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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 are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Second Right intercostal space.
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.

2. What is the hallmark clinical finding associated with pericarditis?
Lowers BP and makes heart beat stronger. SE: flushed face.
To inhibit thrombus and clot formation.
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
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.

3. What should you explain to the patient about an impedance cardiography test?
0.5-2.0 ng/ml
Vitamin K (aqua myphiton)
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

4. Where is the aortic valve landmark on the chest?
ST segment elevation (STEMI)
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Second right intercostal space

5. What is superior vena cava syndrome?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

6. What is important to remember when removing a CVC from a patient?
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
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.
Left sternal border
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

7. What is the treatment for myocardial infarction?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.

8. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

9. For which heart sounds should the diaphragm be used?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Nitrates - Beta blockers - and Calcium channel blockers
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

10. What is intermittent claudication?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
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.
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.

11. What are the proper steps to changing a central venous catheter dressing?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Nitrates - Beta blockers - and Calcium channel blockers
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

12. What should you do if the PTT value is 80 for someone on heparin?
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
D/C the med and call the doctor.

13. What usually triggers angina pain?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
In fatty areas or over major muscles - large breasts - or bony prominences.

14. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.

15. 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?
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
0.5-2.0 ng/ml
An enlarged space indicates fluid accumulation in the pericardial sac.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

16. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
ST segment elevation (STEMI)
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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

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

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18. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

19. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
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 internal jugular veins (external are less reliable).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

20. What type of EKG change indicates MI?
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-
Pulse before and after giving.
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
ST segment elevation (STEMI)

21. What are the treatments/ S&S of peripheral venous disease?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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

22. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

23. What are signs and symptoms of an MI?
Activity intolerance
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

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

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25. What causes essential/primary hypertension?
Idiopathic
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
One at a time to assess the pulse amplitude and contour.
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.

26. What is the goal of treatment for an MI? Treatment?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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
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

27. Where should you place your stethescope to find the mitral (apex) valve?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Must be flushed 1x/month with heparin and between treatments.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Fifth left intercostal space medial to the midclavicular line.

28. What should you teach a patient regarding discharge after a DVT?

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29. What does a swan ganz measure?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

30. How do you prepare a patient for Impedance cardiography monitoring?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
If feel more than 3 shocks in a row or develop signs of infection at the site.

31. What is the maintenance for venous access port that isn't being regularly used?
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.
Must be flushed 1x/month with heparin and between treatments.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
D/C the med and call the doctor.

32. What is an aortic dissection?

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33. What should you teach your patient about an abdominal ultrasonography?
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.
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
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 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

34. What is the treatment for a pt. with ventricular tachycardia?
Vascular - artery disease causing fluid to back up into the lungs.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.

35. 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.
NO NSAIDS or ASA.
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 arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

36. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
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.

37. What is characteristic of premature ventricular contractions?
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.
(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.
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).

38. What are common risk factors for an MI?
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.)
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

39. What makes the symptoms of superior vena cava syndrome better? Worse?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.
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

40. Where should you place your stethescope to find the ERB's Point?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Only for a few hours
(S1 - S2) Third 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.

41. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
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.)
0.5-2.0 ng/ml
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

42. What should you do if you are going to ventilate someone with an ambu bag?
Second Left intercostal space
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
Before
Lower left sternal border

43. What are the steps to perform the heimlich maneuver?
Patient who are unable to tolerate exercise stress testing.
BP is elevated or decreased depending on activity.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.

44. How is the Allen's test done?
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
Fifth left intercostal space medial to the midclavicular line.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Pulse before and after giving.

45. What is labile hypertension?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Protamine Sulfate
Second Right intercostal space.
BP is elevated or decreased depending on activity.

46. What should happen if someone converts to asystole/flatline?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.)

47. What will be the treatment for an acute episode of life threatening tamponade?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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
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.

48. In What time period is the greatest risk of sudden death from an MI?
Patient who are unable to tolerate exercise stress testing.
Activity intolerance
In the first 72 hours!!!!!
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

49. How should you palpate the carotid arteries?
Fourth or fifth intercostal space at or medial to the midclavicular line.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Air embolism
One at a time to assess the pulse amplitude and contour.

50. What body systems are affected by digoxin toxicity? S&S?
Patient who are unable to tolerate exercise stress testing.
An enlarged space indicates fluid accumulation in the pericardial sac.
Don't interfere!
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

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NCLEX Cardiac

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