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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 you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

2. What is angina? Stable vs. unstable?

3. What is the treatments for hypertension?
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Fat - Air - DVT - or Amniotic
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.

4. 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.
Vascular - artery disease causing fluid to back up into the lungs.
One at a time to assess the pulse amplitude and contour.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

5. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
One large emboli (smaller=better)
Air answers (open junctions)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.

6. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Cannot
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.
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
Pulse before and after giving.

7. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.
Second left intercostal space

8. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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).
D/C the med and call the doctor.
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.
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.

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

10. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

11. What is epistaxis?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
4th left intercostal space lower sternal border
A nosebleed
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.

12. What are the S&S associated with right sided heart failure?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

13. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
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
Protamine Sulfate
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.

14. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Maintain BED REST
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

15. What are the five areas for listening to the heart?

16. In What time period is the greatest risk of sudden death from an MI?
D/C the med and call the doctor.
In the first 72 hours!!!!!
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-
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

17. What does vasotec (Enalapril Maleate) do/SE?
Steroid treatment or a pregnant woman who is retaining water.
Don't interfere!
Lowers BP and makes heart beat stronger. SE: flushed face.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

18. What are common risk factors for an MI?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Before
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.

19. How do you prepare a patient for Impedance cardiography monitoring?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Pulmonary edema
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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

20. How is the Allen's test done?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
(S1 - S2) Third left 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
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

21. Where should you place your stethescope to find the aortic valve?
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
Second Right intercostal space.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

22. What is the treatment for myocardial infarction?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer - hurts more - etc.)
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

23. What could happen without immediate intervention for a hematoma?
Fat - Air - DVT - or Amniotic
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
The patient may suffer significant blood loss or femoral nerve compression.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

24. What factors place you at risk for HTN?
Pneumothorax and will end up with chest tube to help reinflate lung.
BP is elevated or decreased depending on activity.
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.
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

25. How does the blood flow through the heart? (valves?)
Whether the patients ulnar and radial arteries are patent.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Maintain BED REST
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!

26. What are the S&S of air embolism?
Fifth left intercostal space medial to the midclavicular line.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

27. What is superior vena cava syndrome?
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.
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.
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.
NO because it isn't sterile so keep out.

28. What is cardiac tamponade? Common causes?
Pneumothorax and will end up with chest tube to help reinflate lung.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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

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

30. What is intermittent claudication?
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.
Second Left intercostal space
One at a time to assess the pulse amplitude and contour.
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.

31. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
An enlarged space indicates fluid accumulation in the pericardial sac.

32. What is the treatment for someone in ventricular fibrillation?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

33. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

34. What are the steps for adult/child 1 rescuer CPR?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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-
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

35. What is labile hypertension?
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-
BP is elevated or decreased depending on activity.
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.
Idiopathic

36. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Pulmonary edema
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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

37. Where should you place your stethescope to find the tricuspid valve?
In fatty areas or over major muscles - large breasts - or bony prominences.
4th left intercostal space lower sternal border
Old truck driver or someone on bed rest or with pelvic trauma.
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.

38. What is CVP? Normal?
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer - hurts more - etc.)
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Fifth left intercostal space medial to the midclavicular line.
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).

39. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Right sided heart failure
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

40. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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
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-
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

41. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
D/C the med and call the doctor.
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.
Fat - Air - DVT - or Amniotic
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

42. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Second right intercostal space
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.

43. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
BP is elevated or decreased depending on activity.
(S1 - S2) Third left intercostal space

44. Where should you place your stethescope to find the ERB's Point?
4th left intercostal space lower sternal border
Pneumothorax and will end up with chest tube to help reinflate lung.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(S1 - S2) Third left intercostal space

45. What do calcium channel blockers do?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Open up blood vessels
In fatty areas or over major muscles - large breasts - or bony prominences.

46. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Open up blood vessels
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Fourth or fifth intercostal space at or medial to the midclavicular line.

47. What is the hallmark clinical finding associated with pericarditis?
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.
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.
NO NSAIDS or ASA.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

48. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Second Left intercostal space

49. Where should you place your stethescope to find the mitral (apex) valve?
One large emboli (smaller=better)
Idiopathic
Fifth left intercostal space medial to the midclavicular line.
Include rest periods prior to any activity.

50. What are signs and symptoms of an MI?
No radial artery punctures if negative
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).
Direct current cardioversion and digoxin/propranolol (inderal).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.