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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 are the steps for adult/child 1 rescuer CPR?
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.
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
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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.

2. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.
Vitamin K (aqua myphiton)

3. What are the nursing interventions for a patient in complete heart block?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Nitrates - Beta blockers - and Calcium channel blockers
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

4. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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5. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Nitrates - Beta blockers - and Calcium channel blockers
0.5-2.0 ng/ml
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

6. What makes the symptoms of superior vena cava syndrome better? Worse?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Idiopathic
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.

7. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
ST segment elevation (STEMI)
Feeling warm (fire) or tin can taste is expected and will pass.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

8. What is important to remember when removing a CVC from a patient?
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
An enlarged space indicates fluid accumulation in the pericardial sac.

9. Where is the aortic valve landmark on the chest?
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Second right intercostal space
Open up blood vessels

10. What is more harmful a lot of little emboli or one large emboli?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
One large emboli (smaller=better)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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

11. What should be done immediately if a pulmonary embolism is suspected?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Poorly controlled hypertension
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session - locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process) - connect lea
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

12. What should you not allow if a patient has a negative Allen's test?
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
No radial artery punctures if negative
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

13. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
Air embolism

14. What should you do to treat pulmonary edema?
Air embolism
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

15. What type of surgery is done for an aortic dissection?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Left sternal border

16. What is an aortic dissection?

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17. What is characteristic of ventricular tachycardia?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

18. What is characteristic of atrial fibrillation?
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
Pulse before and after giving.
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

19. What should you do immediately if you suspect someone of developing a hematoma?
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.
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.
ST segment elevation (STEMI)
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

20. What does a swan ganz measure?
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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

21. What are the signs and symptoms of left sided HF?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

22. What do calcium channel blockers do?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Open up blood vessels
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

23. Which type of patient shouldn't take nitrates?
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!
Lowers BP and makes heart beat stronger. SE: flushed face.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

24. What is the goal of treatment for an MI? Treatment?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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

25. Where is the tricuspid valve landmark on the chest?
Poorly controlled hypertension
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.
Lower left sternal border

26. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
NO NSAIDS or ASA.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
One at a time to assess the pulse amplitude and contour.

27. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Second left intercostal space
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

28. What is labile hypertension?
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.)
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
BP is elevated or decreased depending on activity.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

29. What is the treatment for someone in ventricular fibrillation?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Lowers BP and makes heart beat stronger. SE: flushed face.
One large emboli (smaller=better)

30. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
4th left intercostal space lower sternal border
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

31. What is epistaxis?
Cannot
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
A nosebleed
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.

32. What are the proper steps to changing a central venous catheter dressing?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

33. What is defibrillation?
Fifth left intercostal space medial to the midclavicular line.
In the first 72 hours!!!!!
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

34. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

35. What are the S&S of air embolism?
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
Only for a few hours
One large emboli (smaller=better)
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

36. What is angina? Stable vs. unstable?

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37. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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).

38. What is pulsus paradoxus?
Right sided heart failure
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
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!
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

39. Where should you place your stethescope to find the mitral (apex) valve?
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.
Fifth left intercostal space medial to the midclavicular line.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

40. What is a assessment finding with DVT?

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41. What is characteristic of ventricular fibrillation?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Patient who are unable to tolerate exercise stress testing.

42. What is important to remember when taking care of patients with compression devices?
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
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.

43. What condition can cause left sided heart failure?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Vascular - artery disease causing fluid to back up into the lungs.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

44. What should you do if the PTT value is 80 for someone on heparin?
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
NO NSAIDS or ASA.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
D/C the med and call the doctor.

45. What type of EKG change indicates MI?
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
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
Lowers BP and makes heart beat stronger. SE: flushed face.
ST segment elevation (STEMI)

46. How should you palpate the apical pulse?
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

47. What is the treatment for a patient in complete heart block?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Poorly controlled hypertension

48. What should you explain to the patient about an impedance cardiography test?
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
Old truck driver or someone on bed rest or with pelvic trauma.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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 should you place your stethescope to find the aortic valve?
Second Right intercostal space.
Must be flushed 1x/month with heparin and between treatments.
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
To inhibit thrombus and clot formation.

50. How long is contrast media in the body?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Only for a few hours
Lung disease
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm