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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 does a swan ganz measure?
Direct current cardioversion and digoxin/propranolol (inderal).
Pulse before and after giving.
Before
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

2. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
An enlarged space indicates fluid accumulation in the pericardial sac.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

3. What places someone at risk for an aortic dissection?
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.
Before
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
Poorly controlled hypertension

4. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Right sided heart failure
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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 condition can cause left sided heart failure?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Vascular - artery disease causing fluid to back up into the lungs.
Second right intercostal space
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.

6. What is characteristic of atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
BP is elevated or decreased depending on activity.

7. What makes the symptoms of superior vena cava syndrome better? Worse?
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
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Direct current cardioversion and digoxin/propranolol (inderal).

8. What are the nursing interventions for a patient with premature ventricular contractions?
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Pulse before and after giving.

9. What is important to remember when taking care of patients with compression devices?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

10. What is important to remember when removing a CVC from a patient?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Fat - Air - DVT - or Amniotic
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.

11. What signals an elevated venous pressure based on the internal jugular veins?
An enlarged space indicates fluid accumulation in the pericardial sac.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
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.

12. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
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
One large emboli (smaller=better)
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.

13. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Old truck driver or someone on bed rest or with pelvic trauma.
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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

14. When should bleeding precautions be implemented?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.
Cannot
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

15. What is the treatment for a pt. with ventricular tachycardia?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
In the first 72 hours!!!!!
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.

16. What is intermittent claudication?
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
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

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

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18. What is characteristic of ventricular tachycardia?
Activity intolerance
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

19. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Air embolism
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

20. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
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.
NO NSAIDS or ASA.
Lower left sternal border

21. What should be done immediately for someone with PE?
Include rest periods prior to any activity.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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

22. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

23. What should be done immediately if a pulmonary embolism is suspected?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Don't interfere!
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
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

24. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
To inhibit thrombus and clot formation.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

25. What are signs and symptoms of an MI?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

26. What is the most common cause of arterial insufficiency?
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.
Chronic arteriosclerotic disease.
Must be flushed 1x/month with heparin and between treatments.
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.

27. What should you teach your patient about an abdominal ultrasonography?
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
Poorly controlled hypertension
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

28. What do calcium channel blockers do?
Iodine
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
If feel more than 3 shocks in a row or develop signs of infection at the site.
Open up blood vessels

29. 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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Protamine Sulfate
Maintain BED REST

30. What should be done for someone on bleeding precautions?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.
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

31. What type of EKG change indicates MI?
Air answers (open junctions)
Lowers BP and makes heart beat stronger. SE: flushed face.
ST segment elevation (STEMI)
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

32. How long is contrast media in the body?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Using both gloved hands - apply firm pressure just above the skin puncture site and over the hematoma to compress the area. Wait at least 15 mins before removing pressure and reassessing the site. Then notify the health care provider.
Only for a few hours

33. What is Raynauds disease? Tx?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
D/C the med and call the doctor.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.

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

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35. What is labile hypertension?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
BP is elevated or decreased depending on activity.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Air embolism

36. What is impedance cardiography?
Open up blood vessels
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.

37. What should you do immediately if you suspect someone of developing a hematoma?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
NO NSAIDS or ASA.
Using both gloved hands - apply firm pressure just above the skin puncture site and over the hematoma to compress the area. Wait at least 15 mins before removing pressure and reassessing the site. Then notify the health care provider.
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.

38. How should you palpate the carotid arteries?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Idiopathic
One at a time to assess the pulse amplitude and contour.
NO because it isn't sterile so keep out.

39. What is the antidote for coumadin?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Vitamin K (aqua myphiton)
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

40. What factors place you at risk for HTN?
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

41. What should you teach your patient about an exercise ECG (stress test)?
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-
Before
Air embolism
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

42. What should you teach your patient about a cardiac catheterization?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Iodine
Whether the patients ulnar and radial arteries are patent.
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

43. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Maintain BED REST

44. What should you do if you are going to ventilate someone with an ambu bag?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
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
Fat - Air - DVT - or Amniotic

45. What should you teach someone about iodine?
Patient who are unable to tolerate exercise stress testing.
A nosebleed
Feeling warm (fire) or tin can taste is expected and will pass.
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

46. What should you do if the PT value is 45 sec?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
No radial artery punctures if negative
D/C the med and call the doctor.
0.5-2.0 ng/ml

47. What is a nursing diagnosis for arterial occlusion? Tx
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
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!

48. What is an air embolism?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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 a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

49. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

50. Where is the aortic valve landmark on the chest?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Second right intercostal space
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.