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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. How do you prepare a patient for Impedance cardiography monitoring?
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
NO because it isn't sterile so keep out.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

2. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

3. What usually triggers angina pain?
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

4. How should you palpate the apical pulse?
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

5. What is a nursing diagnosis for arterial occlusion? Tx
(1st) Assess the client for signs of decreased cardiac output and Notify the 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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Must be flushed 1x/month with heparin and between treatments.

6. What is cardioversion?

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7. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
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.

8. What should you teach your patient about an abdominal ultrasonography?
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.
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 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.

9. What is cardiac tamponade? Common causes?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

10. What should you teach your patient about a cardiac catheterization?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

11. What is pulsus paradoxus?
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Right sided heart failure
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

12. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

13. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

14. What is characteristic of ventricular fibrillation?
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Steroid treatment or a pregnant woman who is retaining water.
Patient who are unable to tolerate exercise stress testing.

15. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
To inhibit thrombus and clot formation.
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.

16. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Vitamin K (aqua myphiton)

17. What are the S&S of cardiac tamponade?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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

18. What is the correct way to insert an oropharyngeal airway?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

19. What type of EKG change indicates MI?
Feeling warm (fire) or tin can taste is expected and will pass.
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
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

20. What does an Allen's test determine?
NO because it isn't sterile so keep out.
Whether the patients ulnar and radial arteries are patent.
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.
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.

21. What are the 2 types of pacemakers?
NO because it isn't sterile so keep out.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
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.

22. What are the S&S of aortic dissection?
Must be flushed 1x/month with heparin and between treatments.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A nosebleed
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.

23. What is more harmful a lot of little emboli or one large emboli?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
D/C the med and call the doctor.
One large emboli (smaller=better)

24. What drugs are most commonly used for angina?
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
Nitrates - Beta blockers - and Calcium channel blockers
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

25. What is the goal of treatment for an MI? Treatment?
Air answers (open junctions)
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

26. What is pericarditis?
Pulse before and after giving.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Protamine Sulfate
An inflammation of the pericardium. It may result in MI.

27. Which type of patient shouldn't take nitrates?
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.
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

28. Where is the pulmonic valve landmark on the chest?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
Second left intercostal space
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

29. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
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.
Nitrates - Beta blockers - and Calcium channel blockers
Patient who are unable to tolerate exercise stress testing.

30. What are all the S&S of pericarditis?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Air answers (open junctions)
Must be flushed 1x/month with heparin and between treatments.

31. For which heart sounds should the bell be used?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Old truck driver or someone on bed rest or with pelvic trauma.
Idiopathic

32. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Vitamin K (aqua myphiton)
The patient may suffer significant blood loss or femoral nerve compression.
If feel more than 3 shocks in a row or develop signs of infection at the site.

33. What disease can cause right sided heart failure?
Whether the patients ulnar and radial arteries are patent.
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.
Lung disease
To inhibit thrombus and clot formation.

34. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

35. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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.
Before
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at

36. What should be done immediately for someone with PE?
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.
Second Right intercostal space.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

37. What should you teach a patient regarding discharge after a DVT?

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38. What is characteristic of premature ventricular contractions?
Iodine
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.
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.
The internal jugular veins (external are less reliable).

39. What are the steps to perform the heimlich maneuver?
Chronic arteriosclerotic disease.
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.

40. What is a chemical stress test (persantine stress test)?
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
A nosebleed
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

41. How long is contrast media in the body?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Only for a few hours
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
The internal jugular veins (external are less reliable).

42. What is the treatment for a pt. with ventricular tachycardia?
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.
Only for a few hours
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.
Right sided heart failure

43. When should you be concerned about premature ventricular contraction?
Patient who are unable to tolerate exercise stress testing.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Fat - Air - DVT - or Amniotic
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

44. What needs to be held during the placement of a femoral artery compression device?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
NO NSAIDS or ASA.

45. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
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.

46. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
Second Right intercostal space.
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

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

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48. What should you do if the PT value is 45 sec?
The internal jugular veins (external are less reliable).
D/C the med and call the doctor.
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.
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.

49. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Fifth left intercostal space medial to the midclavicular line.
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

50. What are the nursing interventions for a patient in complete heart block?
Activity intolerance
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Vascular - artery disease causing fluid to back up into the lungs.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

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NCLEX Cardiac

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