Test your basic knowledge |

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. Where should you place your stethescope to find the pulmonic valve?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Second Left intercostal space
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.

2. What should you teach your patient about an electrocardiogram (ECG)?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

3. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.

4. What is defibrillation?
Left sternal border
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.
Vitamin K (aqua myphiton)
Only for a few hours

5. What is an acute peripheral arterial occlusion?
Activity intolerance
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Only for a few hours

6. What is a nursing diagnosis for arterial occlusion? Tx
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.

7. What should you remember while taking care of someone with a peripheral arterial occlusion?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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-
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

8. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Fifth left intercostal space medial to the midclavicular line.
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

9. What is more harmful a lot of little emboli or one large emboli?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
One large emboli (smaller=better)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

10. When should you be concerned about premature ventricular contraction?
ST segment elevation (STEMI)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
NO NSAIDS or ASA.

11. What needs to be held during the placement of a femoral artery compression device?
Second Left intercostal space
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.
NO NSAIDS or ASA.
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.

12. Test ending in Gram=?
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
BP is elevated or decreased depending on activity.
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.
Iodine

13. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Old truck driver or someone on bed rest or with pelvic trauma.
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
Cannot

14. What is important to remember when removing a CVC from a patient?
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

15. What should a patient do if they feel chest pain or discomfort?
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
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
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!
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.

16. What does an Allen's test determine?
BP is elevated or decreased depending on activity.
Whether the patients ulnar and radial arteries are patent.
Steroid treatment or a pregnant woman who is retaining water.
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

17. 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.
Fat - Air - DVT - or Amniotic
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

18. How is angina treated?

19. What should you teach someone about iodine?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Right sided heart failure
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Feeling warm (fire) or tin can taste is expected and will pass.

20. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

21. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Steroid treatment or a pregnant woman who is retaining water.
Cannot
An inflammation of the pericardium. It may result in MI.

22. What should you explain to the patient about an impedance cardiography test?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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

23. What is the maintenance for venous access port that isn't being regularly used?
To inhibit thrombus and clot formation.
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.
Must be flushed 1x/month with heparin and between treatments.
Vascular - artery disease causing fluid to back up into the lungs.

24. What is the treatment for a pt. with ventricular tachycardia?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
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

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

26. What is cardioversion?

27. 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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Before
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.

28. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

29. What is intermittent claudication?
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

30. A femoral artery compression device ______be assigned to an NA?
Cannot
Idiopathic
Left sternal border
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

31. Where do the internal jugular veins lie?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.

32. Who would most likely have peripheral venous disease?
Second Left intercostal space
Direct current cardioversion and digoxin/propranolol (inderal).
Second Right intercostal space.
Old truck driver or someone on bed rest or with pelvic trauma.

33. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
In the first 72 hours!!!!!

34. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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

35. What is Deep Vein Thrombosis (DVT)?
4th left intercostal space lower sternal border
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

36. Where is the aortic valve landmark on the chest?
Second right intercostal space
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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

37. What can result from left sided heart failure if left untreated?
Pulmonary edema
Whether the patients ulnar and radial arteries are patent.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

38. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.

39. What is Raynauds disease? Tx?
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.
Pulse before and after giving.
To inhibit thrombus and clot formation.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

40. What should be checked in a patient on a beta blocker?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Only for a few hours
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pulse before and after giving.

41. For which heart sounds should the diaphragm be used?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

42. What is superior vena cava syndrome?
4th left intercostal space lower sternal border
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.
No radial artery punctures if negative
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

43. What is cardiac tamponade? Common causes?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
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.

44. What is pulsus paradoxus?
Second right intercostal space
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

45. What should you teach your patient about MRI?
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

46. What factors place you at risk for HTN?
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.
(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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

47. What are the indications for a chemical stress test (persantine stress test)?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Patient who are unable to tolerate exercise stress testing.
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.
ST segment elevation (STEMI)

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

49. What is a transthoracic echocardiograph (TTE)?
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.
One at a time to assess the pulse amplitude and contour.
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.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

50. How should you palpate the apical pulse?
Second Left intercostal space
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
BP is elevated or decreased depending on activity.
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