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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 should you go when applying nitroglycerin ointment for angina?
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
Don't interfere!
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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

2. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Lung disease
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

3. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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
Chronic arteriosclerotic disease.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

4. Test ending in Gram=?
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
Iodine
Fourth or fifth intercostal space at or medial to the midclavicular line.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

5. What places someone at risk for an aortic dissection?
Second right intercostal space
One large emboli (smaller=better)
Pulse before and after giving.
Poorly controlled hypertension

6. What are the S&S of pulmonary embolism?
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.
Iodine
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Must be flushed 1x/month with heparin and between treatments.

7. Where is the apex/mitral valve landmark on the chest?
Second left intercostal space
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.

8. Where is the pulmonic valve landmark on the chest?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Second left intercostal space
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

9. What is pericarditis?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
An inflammation of the pericardium. It may result in MI.

10. When should bleeding precautions be implemented?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

11. What is characteristic of ventricular fibrillation?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
BP is elevated or decreased depending on activity.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

12. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
Include rest periods prior to any activity.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
BP is elevated or decreased depending on activity.

13. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Lung disease
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
ST segment elevation (STEMI)

14. What are the 2 types of pacemakers?
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

15. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
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.

16. What makes the symptoms of superior vena cava syndrome better? Worse?
Before
Chronic arteriosclerotic disease.
Feeling warm (fire) or tin can taste is expected and will pass.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

17. What should you teach your patient about an exercise ECG (stress test)?
4th left intercostal space lower sternal border
Whether the patients ulnar and radial arteries are patent.
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 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-

18. What is a major complication of central line placement?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Pneumothorax and will end up with chest tube to help reinflate lung.
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.

19. What is the purpose of compression devices?
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
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
Don't interfere!
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

20. What should you teach someone about iodine?
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.
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.
Maintain BED REST
Feeling warm (fire) or tin can taste is expected and will pass.

21. What is Deep Vein Thrombosis (DVT)?
Lowers BP and makes heart beat stronger. SE: flushed face.
The internal jugular veins (external are less reliable).
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.

22. What is important to remember when removing a CVC from a patient?
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
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
Air answers (open junctions)

23. What signals an elevated venous pressure based on the internal jugular veins?
Steroid treatment or a pregnant woman who is retaining water.
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.
An inflammation of the pericardium. It may result in MI.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

24. What should you not allow if a patient has a negative Allen's test?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
No radial artery punctures if negative
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Poorly controlled hypertension

25. During an Allen's test don't compress one artery _____ the other.
Before
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
D/C the med and call the doctor.

26. What are the nursing interventions for a patient with premature ventricular contractions?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Protamine Sulfate

27. What is the hallmark clinical finding associated with pericarditis?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Patient who are unable to tolerate exercise stress testing.

28. What are the nursing interventions for a patient in complete heart block?
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

29. What is a chemical stress test (persantine stress test)?
Pneumothorax and will end up with chest tube to help reinflate lung.
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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

30. What are the steps for infant 1&2 rescuer CPR?
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.
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
Vitamin K (aqua myphiton)
The internal jugular veins (external are less reliable).

31. What is the treatment for myocardial infarction?
NO NSAIDS or ASA.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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

32. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
Activity intolerance

33. What are the S&S of cardiac tamponade?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

34. How is angina treated?

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35. What should you observe for in someone on bleeding precautions?
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).
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
No radial artery punctures if negative

36. What is the treatment for a pt. with ventricular tachycardia?
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.
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
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.

37. How is the Allen's test done?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Feeling warm (fire) or tin can taste is expected and will pass.

38. What is the treatment for someone with right sided HF? How do you know working?
Second Right intercostal space.
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
Second right intercostal space
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

39. Where is the right ventricle landmark on the chest?
Don't interfere!
Nitrates - Beta blockers - and Calcium channel blockers
Left sternal border
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

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

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41. What is an air embolism?
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

42. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
Iodine
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Pulse before and after giving.

43. What is a assessment finding with DVT?

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44. What is characteristic of premature ventricular contractions?
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

45. What things should you do to assess cardiovascular status?
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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-

46. What type of surgery is done for an aortic dissection?
An inflammation of the pericardium. It may result in MI.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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

47. Which type of patient shouldn't take nitrates?
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
Fat - Air - DVT - or Amniotic
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

48. What is defibrillation?
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.

49. What should you do if the PTT value is 80 for someone on heparin?
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
D/C the med and call the doctor.
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

50. How does the blood flow through the heart? (valves?)
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
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).
D/C the med and call the doctor.