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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 steps for adult 2 rescuer CPR?
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-
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.
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

2. What is cardiac tamponade? Common causes?
Fat - Air - DVT - or Amniotic
BP is elevated or decreased depending on activity.
Lung disease
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

3. What usually triggers angina pain?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.

4. What should you teach your patient about an electrocardiogram (ECG)?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

5. What are the signs and symptoms of left sided HF?
Second Left 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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

6. What is the correct way to insert an oropharyngeal airway?
Maintain BED REST
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
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

7. What are the S&S of air embolism?
Pulmonary edema
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

8. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
ST segment elevation (STEMI)
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

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

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10. What should you teach someone after they have had a pacemaker placed?

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11. When should you be concerned about premature ventricular contraction?
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

12. What are common risk factors for an MI?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Lowers BP and makes heart beat stronger. SE: flushed face.

13. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Lung disease
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).
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

14. What is a transthoracic echocardiograph (TTE)?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Include rest periods prior to any activity.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

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?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

16. How do you prepare a patient for Impedance cardiography monitoring?
Air answers (open junctions)
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
Include rest periods prior to any activity.
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

17. What should you tell someone about taking nitroglycerin tablets (SE)?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
An enlarged space indicates fluid accumulation in the pericardial sac.
They may feel a slight stinging under there tongue when they are dissolving - and they should get a HA (if no HA may not be good bc the pills only last for 6 months). Keep with you at all times.

18. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Whether the patients ulnar and radial arteries are patent.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

19. What do calcium channel blockers do?
Idiopathic
Patient who are unable to tolerate exercise stress testing.
Open up blood vessels
Chronic arteriosclerotic disease.

20. What condition can cause left sided heart failure?
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
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.
Lung disease
Vascular - artery disease causing fluid to back up into the lungs.

21. In what locations should you not place electrodes?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
Only for a few hours
In fatty areas or over major muscles - large breasts - or bony prominences.

22. How does the blood flow through the heart? (valves?)
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.
Fifth left intercostal space medial to the midclavicular line.
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!
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

23. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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.)
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

24. What should be immediately done for a patient experiencing digoxin toxicity?
Air answers (open junctions)
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Left sternal border
The patient may suffer significant blood loss or femoral nerve compression.

25. What is the antidote for coumadin?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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
Vitamin K (aqua myphiton)
Protamine Sulfate

26. What should you teach your patient about a cardiac catheterization?
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.
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
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
Only for a few hours

27. What is a therapeutic digoxin level?
One large emboli (smaller=better)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
0.5-2.0 ng/ml
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

28. What should you explain to the patient about an impedance cardiography test?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

29. When should bleeding precautions be implemented?
Second right intercostal space
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.

30. What are the steps for adult/child 1 rescuer CPR?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

31. What is intermittent claudication?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

32. What SE should you look for with calcium channel blocker use?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
NO because it isn't sterile so keep out.
One large emboli (smaller=better)
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

33. What would make someone more at risk for digoxin toxicity?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.
4th left intercostal space lower sternal border
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.

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

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35. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Maintain BED REST

36. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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.
Before
Maintain BED REST
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

37. What things should you do to assess cardiovascular status?
Air answers (open junctions)
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Nitrates - Beta blockers - and Calcium channel blockers
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

38. What is impedance cardiography?
Feeling warm (fire) or tin can taste is expected and will pass.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
To inhibit thrombus and clot formation.

39. What should you teach someone with arterial insufficiency?

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40. During an Allen's test don't compress one artery _____ the other.
Before
If feel more than 3 shocks in a row or develop signs of infection at the site.
The internal jugular veins (external are less reliable).
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

41. What disease can cause right sided heart failure?
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.
Lung disease
Pneumothorax and will end up with chest tube to help reinflate lung.
One at a time to assess the pulse amplitude and contour.

42. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

43. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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.

44. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Right sided heart failure

45. How long is contrast media in the body?
Only for a few hours
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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

46. What is pulsus paradoxus?
(S1 - S2) Third left intercostal space
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

47. 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).
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.
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

48. What are the nursing interventions for a patient in atrial fibrillation?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Right sided heart failure
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.

49. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Patient who are unable to tolerate exercise stress testing.
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.
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.
One large emboli (smaller=better)

50. What is characteristic of premature ventricular contractions?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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 the client for S&S of decreased cardiac output and Notify physician (2nd).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.