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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 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?
To inhibit thrombus and clot formation.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

2. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Before
If feel more than 3 shocks in a row or develop signs of infection at the site.
Second Right intercostal space.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

3. Where is the aortic valve landmark on the chest?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
Second right intercostal space
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

4. What should be done immediately if a pulmonary embolism is suspected?
An enlarged space indicates fluid accumulation in the pericardial sac.
Feeling warm (fire) or tin can taste is expected and will pass.
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.
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

5. What is the treatments for hypertension?
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.
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

6. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

7. Which type of patient shouldn't take nitrates?
Idiopathic
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.

8. What are the nursing interventions for a patient in atrial fibrillation?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

9. What is the goal of treatment for an MI? Treatment?
Whether the patients ulnar and radial arteries are patent.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

10. What causes essential/primary hypertension?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Fat - Air - DVT - or Amniotic
Idiopathic
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.

11. What should you teach someone about iodine?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Activity intolerance
Pulse before and after giving.
Feeling warm (fire) or tin can taste is expected and will pass.

12. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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.

13. What should you teach your patient about angiography (arteriography)?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Vitamin K (aqua myphiton)
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.
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

14. What is the maintenance for venous access port that isn't being regularly used?
Iodine
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
Must be flushed 1x/month with heparin and between treatments.
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.

15. Where is the pulmonic valve landmark on the chest?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
Second left intercostal space
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

16. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

17. What is an aortic dissection?

18. What is the treatment for premature ventricular contractions?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

19. What are the two common complications of pericarditis?
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Nitrates - Beta blockers - and Calcium channel blockers
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

20. For what disease should you do the Allen's test?

21. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

22. When would a nurse use an external femoral artery compression device?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

23. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
The patient may suffer significant blood loss or femoral nerve compression.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

24. What would make someone more at risk for digoxin toxicity?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

25. What are the nursing interventions for a patient with premature ventricular contractions?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

26. What should you explain to the patient about an impedance cardiography test?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

27. What is characteristic of ventricular fibrillation?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
Whether the patients ulnar and radial arteries are patent.

28. What are the four types of pulmonary emboli?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Second Right intercostal space.
Fat - Air - DVT - or Amniotic
In fatty areas or over major muscles - large breasts - or bony prominences.

29. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
Second left intercostal space
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

30. What are common risk factors for an MI?
Before
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
In the first 72 hours!!!!!

31. What is cardiac tamponade? Common causes?
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

32. What should you teach your patient about an electrocardiogram (ECG)?
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.

33. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

34. What is the correct way to insert an oropharyngeal airway?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Patient who are unable to tolerate exercise stress testing.

35. Where should you place your stethescope to find the mitral (apex) valve?
Chronic arteriosclerotic disease.
Fifth left intercostal space medial to the midclavicular line.
Second right intercostal space
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.

36. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
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.

37. What type of EKG change indicates MI?
ST segment elevation (STEMI)
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
An inflammation of the pericardium. It may result in MI.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

38. What does a swan ganz measure?
Feeling warm (fire) or tin can taste is expected and will pass.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Fat - Air - DVT - or Amniotic

39. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
The internal jugular veins (external are less reliable).

40. What are coumadin and heparin used for?
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
An inflammation of the pericardium. It may result in MI.
To inhibit thrombus and clot formation.

41. What does vasotec (Enalapril Maleate) do/SE?
Air embolism
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Lowers BP and makes heart beat stronger. SE: flushed face.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

42. What should you observe for in someone on bleeding precautions?
An inflammation of the pericardium. It may result in MI.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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).

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

44. What should you do to treat pulmonary edema?
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.
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.
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

45. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
ST segment elevation (STEMI)
Fifth left intercostal space medial to the midclavicular line.
4th left intercostal space lower sternal border

46. What is an acute peripheral arterial occlusion?
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
An inflammation of the pericardium. It may result in MI.

47. Where is the right ventricle landmark on the chest?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Air answers (open junctions)
Left sternal border
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

48. What is characteristic of atrial fibrillation?
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

49. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
Must be flushed 1x/month with heparin and between treatments.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.

50. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.