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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 should you palpate the carotid arteries?
Old truck driver or someone on bed rest or with pelvic trauma.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
One at a time to assess the pulse amplitude and contour.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

2. What are the steps for infant 1&2 rescuer CPR?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Direct current cardioversion and digoxin/propranolol (inderal).
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
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.

3. What is the correct way to insert an oropharyngeal airway?
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-
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
Feeling warm (fire) or tin can taste is expected and will pass.

4. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Open up blood vessels

5. What is Raynauds disease? Tx?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
Chronic arteriosclerotic disease.

6. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Include rest periods prior to any activity.
Protamine Sulfate
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

7. What is the antidote for coumadin?
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
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
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.
Vitamin K (aqua myphiton)

8. 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).
In the first 72 hours!!!!!
Include rest periods prior to any activity.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

9. A femoral artery compression device ______be assigned to an NA?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Cannot
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

10. How is the Allen's test done?
In fatty areas or over major muscles - large breasts - or bony prominences.
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

11. What are the two common complications of pericarditis?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

12. 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
Fifth left intercostal space medial to the midclavicular line.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

13. What are the nursing interventions for a patient in complete heart block?
Include rest periods prior to any activity.
Open up blood vessels
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

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

15. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

16. What should you do if you are going to ventilate someone with an ambu bag?
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
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.
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
Activity intolerance

17. What condition can cause left sided heart failure?
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Vascular - artery disease causing fluid to back up into the lungs.

18. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
Feeling warm (fire) or tin can taste is expected and will pass.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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

19. What is the treatment for a patient in complete heart block?
Second Left intercostal space
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

20. What is more harmful a lot of little emboli or one large emboli?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
One large emboli (smaller=better)
Old truck driver or someone on bed rest or with pelvic trauma.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

21. 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
Second Right intercostal space.
In the first 72 hours!!!!!
BP is elevated or decreased depending on activity.

22. What are the nursing interventions for a patient in atrial fibrillation?
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
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
Second Right intercostal space.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

23. What is epistaxis?
A nosebleed
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.
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
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.

24. What type of surgery is done for an aortic dissection?
Pneumothorax and will end up with chest tube to help reinflate lung.
Whether the patients ulnar and radial arteries are patent.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Lung disease

25. For which heart sounds should the diaphragm be used?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

26. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
ST segment elevation (STEMI)

27. Where is the apex/mitral valve landmark on the chest?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Fourth or fifth intercostal space at or medial to the midclavicular line.

28. What do calcium channel blockers do?
NO NSAIDS or ASA.
Open up blood vessels
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

29. What drugs are most commonly used for angina?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
D/C the med and call the doctor.
Maintain BED REST
Nitrates - Beta blockers - and Calcium channel blockers

30. Where is the pulmonic valve landmark on the chest?
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Old truck driver or someone on bed rest or with pelvic trauma.
Second left intercostal space

31. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
Pulmonary edema
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

32. What is pericarditis?
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.
An inflammation of the pericardium. It may result in MI.
Pulse before and after giving.

33. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Vascular - artery disease causing fluid to back up into the lungs.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.

34. What is pulsus paradoxus?
0.5-2.0 ng/ml
Fifth left intercostal space medial to the midclavicular line.
Only for a few hours
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

35. How long is contrast media in the body?
Only for a few hours
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
4th left intercostal space lower sternal border

36. What are the S&S of pulmonary embolism?
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.
Iodine
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

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

38. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(S1 - S2) Third left intercostal space
Second Right intercostal space.

39. What should you teach someone after they have had a pacemaker placed?

40. In What time period is the greatest risk of sudden death from an MI?
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
In the first 72 hours!!!!!
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

41. What is the nursing care associated with chemical stress tests (persantine stress test)?
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
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
Only for a few hours
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.

42. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
The internal jugular veins (external are less reliable).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

43. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
Patient who are unable to tolerate exercise stress testing.
Second right intercostal space
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

44. What are the steps to perform the heimlich maneuver?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Air answers (open junctions)
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.
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.

45. What does the device for impedance cardiography consist of?
Nitrates - Beta blockers - and Calcium channel blockers
Pneumothorax and will end up with chest tube to help reinflate lung.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Maintain BED REST

46. What SE should you look for with calcium channel blocker use?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
The patient may suffer significant blood loss or femoral nerve compression.
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.

47. What are the steps for adult 2 rescuer CPR?
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.
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.

48. What should you teach your patient about MRI?
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.
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
Second Left 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

49. What makes the symptoms of superior vena cava syndrome better? Worse?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Must be flushed 1x/month with heparin and between treatments.

50. What is characteristic of ventricular tachycardia?
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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.