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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 are signs and symptoms of an MI?
Maintain BED REST
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

2. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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

3. What will a leg with arterial insufficiency look like?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
4th left intercostal space lower sternal border
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

4. What things should you do to assess cardiovascular status?
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
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

5. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Right sided heart failure
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

6. What are all the S&S of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Air answers (open junctions)
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

7. What is important to remember when taking care of patients with compression devices?
Feeling warm (fire) or tin can taste is expected and will pass.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

8. What signals an elevated venous pressure based on the internal jugular veins?
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.
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

9. What is a therapeutic digoxin level?
Chronic arteriosclerotic disease.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
0.5-2.0 ng/ml
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

10. What does a swan ganz measure?
To inhibit thrombus and clot formation.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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

11. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Maintain BED REST
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

12. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

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

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14. When should you be concerned about premature ventricular contraction?
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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

15. What are the S&S of aortic dissection?
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
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Maintain BED REST

16. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Protamine Sulfate
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

17. What is characteristic of premature ventricular contractions?
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.
D/C the med and call the doctor.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Iodine

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

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

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20. Where is the right ventricle landmark on the chest?
Left sternal border
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.

21. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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
Air answers (open junctions)
To inhibit thrombus and clot formation.
An enlarged space indicates fluid accumulation in the pericardial sac.

22. How long is contrast media in the body?
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
Only for a few hours
Steroid treatment or a pregnant woman who is retaining water.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

23. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
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
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

24. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

25. What causes secondary hypertension?
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.
Steroid treatment or a pregnant woman who is retaining water.
Pulse before and after giving.
NO because it isn't sterile so keep out.

26. What does an Allen's test determine?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Maintain BED REST
Whether the patients ulnar and radial arteries are patent.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

27. 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+
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Maintain BED REST

28. Who would most likely have peripheral venous disease?
Include rest periods prior to any activity.
One large emboli (smaller=better)
Old truck driver or someone on bed rest or with pelvic trauma.
A nosebleed

29. What is a good diagnosis for someone with right sided HF?
Activity intolerance
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.
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.

30. What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
0.5-2.0 ng/ml
Pulse before and after giving.
Fifth left intercostal space medial to the midclavicular line.

31. What is a chemical stress test (persantine stress test)?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

32. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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
Include rest periods prior to any activity.
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.
Second Left intercostal space

33. What is characteristic of complete heart block?
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.

34. What is characteristic of atrial fibrillation?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

35. What are the proper steps to changing a central venous catheter dressing?
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
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
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
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

36. 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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

37. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
If feel more than 3 shocks in a row or develop signs of infection at the site.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

38. What are the nursing interventions for a patient with premature ventricular contractions?
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

39. What disease can cause right sided heart failure?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Lung disease

40. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

41. 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.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
4th left intercostal space lower sternal border

42. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
0.5-2.0 ng/ml
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

43. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
BP is elevated or decreased depending on activity.
Fat - Air - DVT - or Amniotic
One large emboli (smaller=better)

44. How should you palpate the carotid arteries?
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
One at a time to assess the pulse amplitude and contour.
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.

45. What is the purpose of compression devices?
(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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
(S1 - S2) Third left intercostal space

46. What should be done for someone on bleeding precautions?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
An inflammation of the pericardium. It may result in MI.

47. What is defibrillation?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
In the first 72 hours!!!!!
Pneumothorax and will end up with chest tube to help reinflate lung.
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.

48. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Chronic arteriosclerotic disease.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
The internal jugular veins (external are less reliable).

49. During an Allen's test don't compress one artery _____ the other.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Pneumothorax and will end up with chest tube to help reinflate lung.
Before
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

50. What is epistaxis?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
A nosebleed