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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. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
One at a time to assess the pulse amplitude and contour.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Direct current cardioversion and digoxin/propranolol (inderal).

2. What do calcium channel blockers do?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Open up blood vessels
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) 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.

3. What is the hallmark clinical finding associated with pericarditis?
Pulmonary edema
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits - leans forward - and breaths out.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va

4. What should you teach your patient about an exercise ECG (stress test)?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
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-
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

5. What should you teach someone with arterial insufficiency?

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6. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Include rest periods prior to any activity.
Fifth left intercostal space medial to the midclavicular line.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

7. What is cardiac tamponade? Common causes?
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
One large emboli (smaller=better)
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.

8. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
Whether the patients ulnar and radial arteries are patent.

9. What are signs and symptoms of an MI?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.
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.

10. What is impedance cardiography?
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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

11. What can result from left sided heart failure if left untreated?
Air embolism
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
Pulmonary edema
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

12. What causes essential/primary hypertension?
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
Idiopathic
Protamine Sulfate
The internal jugular veins (external are less reliable).

13. What is angina? Stable vs. unstable?

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14. What should be done immediately for someone with PE?
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Cannot
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

15. What is the antidote for heparin?
Protamine Sulfate
D/C the med and call the doctor.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

16. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
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).
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

17. What should be checked in a patient on a beta blocker?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Feeling warm (fire) or tin can taste is expected and will pass.
Pulse before and after giving.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

18. What body systems are affected by digoxin toxicity? S&S?
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Air embolism
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

19. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

20. What is the treatment for a pt. with ventricular tachycardia?
Second Right intercostal space.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

21. 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?
Cannot
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Iodine

22. 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
Vitamin K (aqua myphiton)
(S1 - S2) Third left intercostal space
Right sided heart failure

23. What should you teach your patient about MRI?
Don't interfere!
Air answers (open junctions)
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
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho

24. What is Raynauds disease? Tx?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.

25. What is the treatment for a patient in complete heart block?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

26. When would a nurse use an external femoral artery compression device?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Pulmonary edema
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

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

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28. What will be the treatment for an acute episode of life threatening tamponade?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

29. What should you remember while taking care of someone with a peripheral arterial occlusion?
Include rest periods prior to any activity.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
0.5-2.0 ng/ml
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

30. In what locations should you not place electrodes?
Feeling warm (fire) or tin can taste is expected and will pass.
In fatty areas or over major muscles - large breasts - or bony prominences.
The internal jugular veins (external are less reliable).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

31. In What time period is the greatest risk of sudden death from an MI?
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Poorly controlled hypertension
In the first 72 hours!!!!!

32. What does vasotec (Enalapril Maleate) do/SE?
Poorly controlled hypertension
Second Right intercostal space.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.

33. During an Allen's test don't compress one artery _____ the other.
Idiopathic
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Before
Fat - Air - DVT - or Amniotic

34. What is a therapeutic digoxin level?
Don't interfere!
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.
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
0.5-2.0 ng/ml

35. What should you do if the PTT value is 80 for someone on heparin?
4th left intercostal space lower sternal border
D/C the med and call the doctor.
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.
Fifth left intercostal space medial to the midclavicular line.

36. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Left sternal border
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
An enlarged space indicates fluid accumulation in the pericardial sac.

37. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Before
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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

38. Where should you place your stethescope to find the pulmonic valve?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Second Left intercostal space
No radial artery punctures if negative

39. If a victim is choking but can cough - speak - or breath what should you do?

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40. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
Fifth left intercostal space medial to the midclavicular line.

41. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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
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.
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

42. What should be done immediately if a pulmonary embolism is suspected?
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits - leans forward - and breaths out.
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
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
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.

43. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.)
Include rest periods prior to any activity.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

44. What type of EKG change indicates MI?
ST segment elevation (STEMI)
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

45. What is the maintenance for venous access port that isn't being regularly used?
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
Must be flushed 1x/month with heparin and between treatments.

46. Test ending in Gram=?
Iodine
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.

47. What should you observe for in someone on bleeding precautions?
Steroid treatment or a pregnant woman who is retaining water.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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).
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-

48. What could happen without immediate intervention for a hematoma?
0.5-2.0 ng/ml
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.
The patient may suffer significant blood loss or femoral nerve compression.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

49. Who would most likely have peripheral venous disease?
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.
Old truck driver or someone on bed rest or with pelvic trauma.
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
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.

50. What is defibrillation?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Chronic arteriosclerotic disease.