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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?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Second Right intercostal space.

2. What are all the S&S of pericarditis?
Lung disease
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

3. What should you go when applying nitroglycerin ointment for angina?
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.
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.
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
Vitamin K (aqua myphiton)

4. What is CVP? Normal?
Pneumothorax and will end up with chest tube to help reinflate lung.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

5. What should you teach someone with arterial insufficiency?

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6. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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!
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

7. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

8. What should you teach your patient about a cardiac catheterization?
Direct current cardioversion and digoxin/propranolol (inderal).
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
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.
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va

9. What causes essential/primary hypertension?
Idiopathic
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Old truck driver or someone on bed rest or with pelvic trauma.

10. Where is the pulmonic valve landmark on the chest?
Maintain BED REST
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Second left intercostal space

11. If a victim is choking but can cough - speak - or breath what should you do?

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12. What is characteristic of ventricular tachycardia?
NO because it isn't sterile so keep out.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Lower left sternal border
Left sternal border

13. What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

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

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15. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
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.
BP is elevated or decreased depending on activity.

16. Where is the aortic valve landmark on the chest?
Nitrates - Beta blockers - and Calcium channel blockers
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
Steroid treatment or a pregnant woman who is retaining water.

17. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.

18. What usually triggers angina pain?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Feeling warm (fire) or tin can taste is expected and will pass.
0.5-2.0 ng/ml

19. What is the treatment for a pt. with ventricular tachycardia?
An inflammation of the pericardium. It may result in MI.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
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.

20. 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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
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.

21. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
D/C the med and call the doctor.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

22. What are the signs and symptoms of left sided HF?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Fourth or fifth intercostal space at or medial to the midclavicular line.

23. What is the treatments for hypertension?
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
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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

24. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Protamine Sulfate
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.

25. What does vasotec (Enalapril Maleate) do/SE?
Pneumothorax and will end up with chest tube to help reinflate lung.
Chronic arteriosclerotic disease.
Lowers BP and makes heart beat stronger. SE: flushed face.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

26. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
A nosebleed
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.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

27. What are the steps to perform the heimlich maneuver?
NO because it isn't sterile so keep out.
Poorly controlled hypertension
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

28. What are the nursing interventions for a patient in atrial fibrillation?
Cannot
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

29. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Steroid treatment or a pregnant woman who is retaining water.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
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.

30. What would make someone more at risk for digoxin toxicity?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
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
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 should you do to treat pulmonary edema?
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!
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
Vitamin K (aqua myphiton)

32. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
Second left intercostal space
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.

33. What is epistaxis?
A nosebleed
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Poorly controlled hypertension
Activity intolerance

34. What could happen without immediate intervention for a hematoma?
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Protamine Sulfate
The patient may suffer significant blood loss or femoral nerve compression.

35. What is the purpose of compression devices?
Iodine
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

36. What are the S&S associated with right sided heart failure?
To inhibit thrombus and clot formation.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Iodine

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

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38. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.)
The internal jugular veins (external are less reliable).
Nitrates - Beta blockers - and Calcium channel blockers

39. Test ending in Gram=?
Idiopathic
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Iodine
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

40. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.

41. What is intermittent claudication?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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

42. Which type of patient shouldn't take nitrates?
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.)
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
Vascular - artery disease causing fluid to back up into the lungs.

43. 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?
Right sided heart failure
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Fifth left intercostal space medial to the midclavicular line.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

44. What should be done immediately for someone with PE?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

45. What should you not allow if a patient has a negative Allen's test?
Old truck driver or someone on bed rest or with pelvic trauma.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
No radial artery punctures if negative
Second right intercostal space

46. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Maintain BED REST
Patient who are unable to tolerate exercise stress testing.
NO because it isn't sterile so keep out.

47. What do calcium channel blockers do?
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
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.
One at a time to assess the pulse amplitude and contour.
Open up blood vessels

48. What is labile hypertension?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Only for a few hours
To inhibit thrombus and clot formation.
BP is elevated or decreased depending on activity.

49. What causes secondary hypertension?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Steroid treatment or a pregnant woman who is retaining water.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

50. When should you be concerned about premature ventricular contraction?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).