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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 body systems are affected by digoxin toxicity? S&S?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
Cannot

2. What should be immediately done for a patient experiencing digoxin toxicity?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

3. Where should you place your stethescope to find the mitral (apex) valve?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
NO NSAIDS or ASA.
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.
Fifth left intercostal space medial to the midclavicular line.

4. What should you teach your patient about angiography (arteriography)?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
An inflammation of the pericardium. It may result in MI.
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unu
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.

5. What is superior vena cava syndrome?
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 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.
Include rest periods prior to any activity.
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

6. For which heart sounds should the bell be used?
(S1 - S2) Third left intercostal space
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

7. What is defibrillation?
Second right intercostal space
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
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

8. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Lowers BP and makes heart beat stronger. SE: flushed face.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

9. What is impedance cardiography?
ST segment elevation (STEMI)
Cannot
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

10. What is the goal of treatment for an MI? Treatment?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Old truck driver or someone on bed rest or with pelvic trauma.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

11. What is the most common cause of arterial insufficiency?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Chronic arteriosclerotic disease.
Lower left sternal border
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.

12. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
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.
NO because it isn't sterile so keep out.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

13. What is an aortic dissection?

14. What is characteristic of ventricular fibrillation?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Cannot

15. What is labile hypertension?
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
BP is elevated or decreased depending on activity.
Feeling warm (fire) or tin can taste is expected and will pass.

16. What are the S&S of air embolism?
Idiopathic
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
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

17. When would a nurse use an external femoral artery compression device?
Poorly controlled hypertension
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

18. Where is the apex/mitral valve landmark on the chest?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

19. What is characteristic of ventricular tachycardia?
Second left intercostal space
Chronic arteriosclerotic disease.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

20. What is the treatment for someone with right sided HF? How do you know working?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
One large emboli (smaller=better)

21. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Second Right intercostal space.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

22. Where should you place your stethescope to find the ERB's Point?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
(S1 - S2) Third left intercostal space
One large emboli (smaller=better)

23. What could happen without immediate intervention for a hematoma?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
To inhibit thrombus and clot formation.
Second left intercostal space
The patient may suffer significant blood loss or femoral nerve compression.

24. What is the treatment for premature ventricular contractions?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.

25. What is an air embolism?
An enlarged space indicates fluid accumulation in the pericardial sac.
This noninvasive test takes 24 hours and causes no discomfort. Electrodes are applied to your body - you need to log your activities for a 24 hour period (walking - sleeping - urinating - physical symptoms - and medications). Don't tamper with the mo
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.

26. How should you palpate the apical pulse?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

27. Which type of patient shouldn't take nitrates?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Protamine Sulfate
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

28. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
Nitrates - Beta blockers - and Calcium channel blockers
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
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

29. What should be done immediately for someone with PE?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

30. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Patient who are unable to tolerate exercise stress testing.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

31. What should you teach your patient about a cardiac catheterization?
One at a time to assess the pulse amplitude and contour.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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

32. What should you do if you are going to ventilate someone with an ambu bag?
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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
One at a time to assess the pulse amplitude and contour.

33. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Second Left intercostal space

34. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
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.
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).

35. Where is the pulmonic valve landmark on the chest?
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!
Cannot
ST segment elevation (STEMI)

36. Where is the right ventricle landmark on the chest?
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
Left sternal border
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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

37. What is a chemical stress test (persantine stress test)?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

38. What should you do when applying a femoral artery compression device?
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
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.
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

39. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Air embolism
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

40. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
D/C the med and call the doctor.
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
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

41. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Must be flushed 1x/month with heparin and between treatments.

42. What are the steps for adult 2 rescuer CPR?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
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

43. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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.
Old truck driver or someone on bed rest or with pelvic trauma.
Before

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

45. Where is the aortic valve landmark on the chest?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Second right intercostal space
Old truck driver or someone on bed rest or with pelvic trauma.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

46. What is INR?
Pulse before and after giving.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

47. What is intermittent claudication?
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
The patient may suffer significant blood loss or femoral nerve compression.
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

48. What should you remember while taking care of someone with a peripheral arterial occlusion?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.

49. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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
Maintain BED REST

50. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
Lower left sternal border