are coumadin and heparin used for?
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-
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
To inhibit thrombus and clot formation.
Idiopathic

24. What factors place you at risk for HTN?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
Must be flushed 1x/month with heparin and between treatments.
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.

25. What are the S&S of air embolism?
Second Left intercostal space
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.

26. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Maintain BED REST
Protamine Sulfate

27. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
Right sided heart failure

28. In What time period is the greatest risk of sudden death from an MI?
Feeling warm (fire) or tin can taste is expected and will pass.
In the first 72 hours!!!!!
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

29. How is the Allen's test done?
Second Right intercostal space.
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
A nosebleed
Air embolism

30. What would make someone more at risk for digoxin toxicity?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
In fatty areas or over major muscles - large breasts - or bony prominences.
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.

31. What are the nursing interventions for a pt. with ventricular tachycardia?
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.

32. What does plan of care include?
Old truck driver or someone on bed rest or with pelvic trauma.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Steroid treatment or a pregnant woman who is retaining water.
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.

33. What things should you do to assess cardiovascular status?
Lower left sternal border
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

34. What is cardioversion?

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35. What should you do to treat pulmonary edema?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Protamine Sulfate
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

36. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Steroid treatment or a pregnant woman who is retaining water.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
NO because it isn't sterile so keep out.
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.

37. Where should you place your stethescope to find the tricuspid valve?
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.
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
4th left intercostal space lower sternal border

38. What should you teach your patient about a cardiac catheterization?
An inflammation of the pericardium. It may result in MI.
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
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

39. What are the nursing interventions for a patient with premature ventricular contractions?
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
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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

40. What is characteristic of ventricular tachycardia?
Poorly controlled hypertension
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

41. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

42. What should you watch for with PICC lines that have been in place for 6 months?
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
Air answers (open junctions)
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

43. What does a swan ganz measure?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Second Right intercostal space.

44. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Second Left intercostal space
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

45. What is a nursing diagnosis for arterial occlusion? Tx
BP is elevated or decreased depending on activity.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Lowers BP and makes heart beat stronger. SE: flushed face.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

46. What is Raynauds disease? Tx?
Idiopathic
Poorly controlled hypertension
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.
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

47. What is the maintenance for venous access port that isn't being regularly used?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Must be flushed 1x/month with heparin and between treatments.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

48. What type of surgery is done for an aortic dissection?
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.
Pulse before and after giving.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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

49. 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.
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.
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.
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.

50. What is defibrillation?
A disease in which thrombi trap blood in the deep veins of the pelvis and 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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.