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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 goal of treatment for an MI? Treatment?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
Open up blood vessels
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.

2. What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

3. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The internal jugular veins (external are less reliable).
Protamine Sulfate

4. What is pericarditis?
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.
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
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).

5. What is the treatment for atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Direct current cardioversion and digoxin/propranolol (inderal).
Air embolism
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

6. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Second Right intercostal space.
Lung disease

7. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

8. What places someone at risk for an aortic dissection?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Poorly controlled hypertension
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.

9. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
To inhibit thrombus and clot formation.
An inflammation of the pericardium. It may result in MI.
Fourth or fifth intercostal space at or medial to the midclavicular line.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

10. What should you teach your patient about an abdominal ultrasonography?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

11. What is epistaxis?
A nosebleed
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

12. What is the treatment for someone in ventricular fibrillation?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

13. What is defibrillation?
Air answers (open junctions)
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

14. What is labile hypertension?
BP is elevated or decreased depending on activity.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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!
Left sternal border

15. What is Deep Vein Thrombosis (DVT)?
Vascular - artery disease causing fluid to back up into the lungs.
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.
Must be flushed 1x/month with heparin and between treatments.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

16. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
In the first 72 hours!!!!!
Pulse before and after giving.

17. What should you teach a patient regarding discharge after a DVT?

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18. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
NO NSAIDS or ASA.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Second right intercostal space
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.

19. 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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.

20. 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?
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).
Left sternal border
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
In fatty areas or over major muscles - large breasts - or bony prominences.

21. What type of surgery is done for an aortic dissection?
Second Right intercostal space.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
The patient may suffer significant blood loss or femoral nerve compression.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

22. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Whether the patients ulnar and radial arteries are patent.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

23. What is a transthoracic echocardiograph (TTE)?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
One large emboli (smaller=better)
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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

24. What are the 2 types of pacemakers?
Fourth or fifth intercostal space at or medial to the midclavicular line.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
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.

25. What are the steps for adult 2 rescuer CPR?
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
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.
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.)

26. Who would most likely have peripheral venous disease?
Second Left intercostal space
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Old truck driver or someone on bed rest or with pelvic trauma.
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.

27. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Pneumothorax and will end up with chest tube to help reinflate lung.
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.

28. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
One at a time to assess the pulse amplitude and contour.
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.
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
A nosebleed

29. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
NO because it isn't sterile so keep out.

30. What are all the S&S of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.

31. What is CVP? Normal?
In the first 72 hours!!!!!
Don't interfere!
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

32. 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
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).
D/C the med and call the doctor.

33. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
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.
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!
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

34. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
One at a time to assess the pulse amplitude and contour.
A nosebleed
Fourth or fifth intercostal space at or medial to the midclavicular line.

35. When should bleeding precautions be implemented?
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
Nitrates - Beta blockers - and Calcium channel blockers

36. What is the purpose of compression devices?
Air embolism
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

37. What should you observe for in someone on bleeding precautions?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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).
D/C the med and call the doctor.

38. What is the treatment for a patient in complete heart block?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

39. What is characteristic of ventricular fibrillation?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Nitrates - Beta blockers - and Calcium channel blockers
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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

40. A femoral artery compression device ______be assigned to an NA?
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.
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
An enlarged space indicates fluid accumulation in the pericardial sac.
Cannot

41. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Right sided heart failure
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

42. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
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
Idiopathic

43. What condition can cause left sided heart failure?
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.
Vascular - artery disease causing fluid to back up into the lungs.
Fourth or fifth intercostal space at or medial to the midclavicular line.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

44. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
Maintain BED REST
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.
Second Right intercostal space.

45. Where is the apex/mitral valve landmark on the chest?
Fifth left intercostal space medial to the midclavicular line.
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
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.

46. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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47. What are the S&S of superior vena cava syndrome?
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
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Feeling warm (fire) or tin can taste is expected and will pass.

48. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Don't interfere!
To inhibit thrombus and clot formation.

49. What should be done for someone on bleeding precautions?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
One large emboli (smaller=better)

50. What type of EKG change indicates MI?
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.
Lower left sternal border
ST segment elevation (STEMI)
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.