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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 the treatment for someone in ventricular fibrillation?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

2. What is a nursing diagnosis for arterial occlusion? Tx
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

3. What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
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
Second left intercostal space
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).

4. What are the proper steps to changing a central venous catheter dressing?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Protamine Sulfate
One at a time to assess the pulse amplitude and contour.
It is a sterile procedure so both nurse and patient should wear a mask - arrange sterile field - remove dressing - assess the catheter insertion site for infection - put on sterile gloves - clean the site moving outwardly in a circular motion - apply

5. What should you do when applying a femoral artery compression device?
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
In fatty areas or over major muscles - large breasts - or bony prominences.
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
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

6. Which type of patient shouldn't take nitrates?
BP is elevated or decreased depending on activity.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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

7. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
NO NSAIDS or ASA.

8. Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
In the first 72 hours!!!!!
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.

9. What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Rescuer arrives with AED - turn AED on - select proper pads and apply - clear victim to analyze - clear victim to shock/press shock - resume chest compressions after 1 shock - delivers cycle of compressions at correct rate - pause to allow other resc
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Lung disease

10. What should you teach your patient about an electrocardiogram (ECG)?
Activity intolerance
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
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.
It is a sterile procedure so both nurse and patient should wear a mask - arrange sterile field - remove dressing - assess the catheter insertion site for infection - put on sterile gloves - clean the site moving outwardly in a circular motion - apply

11. What type of EKG change indicates MI?
ST segment elevation (STEMI)
Steroid treatment or a pregnant woman who is retaining water.
Whether the patients ulnar and radial arteries are patent.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

12. What should happen if someone converts to asystole/flatline?
Vascular - artery disease causing fluid to back up into the lungs.
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

13. Where should you place your stethescope to find the aortic valve?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Second Right intercostal space.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

14. How should you palpate the carotid arteries?
Only for a few hours
One at a time to assess the pulse amplitude and contour.
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
Maintain BED REST

15. What are examples of calcium channel blockers?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
Lung disease
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

16. What should be done immediately for someone with PE?
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.
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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

17. What should be done for someone on bleeding precautions?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Vascular - artery disease causing fluid to back up into the lungs.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

18. What is the hallmark clinical finding associated with pericarditis?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Lower left sternal border
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.

19. What is the treatment for premature ventricular contractions?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
The patient may suffer significant blood loss or femoral nerve compression.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

20. What is the antidote for heparin?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Protamine Sulfate
Include rest periods prior to any activity.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

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

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22. Where do the internal jugular veins lie?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
One at a time to assess the pulse amplitude and contour.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

23. What should you do to treat pulmonary edema?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.
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

24. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

25. Test ending in Gram=?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
To inhibit thrombus and clot formation.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Iodine

26. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Direct current cardioversion and digoxin/propranolol (inderal).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Lung disease

27. What are the two common complications of pericarditis?
Open up blood vessels
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

28. 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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
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

29. What does an Allen's test determine?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Whether the patients ulnar and radial arteries are patent.
Air embolism
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

30. What should a patient do if they feel chest pain or discomfort?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Second Left intercostal space
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

31. What body systems are affected by digoxin toxicity? S&S?
Must be flushed 1x/month with heparin and between treatments.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
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

32. What is defibrillation?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
Chronic arteriosclerotic disease.
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

33. How does the blood flow through the heart? (valves?)
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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!

34. What are the nursing interventions for a pt. with ventricular tachycardia?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.)
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

35. What are the 2 types of pacemakers?
Idiopathic
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.
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.
The patient may suffer significant blood loss or femoral nerve compression.

36. Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.

37. During an Allen's test don't compress one artery _____ the other.
Fat - Air - DVT - or Amniotic
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).
An enlarged space indicates fluid accumulation in the pericardial sac.
Before

38. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Feeling warm (fire) or tin can taste is expected and will pass.
Pulse before and after giving.
Second left intercostal space
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

39. 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?
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.
Direct current cardioversion and digoxin/propranolol (inderal).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
NO NSAIDS or ASA.

40. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
0.5-2.0 ng/ml
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.
Maintain BED REST
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.

41. What is the treatment for myocardial infarction?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Pulse before and after giving.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

42. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
NO because it isn't sterile so keep out.

43. What should you teach your patient about angiography (arteriography)?
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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
Lung disease

44. 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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
Lung disease

45. What is more harmful a lot of little emboli or one large emboli?
Lung disease
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
One large emboli (smaller=better)
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

46. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Left sternal border
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

47. What is a chemical stress test (persantine stress test)?
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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

48. What causes essential/primary hypertension?
Lung disease
One large emboli (smaller=better)
Idiopathic
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

49. What should be checked in a patient on a beta blocker?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Pulse before and after giving.

50. What is characteristic of atrial fibrillation?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
A monitor with four dual electrodes that are applied to the patients neck and thorax.