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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 is an aortic dissection?

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2. What should you teach your patient about angiography (arteriography)?
One large emboli (smaller=better)
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.
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
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.

3. What is the goal of treatment for an MI? Treatment?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

4. What is a good diagnosis for someone with right sided HF?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
Only for a few hours
Activity intolerance

5. 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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Iodine
Second Right intercostal space.

6. What are the S&S of pulmonary embolism?
D/C the med and call the doctor.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

7. How does the blood flow through the heart? (valves?)
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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!
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.

8. What should you do when applying a femoral artery compression device?
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.

9. What is characteristic of ventricular tachycardia?
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.
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

10. 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).
Air embolism
Air answers (open junctions)
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.

11. What are the steps for infant 1&2 rescuer CPR?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.
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
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

12. 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?
ST segment elevation (STEMI)
Chronic arteriosclerotic disease.
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

13. What should you remember while taking care of someone with a peripheral arterial occlusion?
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

14. Where should you place your stethescope to find the aortic valve?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
4th left intercostal space lower sternal border
Second Right intercostal space.
Fat - Air - DVT - or Amniotic

15. What are the S&S of aortic dissection?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
BP is elevated or decreased depending on activity.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

16. What disease can cause right sided heart failure?
Lung disease
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.

17. How is the Allen's test done?
(S1 - S2) Third left intercostal space
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
ST segment elevation (STEMI)
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

18. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
The internal jugular veins (external are less reliable).
Air answers (open junctions)
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

19. What body systems are affected by digoxin toxicity? S&S?
A nosebleed
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.

20. What is the most common cause of arterial insufficiency?
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
Second Right intercostal space.
Chronic arteriosclerotic disease.
Cannot

21. How should you palpate the carotid arteries?
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.
Lower left sternal border
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
One at a time to assess the pulse amplitude and contour.

22. What are all the S&S of pericarditis?
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
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
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

23. When should you be concerned about premature ventricular contraction?
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
4th left intercostal space lower sternal border

24. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
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.)
Feeling warm (fire) or tin can taste is expected and will pass.
Pneumothorax and will end up with chest tube to help reinflate lung.

25. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
An enlarged space indicates fluid accumulation in the pericardial sac.

26. What is the treatments for hypertension?
Air answers (open junctions)
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
Feeling warm (fire) or tin can taste is expected and will pass.

27. What is defibrillation?
ST segment elevation (STEMI)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
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

28. What is INR?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

29. What drugs are most commonly used for angina?
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
In fatty areas or over major muscles - large breasts - or bony prominences.

30. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.

31. What is superior vena cava syndrome?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.

32. What is cardioversion?

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33. What is a therapeutic digoxin level?
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.
0.5-2.0 ng/ml
Nitrates - Beta blockers - and Calcium channel blockers
Steroid treatment or a pregnant woman who is retaining water.

34. A femoral artery compression device ______be assigned to an NA?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Cannot
Steroid treatment or a pregnant woman who is retaining water.

35. For which heart sounds should the bell be used?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
Air embolism

36. What are the four types of pulmonary emboli?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
BP is elevated or decreased depending on activity.
Fat - Air - DVT - or Amniotic

37. Where should you place your stethescope to find the mitral (apex) valve?
A complication from a venous access device or port. It is a blockage of the superior vena cava preventing superior blood flow from reaching the heart.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
Fifth left intercostal space medial to the midclavicular line.

38. What does an Allen's test determine?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Whether the patients ulnar and radial arteries are patent.
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.

39. What factors place you at risk for HTN?
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
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.
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.
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.

40. What is a nursing diagnosis for arterial occlusion? Tx
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Second right intercostal space
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.

41. What condition can cause left sided heart failure?
In fatty areas or over major muscles - large breasts - or bony prominences.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Vascular - artery disease causing fluid to back up into the lungs.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

42. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Cannot
NO because it isn't sterile so keep out.
Before

43. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
In the first 72 hours!!!!!
Vascular - artery disease causing fluid to back up into the lungs.
If feel more than 3 shocks in a row or develop signs of infection at the site.

44. What is impedance cardiography?
Activity intolerance
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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

45. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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
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.

46. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

47. What is labile hypertension?
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
BP is elevated or decreased depending on activity.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.

48. Without prompt surgery for an aortic dissection What is someone at risk for developing?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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

49. Where is the right ventricle landmark on the chest?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Left sternal border
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

50. What landmarks should you be looking for on someone's chest?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Right sided heart failure
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.