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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 epistaxis?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
A nosebleed
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

2. What is CVP? Normal?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
NO NSAIDS or ASA.

3. What drugs are most commonly used for angina?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Nitrates - Beta blockers - and Calcium channel blockers
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

4. What body systems are affected by digoxin toxicity? S&S?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Right sided heart failure
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.

5. 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
Left sternal border
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.
To inhibit thrombus and clot formation.

6. What is a nursing diagnosis for arterial occlusion? Tx
The patient may suffer significant blood loss or femoral nerve compression.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Vascular - artery disease causing fluid to back up into the lungs.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

7. What will be the treatment for an acute episode of life threatening tamponade?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Direct current cardioversion and digoxin/propranolol (inderal).
Right sided heart failure
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

8. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

9. What is a good diagnosis for someone with right sided HF?
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
Pneumothorax and will end up with chest tube to help reinflate lung.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Activity intolerance

10. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Second Left intercostal space

11. What should you teach your patient about an electrocardiogram (ECG)?
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
D/C the med and call the doctor.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
4th left intercostal space lower sternal border

12. What usually triggers angina pain?
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.
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
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).

13. What is the maintenance for venous access port that isn't being regularly used?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Must be flushed 1x/month with heparin and between treatments.

14. What are all the S&S of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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
Maintain BED REST
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

15. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
ST segment elevation (STEMI)

16. What are the signs and symptoms of left sided HF?
D/C the med and call the doctor.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

17. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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

18. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
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.
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.
Don't interfere!

19. Which type of patient shouldn't take nitrates?
Must be flushed 1x/month with heparin and between treatments.
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

20. What are the four types of pulmonary emboli?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
4th left intercostal space lower sternal border
Fat - Air - DVT - or Amniotic

21. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
The internal jugular veins (external are less reliable).
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.
One large emboli (smaller=better)

22. What places someone at risk for an aortic dissection?
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.
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.
Poorly controlled hypertension
Pulse before and after giving.

23. What is cardioversion?

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24. What is characteristic of ventricular fibrillation?
The internal jugular veins (external are less reliable).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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

25. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

26. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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
Fourth or fifth intercostal space at or medial to the midclavicular line.

27. What is the treatment for someone in ventricular fibrillation?
Fat - Air - DVT - or Amniotic
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Only for a few hours

28. What should you teach your patient about a cardiac catheterization?
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!
Right sided heart failure
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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

29. What are the steps for adult 2 rescuer CPR?
Rescuer arrives with AED - turn AED on - select proper pads and apply - clear victim to analyze - clear victim to shock/press shock - resume chest compressions after 1 shock - delivers cycle of compressions at correct rate - pause to allow other resc
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.

30. What do calcium channel blockers do?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
In the first 72 hours!!!!!
Open up blood vessels
No radial artery punctures if negative

31. What are the S&S of superior vena cava syndrome?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Don't interfere!
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
D/C the med and call the doctor.

32. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
An enlarged space indicates fluid accumulation in the pericardial sac.

33. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
In the first 72 hours!!!!!
File toe nails - if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
Right sided heart failure
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.)

34. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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!
Direct current cardioversion and digoxin/propranolol (inderal).
Chronic arteriosclerotic disease.
Include rest periods prior to any activity.

35. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
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
An enlarged space indicates fluid accumulation in the pericardial sac.

36. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
To inhibit thrombus and clot formation.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.

37. What should you go when applying nitroglycerin ointment for angina?
NO NSAIDS or ASA.
Feeling warm (fire) or tin can taste is expected and will pass.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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

38. How do you prepare a patient for Impedance cardiography monitoring?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

39. Where do the internal jugular veins lie?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

40. What should you do if the PT value is 45 sec?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
NO because it isn't sterile so keep out.
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
D/C the med and call the doctor.

41. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Second left intercostal space
Right sided heart failure

42. What type of EKG change indicates MI?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Right sided heart failure
In fatty areas or over major muscles - large breasts - or bony prominences.
ST segment elevation (STEMI)

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

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44. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
One large emboli (smaller=better)
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

45. What are the nursing interventions for a patient in atrial fibrillation?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

46. 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?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

47. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

48. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Idiopathic
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
Air answers (open junctions)

49. What is pericarditis?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
An inflammation of the pericardium. It may result in MI.

50. How long is contrast media in the body?
Cannot
Only for a few hours
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.
BP is elevated or decreased depending on activity.