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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 frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Don't interfere!
Must be flushed 1x/month with heparin and between treatments.
ST segment elevation (STEMI)

2. What are the S&S associated with right sided heart failure?
NO because it isn't sterile so keep out.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
Pulmonary edema

3. How does the blood flow through the heart? (valves?)
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

4. What is characteristic of ventricular fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Pulse before and after giving.

5. What does vasotec (Enalapril Maleate) do/SE?
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
Lowers BP and makes heart beat stronger. SE: flushed face.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.

6. What are the steps to perform the heimlich maneuver?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

7. What does an Allen's test determine?
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
Whether the patients ulnar and radial arteries are patent.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

8. What factors place you at risk for HTN?
Air embolism
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.

9. For which heart sounds should the bell be used?
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

10. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
Lowers BP and makes heart beat stronger. SE: flushed face.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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

11. What are the five areas for listening to the heart?

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12. What body systems are affected by digoxin toxicity? S&S?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.

13. What should you do immediately if you suspect someone of developing a hematoma?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.

14. What is pericarditis?
Direct current cardioversion and digoxin/propranolol (inderal).
An inflammation of the pericardium. It may result in MI.
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
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

15. What is the hallmark clinical finding associated with pericarditis?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

16. What is pulsus paradoxus?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Second left intercostal space
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

17. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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
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.
4th left intercostal space lower sternal border
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

18. How should you palpate the apical pulse?
One at a time to assess the pulse amplitude and contour.
Iodine
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

19. What is CVP? Normal?
Lowers BP and makes heart beat stronger. SE: flushed face.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

20. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.

21. What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Pulse before and after giving.

22. What is the treatment for atrial fibrillation?
The patient may suffer significant blood loss or femoral nerve compression.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Direct current cardioversion and digoxin/propranolol (inderal).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

23. What type of EKG change indicates MI?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
ST segment elevation (STEMI)

24. What is the treatment for a pt. with ventricular tachycardia?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
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.

25. What are common risk factors for an MI?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

26. What should you teach your patient about a cardiac catheterization?
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.
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
Direct current cardioversion and digoxin/propranolol (inderal).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

27. What are the S&S of cardiac tamponade?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pneumothorax and will end up with chest tube to help reinflate lung.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

28. What are all the S&S of pericarditis?
D/C the med and call the doctor.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

29. What should be checked in a patient on a beta blocker?
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Lowers BP and makes heart beat stronger. SE: flushed face.
Pulse before and after giving.

30. What should you teach someone about iodine?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Idiopathic
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Feeling warm (fire) or tin can taste is expected and will pass.

31. What will a leg with arterial insufficiency look like?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
BP is elevated or decreased depending on activity.

32. What SE should you look for with calcium channel blocker use?
Air embolism
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.

33. What are the nursing interventions for a patient in complete heart block?
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-
BP is elevated or decreased depending on activity.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

34. When would a nurse use an external femoral artery compression device?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

35. What is characteristic of atrial fibrillation?
NO NSAIDS or ASA.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
Right sided heart failure

36. What is intermittent claudication?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
Fat - Air - DVT - or Amniotic

37. What things should you do to assess cardiovascular status?
NO NSAIDS or ASA.
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
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

38. What needs to be held during the placement of a femoral artery compression device?
Before
NO NSAIDS or ASA.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

39. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
0.5-2.0 ng/ml
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

40. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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41. Where should you place your stethescope to find the aortic valve?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Open up blood vessels
Second Right intercostal space.
Old truck driver or someone on bed rest or with pelvic trauma.

42. What is important to remember when taking care of patients with compression devices?
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.
Cannot
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Whether the patients ulnar and radial arteries are patent.

43. What is the purpose of compression devices?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Protamine Sulfate
One at a time to assess the pulse amplitude and contour.

44. What are the 2 types of pacemakers?
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.
Direct current cardioversion and digoxin/propranolol (inderal).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.

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

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46. What is the goal of treatment for an MI? Treatment?
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Maintain BED REST
Lung disease

47. What should you teach a patient regarding discharge after a DVT?

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48. Where should you place your stethescope to find the tricuspid valve?
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.
4th left intercostal space lower sternal border
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
BP is elevated or decreased depending on activity.

49. 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?
Feeling warm (fire) or tin can taste is expected and will pass.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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

50. What should you teach your patient about angiography (arteriography)?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.