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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 treatment for someone in ventricular fibrillation?
4th left intercostal space lower sternal border
Vitamin K (aqua myphiton)
Whether the patients ulnar and radial arteries are patent.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

2. What is important to remember when removing a CVC from a patient?
Don't interfere!
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.
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
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.

3. 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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

4. What needs to be held during the placement of a femoral artery compression device?
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.
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.
NO NSAIDS or ASA.
Iodine

5. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Steroid treatment or a pregnant woman who is retaining water.
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

6. What is intermittent claudication?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
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

7. What is pulsus paradoxus?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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

8. What does vasotec (Enalapril Maleate) do/SE?
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.
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.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.

9. What will be the treatment for an acute episode of life threatening tamponade?
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Fourth or fifth intercostal space at or medial to the midclavicular line.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

10. What landmarks should you be looking for on someone's chest?
No radial artery punctures if negative
Open up blood vessels
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Vascular - artery disease causing fluid to back up into the lungs.

11. What is important to remember when taking care of patients with compression devices?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
The patient may suffer significant blood loss or femoral nerve compression.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

12. What should you teach your patient about angiography (arteriography)?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
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
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.

13. What is a good diagnosis for someone with right sided HF?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Activity intolerance
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

14. Where should you place your stethescope to find the pulmonic valve?
NO NSAIDS or ASA.
Second Left intercostal space
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.
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.

15. Where is the right ventricle landmark on the chest?
Left sternal border
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
If feel more than 3 shocks in a row or develop signs of infection at the site.

16. What factors place you at risk for HTN?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
No radial artery punctures if negative
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.)

17. What places someone at risk for an aortic dissection?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
One large emboli (smaller=better)
Air answers (open junctions)
Poorly controlled hypertension

18. What is the maintenance for venous access port that isn't being regularly used?
NO because it isn't sterile so keep out.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Must be flushed 1x/month with heparin and between treatments.
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.

19. 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?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.

20. What could happen without immediate intervention for a hematoma?
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.
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.
The patient may suffer significant blood loss or femoral nerve compression.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

21. 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.
In the first 72 hours!!!!!
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

22. What are signs and symptoms of an MI?
Vascular - artery disease causing fluid to back up into the lungs.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

23. What should you do to treat pulmonary edema?
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
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.

24. What is the goal of treatment for an MI? Treatment?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

25. What is a transthoracic echocardiograph (TTE)?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
The internal jugular veins (external are less reliable).
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

26. Where is the tricuspid valve landmark on the chest?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Lower left sternal border
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

27. What can result from left sided heart failure if left untreated?
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.
Right sided heart failure
Pulmonary edema
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.

28. What is characteristic of ventricular fibrillation?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Second left intercostal space
Open up blood vessels
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

29. For which heart sounds should the bell be used?
Nitrates - Beta blockers - and Calcium channel blockers
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

30. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

31. What should you do immediately if you suspect someone of developing a hematoma?
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.
Maintain BED REST
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

32. What usually triggers angina pain?
Fourth or fifth intercostal space at or medial to the midclavicular line.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

33. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Open up blood vessels

34. What are the steps for adult/child 1 rescuer CPR?
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
In the first 72 hours!!!!!
A nosebleed

35. How do you prepare a patient for Impedance cardiography monitoring?
Fifth left intercostal space medial to the midclavicular line.
Activity intolerance
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

36. What should you do if the PTT value is 80 for someone on heparin?
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.
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.
D/C the med and call the doctor.

37. What is impedance cardiography?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea
D/C the med and call the doctor.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

38. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
Second left intercostal space
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-
D/C the med and call the doctor.

39. What are the nursing interventions for a patient in complete heart block?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
Lower left sternal border
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

40. What will a leg with arterial insufficiency look like?
An enlarged space indicates fluid accumulation in the pericardial sac.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Lower left sternal border

41. How should you palpate the carotid arteries?
A nosebleed
One at a time to assess the pulse amplitude and contour.
Pulse before and after giving.
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.

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

43. What are the signs and symptoms of left sided HF?
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

44. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
Idiopathic
D/C the med and call the doctor.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

45. What are all the S&S of pericarditis?
Whether the patients ulnar and radial arteries are patent.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

46. 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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

47. What is angina? Stable vs. unstable?

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48. What is the antidote for coumadin?
Maintain BED REST
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.
Air answers (open junctions)
Vitamin K (aqua myphiton)

49. How does the blood flow through the heart? (valves?)
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.
Don't interfere!
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!
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

50. What should be immediately done for a patient experiencing digoxin toxicity?
Protamine Sulfate
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

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NCLEX Cardiac

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