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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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

1. What is the treatments for hypertension?
Second right intercostal space
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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).
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.

2. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
Pneumothorax and will end up with chest tube to help reinflate lung.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

3. What is a therapeutic digoxin level?
Fat - Air - DVT - or Amniotic
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
0.5-2.0 ng/ml

4. What should you watch for with PICC lines that have been in place for 6 months?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Air answers (open junctions)
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Only for a few hours

5. What are the steps for adult 2 rescuer CPR?
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
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.
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
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

6. What is impedance cardiography?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Pulmonary edema

7. What are the S&S of air embolism?
Fourth or fifth intercostal space at or medial to the midclavicular line.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Direct current cardioversion and digoxin/propranolol (inderal).

8. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Maintain BED REST
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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!
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

9. What should you tell someone about taking nitroglycerin tablets (SE)?
One at a time to assess the pulse amplitude and contour.
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.
Don't interfere!
Air embolism

10. What will a leg with arterial insufficiency look like?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Fat - Air - DVT - or Amniotic
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Maintain BED REST

11. 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?
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
Lung disease

12. What is important to remember when removing a CVC from a patient?
Whether the patients ulnar and radial arteries are patent.
Iodine
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

13. 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?
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Pulmonary edema
Direct current cardioversion and digoxin/propranolol (inderal).

14. What do calcium channel blockers do?
Open up blood vessels
Second Right intercostal space.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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

15. How does the blood flow through the heart? (valves?)
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
Cannot
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!
Lower left sternal border

16. What are the nursing interventions for a patient with premature ventricular contractions?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Nitrates - Beta blockers - and Calcium channel blockers

17. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Direct current cardioversion and digoxin/propranolol (inderal).

18. What are the nursing interventions for a patient in complete heart block?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

19. What should you not allow if a patient has a negative Allen's test?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
No radial artery punctures if negative
Cannot
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

20. What is the treatment for myocardial infarction?
Air embolism
D/C the med and call the doctor.
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

21. Where should you place your stethescope to find the ERB's Point?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
(S1 - S2) Third left intercostal space
Nitrates - Beta blockers - and Calcium channel blockers

22. What body systems are affected by digoxin toxicity? S&S?
Direct current cardioversion and digoxin/propranolol (inderal).
NO NSAIDS or ASA.
Fat - Air - DVT - or Amniotic
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

23. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
D/C the med and call the doctor.
In the first 72 hours!!!!!
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-

24. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
Cannot
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

25. What should you do to treat pulmonary edema?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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

26. What are the four types of pulmonary emboli?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Fat - Air - DVT - or Amniotic
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

27. What is a assessment finding with DVT?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Right sided heart failure
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

28. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
4th left intercostal space lower sternal border

29. What is characteristic of ventricular fibrillation?
No radial artery punctures if negative
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
The patient may suffer significant blood loss or femoral nerve compression.

30. Where is the aortic valve landmark on the chest?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Second right intercostal space
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.

31. What causes essential/primary hypertension?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
Old truck driver or someone on bed rest or with pelvic trauma.
Idiopathic

32. What is characteristic of premature ventricular contractions?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Fifth left intercostal space medial to the midclavicular line.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.

33. 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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

34. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
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.
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.
Old truck driver or someone on bed rest or with pelvic trauma.

35. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
An inflammation of the pericardium. It may result in MI.
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.

36. What are the nursing interventions for a pt. with ventricular tachycardia?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

37. For which heart sounds should the bell be used?
Patient who are unable to tolerate exercise stress testing.
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

38. How should you palpate the apical pulse?
Lower left sternal border
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
To inhibit thrombus and clot formation.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

39. What factors place you at risk for HTN?
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
Before
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

40. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Cannot
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Lowers BP and makes heart beat stronger. SE: flushed face.

41. What should you teach your patient about an exercise ECG (stress test)?
Left sternal border
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-
One at a time to assess the pulse amplitude and contour.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

42. Where is the apex/mitral valve landmark on the chest?
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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

43. What are the five areas for listening to the heart?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
BP is elevated or decreased depending on activity.
Before
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.

44. What is a major complication of central line placement?
One at a time to assess the pulse amplitude and contour.
Pneumothorax and will end up with chest tube to help reinflate lung.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Direct current cardioversion and digoxin/propranolol (inderal).

45. How long is contrast media in the body?
The patient may suffer significant blood loss or femoral nerve compression.
Only for a few hours
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.

46. How should you palpate the carotid arteries?
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.
Fifth left intercostal space medial to the midclavicular line.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
One at a time to assess the pulse amplitude and contour.

47. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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
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

48. 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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

49. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Patient who are unable to tolerate exercise stress testing.
One large emboli (smaller=better)
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

50. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Cannot
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

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