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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 is a nursing diagnosis for arterial occlusion? Tx
Second right intercostal space
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
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

2. For what disease should you do the Allen's test?

3. What is an air embolism?
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
Lowers BP and makes heart beat stronger. SE: flushed face.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

4. Where should you place your stethescope to find the tricuspid valve?
Only for a few hours
4th left intercostal space lower 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.
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.

5. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Fourth or fifth intercostal space at or medial to the midclavicular line.
Second right intercostal space

6. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
The internal jugular veins (external are less reliable).
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.
NO because it isn't sterile so keep out.

7. What is characteristic of ventricular tachycardia?
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
D/C the med and call the doctor.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

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

9. What type of EKG change indicates MI?
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.
Nitrates - Beta blockers - and Calcium channel blockers
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.
ST segment elevation (STEMI)

10. What is the treatment for premature ventricular contractions?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Left sternal border

11. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Air answers (open junctions)
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

12. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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 Right intercostal space.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

13. What are the S&S of aortic dissection?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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.
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

14. What is the goal of treatment for an MI? Treatment?
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.
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.
Fifth left intercostal space medial to the midclavicular line.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

15. What places someone at risk for an aortic dissection?
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
Poorly controlled hypertension
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
One large emboli (smaller=better)

16. What is labile hypertension?
BP is elevated or decreased depending on activity.
Only for a few hours
The internal jugular veins (external are less reliable).
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.

17. 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.
Whether the patients ulnar and radial arteries are patent.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.

18. What do calcium channel blockers do?
Open up blood vessels
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-
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.

19. What is more harmful a lot of little emboli or one large emboli?
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
One large emboli (smaller=better)
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

20. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
An inflammation of the pericardium. It may result in MI.

21. For which heart sounds should the diaphragm be used?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Protamine Sulfate
In fatty areas or over major muscles - large breasts - or bony prominences.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

22. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Chronic arteriosclerotic disease.
Iodine

23. What is the most common cause of arterial insufficiency?
NO because it isn't sterile so keep out.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Chronic arteriosclerotic disease.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

24. What should you teach your patient about angiography (arteriography)?
To inhibit thrombus and clot formation.
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
An inflammation of the pericardium. It may result in 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).

25. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Iodine
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

26. What are the steps for infant 1&2 rescuer CPR?
The internal jugular veins (external are less reliable).
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
Maintain BED REST
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

27. What does plan of care include?
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.
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.
The patient may suffer significant blood loss or femoral nerve compression.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

28. What are the steps for adult/child 1 rescuer CPR?
D/C the med and call the doctor.
The internal jugular veins (external are less reliable).
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

29. What is an acute peripheral arterial occlusion?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

30. How is angina treated?

31. What is the maintenance for venous access port that isn't being regularly used?
Old truck driver or someone on bed rest or with pelvic trauma.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Must be flushed 1x/month with heparin and between treatments.

32. What does a swan ganz measure?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
D/C the med and call the doctor.

33. If a victim is choking but can cough - speak - or breath what should you do?

34. What condition can cause left sided heart failure?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Pulse before and after giving.
Vascular - artery disease causing fluid to back up into the lungs.
The internal jugular veins (external are less reliable).

35. What things should you do to assess cardiovascular status?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Lung disease

36. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.

37. What are the S&S of superior vena cava syndrome?
Activity intolerance
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
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
NO because it isn't sterile so keep out.

38. What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Open up blood vessels
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Vascular - artery disease causing fluid to back up into the lungs.

39. What are the S&S of pulmonary embolism?
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.
Old truck driver or someone on bed rest or with pelvic trauma.
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

40. What is the treatment for myocardial infarction?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
Protamine Sulfate
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

41. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
A nosebleed

42. When would a nurse use an external femoral artery compression device?
Poorly controlled hypertension
Open up blood vessels
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

43. What is angina? Stable vs. unstable?

44. Where should you place your stethescope to find the pulmonic valve?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Air embolism
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.
Second Left intercostal space

45. What should you go when applying nitroglycerin ointment for angina?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

46. What are the nursing interventions for a patient in atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Vascular - artery disease causing fluid to back up into the lungs.
Before
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.

47. What should you watch for with PICC lines that have been in place for 6 months?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Second Left intercostal space
Poorly controlled hypertension
Air answers (open junctions)

48. What are the steps for adult 2 rescuer CPR?
Old truck driver or someone on bed rest or with pelvic trauma.
Patient who are unable to tolerate exercise stress testing.
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

49. What is CVP? Normal?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Idiopathic
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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!

50. What is the treatment for a pt. with ventricular tachycardia?
Don't interfere!
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.