NCLEX Cardiac

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 characteristic of atrial fibrillation?
Second Right intercostal space.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.


2. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
The patient may suffer significant blood loss or femoral nerve compression.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Maintain BED REST


3. What is characteristic of ventricular fibrillation?
Second Right intercostal space.
Right sided heart failure
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


4. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.


5. What does plan of care include?
Activity intolerance
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.
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.


6. 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
An enlarged space indicates fluid accumulation in the pericardial sac.
Second right intercostal space
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


7. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Second Right intercostal space.


8. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
The internal jugular veins (external are less reliable).
In the first 72 hours!!!!!
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.


9. What is an air embolism?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.


10. What is characteristic of complete heart block?
Steroid treatment or a pregnant woman who is retaining water.
One large emboli (smaller=better)
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.


11. What should be immediately done for a patient experiencing digoxin toxicity?
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
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
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.


12. What is a nursing diagnosis for arterial occlusion? Tx
(S1 - S2) Third left intercostal space
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Fourth or fifth intercostal space at or medial to the midclavicular line.


13. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Pulse before and after giving.
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


14. 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?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.


15. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Poorly controlled hypertension
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
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.


16. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Protamine Sulfate
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm


17. What are the steps for adult/child 1 rescuer CPR?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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


18. How is angina treated?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


19. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).


20. What are the steps to perform the heimlich maneuver?
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.
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.
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.


21. What causes essential/primary hypertension?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
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
Idiopathic


22. What is pulsus paradoxus?
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 drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Lung disease


23. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
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).
In the first 72 hours!!!!!


24. What is Raynauds disease? Tx?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!


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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


26. What is the maintenance for venous access port that isn't being regularly used?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Lower left sternal border
Must be flushed 1x/month with heparin and between treatments.
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.


27. How long is contrast media in the body?
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.
Only for a few hours
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.


28. What is the nursing care associated with chemical stress tests (persantine stress test)?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Must be flushed 1x/month with heparin and between treatments.


29. What is angina? Stable vs. unstable?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


30. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
An enlarged space indicates fluid accumulation in the pericardial sac.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).


31. In What time period is the greatest risk of sudden death from an MI?
In the first 72 hours!!!!!
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).


32. What is epistaxis?
Nitrates - Beta blockers - and Calcium channel blockers
A nosebleed
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
ST segment elevation (STEMI)


33. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
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.
Old truck driver or someone on bed rest or with pelvic trauma.


34. Where is the tricuspid valve landmark on the chest?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Lower left sternal border
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.
(S1 - S2) Third left intercostal space


35. What type of EKG change indicates MI?
ST segment elevation (STEMI)
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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


36. What is the hallmark clinical finding associated with pericarditis?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
0.5-2.0 ng/ml


37. What is important to remember when taking care of patients with compression devices?
Right sided heart failure
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.


38. What should happen if someone converts to asystole/flatline?
Protamine Sulfate
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
A nosebleed
BP is elevated or decreased depending on activity.


39. What is superior vena cava syndrome?
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
The damaged portion of the aorta is removed and is repaired with a synthetic graft.


40. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.


41. What lab value is used to evaluate a patient on coumadin? What is the normal value?
NO NSAIDS or ASA.
Iodine
Pulse before and after giving.
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.


42. What should you teach your patient about an exercise ECG (stress test)?
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-
NO NSAIDS or ASA.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Include rest periods prior to any activity.


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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


44. What should you teach someone with arterial insufficiency?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183


45. How is the Allen's test done?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Second Left intercostal space
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


46. What drugs are most commonly used for angina?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Nitrates - Beta blockers - and Calcium channel blockers
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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


47. 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.
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.


48. What is CVP? Normal?
Activity intolerance
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.


49. What places someone at risk for an aortic dissection?
Fifth left intercostal space medial to the midclavicular line.
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.
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!
Poorly controlled hypertension


50. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
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
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 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.