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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 drugs are most commonly used for angina?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Nitrates - Beta blockers - and Calcium channel blockers
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

2. What are signs and symptoms of an MI?
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).
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

3. 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.
(S1 - S2) Third left intercostal space
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.
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

4. What SE should you look for with calcium channel blocker use?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.
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

5. 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
Fifth left intercostal space medial to the midclavicular line.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
In the first 72 hours!!!!!

6. What is a chemical stress test (persantine stress test)?
Fat - Air - DVT - or Amniotic
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
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

7. What is the most common cause of arterial insufficiency?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
In fatty areas or over major muscles - large breasts - or bony prominences.
Chronic arteriosclerotic disease.
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.

8. Where is the right ventricle landmark on the chest?
0.5-2.0 ng/ml
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.
Vitamin K (aqua myphiton)
Left sternal border

9. What type of surgery is done for an aortic dissection?
Open up blood vessels
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

10. What should you do to treat pulmonary edema?
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.
Steroid treatment or a pregnant woman who is retaining water.
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
Include rest periods prior to any activity.

11. What places someone at risk for an aortic dissection?
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.
Feeling warm (fire) or tin can taste is expected and will pass.
Poorly controlled hypertension
Activity intolerance

12. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Iodine
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

13. What is characteristic of ventricular tachycardia?
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.
Cannot
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

14. What is the treatment for atrial fibrillation?
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Iodine
Direct current cardioversion and digoxin/propranolol (inderal).

15. What are the four types of pulmonary emboli?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Fat - Air - DVT - or Amniotic

16. What are the nursing interventions for a patient with premature ventricular contractions?
ST segment elevation (STEMI)
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

17. 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
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
ST segment elevation (STEMI)
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

18. What are the steps for adult 2 rescuer CPR?
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
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

19. What are all the S&S of pericarditis?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
D/C the med and call the doctor.
NO because it isn't sterile so keep out.

20. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Protamine Sulfate

21. Where should you place your stethescope to find the ERB's Point?
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.
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
Lower left sternal border
(S1 - S2) Third left intercostal space

22. What is an air embolism?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Protamine Sulfate
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

23. Test ending in Gram=?
Idiopathic
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
Iodine
Left sternal border

24. What should you do if you are going to ventilate someone with an ambu bag?
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
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
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.
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!

25. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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
Air embolism
Right sided heart failure
Feeling warm (fire) or tin can taste is expected and will pass.

26. Where do the internal jugular veins lie?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Must be flushed 1x/month with heparin and between treatments.

27. What are the S&S of cardiac tamponade?
Second left intercostal space
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Maintain BED REST
In the first 72 hours!!!!!

28. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Maintain BED REST
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
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.

29. What should you teach your patient about a cardiac catheterization?
Chronic arteriosclerotic disease.
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
NO because it isn't sterile so keep out.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

30. What is Raynauds disease? Tx?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

31. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
Nitrates - Beta blockers - and Calcium channel blockers
Only for a few hours
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

32. What are the nursing interventions for a patient in atrial fibrillation?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Whether the patients ulnar and radial arteries are patent.
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.

33. Where should you place your stethescope to find the aortic valve?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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).
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
Second Right intercostal space.

34. What is the treatment for myocardial infarction?
4th left intercostal space lower sternal border
Pulmonary edema
Lower left sternal border
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

35. What could happen without immediate intervention for a hematoma?
Air embolism
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
The patient may suffer significant blood loss or femoral nerve compression.

36. What body systems are affected by digoxin toxicity? S&S?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Protamine Sulfate
Only for a few hours
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.

37. Where is the tricuspid valve landmark on the chest?
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
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Lower left sternal border

38. What is INR?
Vascular - artery disease causing fluid to back up into the lungs.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Steroid treatment or a pregnant woman who is retaining water.

39. What should you teach your patient about an exercise ECG (stress test)?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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-
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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. What is labile hypertension?
BP is elevated or decreased depending on activity.
One at a time to assess the pulse amplitude and contour.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
One large emboli (smaller=better)

41. 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
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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!

42. How should you palpate the carotid arteries?
Lung disease
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
One at a time to assess the pulse amplitude and contour.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

43. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Iodine
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

44. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
If feel more than 3 shocks in a row or develop signs of infection at the site.
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.

45. What is characteristic of ventricular fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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

46. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
No radial artery punctures if negative
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

47. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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

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

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49. What will be the treatment for an acute episode of life threatening tamponade?
Lung disease
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pulmonary edema
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

50. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
BP is elevated or decreased depending on activity.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).