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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 places someone at risk for an aortic dissection?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Poorly controlled hypertension

2. What should a patient do if they feel chest pain or discomfort?
Second Right intercostal space.
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
Patient who are unable to tolerate exercise stress testing.
One at a time to assess the pulse amplitude and contour.

3. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Steroid treatment or a pregnant woman who is retaining water.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.

4. What is superior vena cava syndrome?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.

5. What is the antidote for coumadin?
Patient who are unable to tolerate exercise stress testing.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Vitamin K (aqua myphiton)
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.

6. Where is the pulmonic valve landmark on the chest?
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
Second left intercostal space
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
A nosebleed

7. What type of surgery is done for an aortic dissection?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
ST segment elevation (STEMI)
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

8. What is Deep Vein Thrombosis (DVT)?
The patient may suffer significant blood loss or femoral nerve compression.
One large emboli (smaller=better)
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Cannot

9. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
The internal jugular veins (external are less reliable).
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.

10. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Second Right intercostal space.

11. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Left sternal border
Cannot
Maintain BED REST
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.

12. Which type of patient shouldn't take nitrates?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Fat - Air - DVT - or Amniotic
In the first 72 hours!!!!!

13. What should you teach your patient about an electrocardiogram (ECG)?
Before
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
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

14. What should you teach someone with arterial insufficiency?

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15. What body systems are affected by digoxin toxicity? S&S?
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 shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Don't interfere!

16. What will be the treatment for an acute episode of life threatening tamponade?
Pulse before and after giving.
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
Lowers BP and makes heart beat stronger. SE: flushed face.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

17. What are the S&S of cardiac tamponade?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.)
Poorly controlled hypertension
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.

18. What are the S&S of superior vena cava syndrome?
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
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
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

19. What should be done for someone on bleeding precautions?
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

20. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
Only for a few hours
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.
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

21. What is Raynauds disease? Tx?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.

22. What is an aortic dissection?

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23. In What time period is the greatest risk of sudden death from an MI?
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
In the first 72 hours!!!!!
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

24. What are the treatments/ S&S of peripheral venous disease?
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

25. What is characteristic of ventricular tachycardia?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.

26. Where is the aortic valve landmark on the chest?
Second right intercostal space
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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!

27. Where do the internal jugular veins lie?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

28. What is cardiac tamponade? Common causes?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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-

29. 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?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

30. What is pericarditis?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
An inflammation of the pericardium. It may result in MI.
Air embolism
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.

31. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
If feel more than 3 shocks in a row or develop signs of infection at the site.

32. What causes secondary hypertension?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Air embolism
Second Left intercostal space
Steroid treatment or a pregnant woman who is retaining water.

33. What are examples of calcium channel blockers?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Don't interfere!
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

34. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
D/C the med and call the doctor.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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

35. What is a chemical stress test (persantine stress test)?
The patient may suffer significant blood loss or femoral nerve compression.
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
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.
Steroid treatment or a pregnant woman who is retaining water.

36. In what locations should you not place electrodes?
The internal jugular veins (external are less reliable).
In fatty areas or over major muscles - large breasts - or bony prominences.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Lung disease

37. What factors place you at risk for HTN?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Pulse before and after giving.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.

38. For which heart sounds should the bell be used?
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
In the first 72 hours!!!!!

39. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Only for a few hours
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

40. For which heart sounds should the diaphragm be used?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
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.

41. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Chronic arteriosclerotic disease.
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
In fatty areas or over major muscles - large breasts - or bony prominences.

42. What are the nursing interventions for a patient with premature ventricular contractions?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Air answers (open junctions)
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Direct current cardioversion and digoxin/propranolol (inderal).

43. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Lowers BP and makes heart beat stronger. SE: flushed face.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

44. When would a nurse use an external femoral artery compression device?
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.

45. What will a leg with arterial insufficiency look like?
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.
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.
Include rest periods prior to any activity.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

46. What is labile hypertension?
Left sternal border
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
BP is elevated or decreased depending on activity.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

47. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Chronic arteriosclerotic disease.

48. What would make someone more at risk for digoxin toxicity?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Patient who are unable to tolerate exercise stress testing.
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

49. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Steroid treatment or a pregnant woman who is retaining water.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

50. What does a swan ganz measure?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Nitrates - Beta blockers - and Calcium channel blockers
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.