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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 type of EKG change indicates MI?
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.
ST segment elevation (STEMI)
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

2. Where should you place your stethescope to find the mitral (apex) valve?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Fifth left intercostal space medial to the midclavicular line.
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
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.

3. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Nitrates - Beta blockers - and Calcium channel blockers
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

4. When should bleeding precautions be implemented?
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.
An enlarged space indicates fluid accumulation in the pericardial sac.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

5. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Poorly controlled hypertension
If feel more than 3 shocks in a row or develop signs of infection at the site.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

6. What should you go when applying nitroglycerin ointment for angina?
In fatty areas or over major muscles - large breasts - or bony prominences.
NO NSAIDS or ASA.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

7. What are the nursing interventions for a patient in atrial fibrillation?
If feel more than 3 shocks in a row or develop signs of infection at the 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.
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!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

8. What are the steps to perform the heimlich maneuver?
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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

9. What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
If feel more than 3 shocks in a row or develop signs of infection at the site.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

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

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11. 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.
The patient may suffer significant blood loss or femoral nerve compression.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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

12. What is a good diagnosis for someone with right sided HF?
Activity intolerance
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
0.5-2.0 ng/ml
Steroid treatment or a pregnant woman who is retaining water.

13. What is INR?
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
Second right intercostal space

14. What makes the symptoms of superior vena cava syndrome better? Worse?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Fifth left intercostal space medial to the midclavicular line.
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.

15. What does the device for impedance cardiography consist of?
One at a time to assess the pulse amplitude and contour.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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

16. What are the proper steps to changing a central venous catheter dressing?
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
Second Right intercostal space.
ST segment elevation (STEMI)
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.

17. What is the treatment for myocardial infarction?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Protamine Sulfate
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.
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.

18. What is a therapeutic digoxin level?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
One large emboli (smaller=better)
0.5-2.0 ng/ml

19. What is defibrillation?
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 nosebleed
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

20. What do calcium channel blockers do?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
Open up blood vessels
A nosebleed

21. Which type of patient shouldn't take nitrates?
ST segment elevation (STEMI)
Right sided heart failure
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

22. 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?
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.)
Open up blood vessels
ST segment elevation (STEMI)
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

23. What should you do if the PT value is 45 sec?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
An inflammation of the pericardium. It may result in MI.
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
D/C the med and call the doctor.

24. What factors place you at risk for HTN?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
No radial artery punctures if negative
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.
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.

25. What is angina? Stable vs. unstable?

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26. What is more harmful a lot of little emboli or one large emboli?
Poorly controlled hypertension
Old truck driver or someone on bed rest or with pelvic trauma.
One large emboli (smaller=better)
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

27. What type of surgery is done for an aortic dissection?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
A nosebleed

28. What are the steps for adult 2 rescuer CPR?
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
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
Chronic arteriosclerotic disease.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

29. What is the purpose of compression devices?
Iodine
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

30. What should you remember while taking care of someone with a peripheral arterial occlusion?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
To inhibit thrombus and clot formation.

31. What should you do if you are going to ventilate someone with an ambu bag?
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
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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

32. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
Air embolism
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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

33. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Old truck driver or someone on bed rest or with pelvic trauma.
Nitrates - Beta blockers - and Calcium channel blockers

34. What should be done immediately if a pulmonary embolism is suspected?
ST segment elevation (STEMI)
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
Only for a few hours
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

35. What does plan of care include?
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 S&S of decreased cardiac output and Notify physician (2nd).
BP is elevated or decreased depending on activity.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

36. What should you watch for with PICC lines that have been in place for 6 months?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Air answers (open junctions)
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.

37. What does vasotec (Enalapril Maleate) do/SE?
Fifth left intercostal space medial to the midclavicular line.
Lowers BP and makes heart beat stronger. SE: flushed face.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

38. In what locations should you not place electrodes?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
Steroid treatment or a pregnant woman who is retaining water.
Maintain BED REST

39. Where is the tricuspid valve landmark on the chest?
Lower left sternal border
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
Nitrates - Beta blockers - and Calcium channel blockers

40. What is a transthoracic echocardiograph (TTE)?
Pulse before and after giving.
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

41. What are examples of calcium channel blockers?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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).

42. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.)
D/C the med and call the doctor.

43. Test ending in Gram=?
Iodine
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Pulmonary edema
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.

44. What should you teach your patient about an exercise ECG (stress test)?
NO because it isn't sterile so keep out.
Direct current cardioversion and digoxin/propranolol (inderal).
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-

45. What is characteristic of premature ventricular contractions?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
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
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.

46. What is characteristic of complete heart block?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Air answers (open junctions)
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

47. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Second Right intercostal space.
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

48. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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
Include rest periods prior to any activity.
Whether the patients ulnar and radial arteries are patent.
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.

49. For which heart sounds should the bell be used?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

50. Where is the aortic valve landmark on the chest?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Second right intercostal space
The internal jugular veins (external are less reliable).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+