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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 should be done immediately for someone with PE?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Direct current cardioversion and digoxin/propranolol (inderal).

2. What should be done for someone on bleeding precautions?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

3. What are common risk factors for an MI?
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
NO NSAIDS or ASA.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

4. What type of surgery is done for an aortic dissection?
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.
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

5. Where is the apex/mitral valve landmark on the chest?
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
Lung disease
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

6. What should be immediately done for a patient experiencing digoxin toxicity?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
D/C the med and call the doctor.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

7. What is impedance cardiography?
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!
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Air embolism

8. During an Allen's test don't compress one artery _____ the other.
Before
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

9. What SE should you look for with calcium channel blocker use?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
No radial artery punctures if negative
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.

10. When should bleeding precautions be implemented?
When: using anticoagulants - liver disease - decrease in platelets (less than 150 -000) - hemophilia - using thrombolytic meds - DIC - CA - HIV - chemo - bone marrow problems - and ASA/NSAIDS.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
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.

11. What is the purpose of compression devices?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

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

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13. Where should you place your stethescope to find the mitral (apex) valve?
Fifth left intercostal space medial to the midclavicular line.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

14. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
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
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.
Activity intolerance

15. What is a therapeutic digoxin level?
NO because it isn't sterile so keep out.
0.5-2.0 ng/ml
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Pulmonary edema

16. What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
An enlarged space indicates fluid accumulation in the pericardial sac.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

17. What are the four types of pulmonary emboli?
Lower left sternal border
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Fat - Air - DVT - or Amniotic

18. Where should you place your stethescope to find the tricuspid valve?
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.
4th left intercostal space lower sternal border
Poorly controlled hypertension
Nitrates - Beta blockers - and Calcium channel blockers

19. What is important to remember when taking care of patients with compression devices?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Second Left intercostal space
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!
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

20. What are the S&S of cardiac tamponade?
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
Include rest periods prior to any activity.
Idiopathic
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

21. What is cardiac tamponade? Common causes?
ST segment elevation (STEMI)
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
In fatty areas or over major muscles - large breasts - or bony prominences.
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

22. What body systems are affected by digoxin toxicity? S&S?
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Chronic arteriosclerotic disease.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

23. What causes secondary hypertension?
BP is elevated or decreased depending on activity.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Steroid treatment or a pregnant woman who is retaining water.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

24. What is angina? Stable vs. unstable?

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25. What could happen without immediate intervention for a hematoma?
Pulmonary edema
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
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
The patient may suffer significant blood loss or femoral nerve compression.

26. 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?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

27. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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

28. What should you do if the PTT value is 80 for someone on heparin?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
D/C the med and call the doctor.

29. What does an Allen's test determine?
Pulmonary edema
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.
Whether the patients ulnar and radial arteries are patent.

30. Where is the pulmonic valve landmark on the chest?
Pulmonary edema
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!
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Second left intercostal space

31. What is Raynauds disease? Tx?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
Steroid treatment or a pregnant woman who is retaining water.
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.

32. What are the nursing interventions for a patient in complete heart block?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

33. What signals an elevated venous pressure based on the internal jugular veins?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

34. What can result from left sided heart failure if left untreated?
Pulmonary edema
Don't interfere!
Lowers BP and makes heart beat stronger. SE: flushed face.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

35. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
Air embolism
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
0.5-2.0 ng/ml

36. What is epistaxis?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
A nosebleed
NO because it isn't sterile so keep out.

37. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

38. How long is contrast media in the body?
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.
Only for a few hours
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

39. In what locations should you not place electrodes?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
NO because it isn't sterile so keep out.
In fatty areas or over major muscles - large breasts - or bony prominences.
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

40. What should you do when applying a femoral artery compression device?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Direct current cardioversion and digoxin/propranolol (inderal).

41. What is CVP? Normal?
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
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).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

42. What are the two common complications of pericarditis?
0.5-2.0 ng/ml
In the first 72 hours!!!!!
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
ST segment elevation (STEMI)

43. What needs to be held during the placement of a femoral artery compression device?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Second Right intercostal space.
NO NSAIDS or ASA.
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.

44. What things should you do to assess cardiovascular status?
4th left intercostal space lower sternal border
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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
Poorly controlled hypertension

45. Who would most likely have peripheral venous disease?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Old truck driver or someone on bed rest or with pelvic trauma.
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.

46. What are the S&S of aortic dissection?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

47. What are the S&S of pulmonary embolism?
Open up blood vessels
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.

48. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Vitamin K (aqua myphiton)
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

49. What are the steps for infant 1&2 rescuer CPR?
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
Left sternal border
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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

50. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
One large emboli (smaller=better)
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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