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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. Where is the pulmonic valve landmark on the chest?
If feel more than 3 shocks in a row or develop signs of infection at the site.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
Second left intercostal space

2. What should you go when applying nitroglycerin ointment for angina?
ST segment elevation (STEMI)
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

3. For which heart sounds should the bell be used?
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
To inhibit thrombus and clot formation.

4. What condition can cause left sided heart failure?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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-
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.
Vascular - artery disease causing fluid to back up into the lungs.

5. How does the blood flow through the heart? (valves?)
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Don't interfere!
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.
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!

6. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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
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.
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

7. What should you explain to the patient about an impedance cardiography test?
BP is elevated or decreased depending on activity.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
Lower left sternal border

8. What does vasotec (Enalapril Maleate) do/SE?
An inflammation of the pericardium. It may result in MI.
A nosebleed
Lowers BP and makes heart beat stronger. SE: flushed face.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

9. What are the proper steps to changing a central venous catheter dressing?
Lung disease
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

10. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Direct current cardioversion and digoxin/propranolol (inderal).
Protamine Sulfate
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.

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

12. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Second Left intercostal space
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.
In the first 72 hours!!!!!
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

13. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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.
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

14. What should you teach someone with arterial insufficiency?

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15. What are the steps to perform the heimlich maneuver?
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.
Air 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.
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.

16. What is angina? Stable vs. unstable?

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17. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Must be flushed 1x/month with heparin and between treatments.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

18. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
To inhibit thrombus and clot formation.
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

19. What are the S&S of cardiac tamponade?
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

20. 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?
Left sternal border
Pulse before and after giving.
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

21. What are the S&S associated with right sided heart failure?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.

22. What is pulsus paradoxus?
D/C the med and call the doctor.
A nosebleed
Second right intercostal space
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

23. What are the five areas for listening to the heart?

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24. What is a assessment finding with DVT?

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25. What should you teach your patient about an abdominal ultrasonography?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
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.
Second Right intercostal space.

26. What needs to be held during the placement of a femoral artery compression device?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
NO NSAIDS or ASA.

27. What is epistaxis?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
A nosebleed

28. What will a leg with arterial insufficiency look like?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
NO because it isn't sterile so keep out.

29. What should you do when applying a femoral artery compression device?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
Chronic arteriosclerotic disease.
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

30. What should you observe for in someone on bleeding precautions?
Air embolism
Patient who are unable to tolerate exercise stress testing.
Include rest periods prior to any activity.
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).

31. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Protamine Sulfate
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

32. How should you palpate the carotid arteries?
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.
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
One at a time to assess the pulse amplitude and contour.

33. What should be done immediately if a pulmonary embolism is suspected?
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
Activity intolerance
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.
Old truck driver or someone on bed rest or with pelvic trauma.

34. What is characteristic of atrial fibrillation?
An enlarged space indicates fluid accumulation in the pericardial sac.
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Chronic arteriosclerotic disease.

35. What drugs are most commonly used for angina?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Nitrates - Beta blockers - and Calcium channel blockers
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
A nosebleed

36. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.

37. What should you do if you are going to ventilate someone with an ambu bag?
Cannot
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
0.5-2.0 ng/ml
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

38. What should a patient do if they feel chest pain or discomfort?
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
Whether the patients ulnar and radial arteries are patent.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

39. What is Deep Vein Thrombosis (DVT)?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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.
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

40. What could happen without immediate intervention for a hematoma?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
The patient may suffer significant blood loss or femoral nerve compression.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
BP is elevated or decreased depending on activity.

41. What are common risk factors for an MI?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
An enlarged space indicates fluid accumulation in the pericardial sac.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

42. What signals an elevated venous pressure based on the internal jugular veins?
0.5-2.0 ng/ml
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

43. What type of EKG change indicates MI?
ST segment elevation (STEMI)
To inhibit thrombus and clot formation.
Left sternal border
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

44. What are the steps for adult 2 rescuer CPR?
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Protamine Sulfate
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!

45. How long is contrast media in the body?
Maintain BED REST
Only for a few hours
Right sided heart failure
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.

46. What are the nursing interventions for a patient in complete heart block?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

47. What disease can cause right sided heart failure?
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.
Lower left sternal border
Lung disease
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

48. What should be immediately done for a patient experiencing digoxin toxicity?
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

49. What would make someone more at risk for digoxin toxicity?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Nitrates - Beta blockers - and Calcium channel blockers
A nosebleed

50. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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
Include rest periods prior to any activity.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Direct current cardioversion and digoxin/propranolol (inderal).