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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 is the correct way to insert an oropharyngeal airway?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

2. What should you do immediately if you suspect someone of developing a hematoma?
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.
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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

3. What are the steps for infant 1&2 rescuer CPR?
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
To inhibit thrombus and clot formation.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

4. What are the nursing interventions for a patient in atrial fibrillation?
Don't interfere!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
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

5. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

6. What landmarks should you be looking for on someone's chest?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Second left intercostal space
Right sided heart failure

7. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Fifth left intercostal space medial to the midclavicular line.

8. What should a patient do if they feel chest pain or discomfort?
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.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

9. A femoral artery compression device ______be assigned to an NA?
D/C the med and call the doctor.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
BP is elevated or decreased depending on activity.
Cannot

10. What are the S&S of cardiac tamponade?
Fat - Air - DVT - or Amniotic
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
The patient may suffer significant blood loss or femoral nerve compression.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

11. What are common risk factors for an MI?
Fifth left intercostal space medial to the midclavicular line.
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

12. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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).
Feeling warm (fire) or tin can taste is expected and will pass.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

13. 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
Don't interfere!
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

14. What things should you do to assess cardiovascular status?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
In the first 72 hours!!!!!
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

15. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Lung disease
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

16. What is the antidote for coumadin?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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)

17. What should you go when applying nitroglycerin ointment for angina?
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

18. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Direct current cardioversion and digoxin/propranolol (inderal).
Iodine
Air embolism
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.

19. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

20. Where is the right ventricle landmark on the chest?
In the first 72 hours!!!!!
Fifth left intercostal space medial to the midclavicular line.
Left sternal border
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

21. What is more harmful a lot of little emboli or one large emboli?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
One large emboli (smaller=better)
If feel more than 3 shocks in a row or develop signs of infection at the site.

22. What are signs and symptoms of an MI?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

23. What are the steps for adult 2 rescuer CPR?
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

24. What is pericarditis?
No radial artery punctures if negative
ST segment elevation (STEMI)
An inflammation of the pericardium. It may result in MI.
D/C the med and call the doctor.

25. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Air embolism
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

26. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Lung disease

27. What causes essential/primary hypertension?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Open up blood vessels
Idiopathic

28. What SE should you look for with calcium channel blocker use?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Direct current cardioversion and digoxin/propranolol (inderal).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

29. What is cardioversion?

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30. What lab value is used to evaluate a patient on coumadin? What is the normal value?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Vascular - artery disease causing fluid to back up into the lungs.
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

31. In what locations should you not place electrodes?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Vascular - artery disease causing fluid to back up into the lungs.
In fatty areas or over major muscles - large breasts - or bony prominences.
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.

32. How does the blood flow through the heart? (valves?)
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
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!
Air answers (open junctions)
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

33. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
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
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

34. What should you do when applying a femoral artery compression device?
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
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

35. What is CVP? Normal?
Feeling warm (fire) or tin can taste is expected and will pass.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.

36. What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Second Right intercostal space.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Patient who are unable to tolerate exercise stress testing.

37. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

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

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39. How should you palpate the carotid arteries?
An inflammation of the pericardium. It may result in MI.
One at a time to assess the pulse amplitude and contour.
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 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

40. What is the treatment for premature ventricular contractions?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches

41. What are the proper steps to changing a central venous catheter dressing?
Don't interfere!
Second right intercostal space
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
0.5-2.0 ng/ml

42. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
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.

43. What are the S&S of superior vena cava syndrome?
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
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.
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.
Poorly controlled hypertension

44. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
One large emboli (smaller=better)
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.

45. Should the tubing for a venous access port be included under the dressing site?

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46. Where is the aortic valve landmark on the chest?
(S1 - S2) Third left intercostal space
Second right intercostal space
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

47. What are the nursing interventions for a patient in complete heart block?
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
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

48. What should you teach your patient about a holter monitor?

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49. What is a chemical stress test (persantine stress test)?
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
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

50. What are the four types of pulmonary emboli?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Fat - Air - DVT - or Amniotic
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
Vitamin K (aqua myphiton)