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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 an acute peripheral arterial occlusion?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Right sided heart failure

2. For which heart sounds should the diaphragm be used?
Iodine
Patient who are unable to tolerate exercise stress testing.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

3. What is superior vena cava syndrome?
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
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.
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

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

5. What should you teach someone after they have had a pacemaker placed?

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6. What is the treatment for a patient in complete heart block?
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

7. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Steroid treatment or a pregnant woman who is retaining water.
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.

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

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9. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
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
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.

10. What does a swan ganz measure?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
NO because it isn't sterile so keep out.

11. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

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

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13. What should you not allow if a patient has a negative Allen's test?
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
No radial artery punctures if negative
Lung disease

14. What is Raynauds disease? Tx?
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
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.
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
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.

15. What are the nursing interventions for a pt. with ventricular tachycardia?
Second Right intercostal space.
Chronic arteriosclerotic disease.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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

16. Where is the aortic valve landmark on the chest?
Second right intercostal space
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Left sternal border

17. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The patient may suffer significant blood loss or femoral nerve compression.
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
Pulmonary edema

18. What are common risk factors for an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
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.

19. What is an air embolism?
Pneumothorax and will end up with chest tube to help reinflate lung.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Open up blood vessels

20. What are the S&S of pulmonary embolism?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

21. What should you teach someone about iodine?
The patient may suffer significant blood loss or femoral nerve compression.
Feeling warm (fire) or tin can taste is expected and will pass.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

22. What should you watch for with PICC lines that have been in place for 6 months?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Air answers (open junctions)
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.
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.

23. 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.
Old truck driver or someone on bed rest or with pelvic trauma.
Cannot
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

24. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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
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.
The internal jugular veins (external are less reliable).

25. What is cardiac tamponade? Common causes?
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.
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

26. What is the treatments for hypertension?
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.
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.
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.
NO because it isn't sterile so keep out.

27. What is characteristic of ventricular fibrillation?
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
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
An enlarged space indicates fluid accumulation in the pericardial sac.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

28. 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
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

29. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

30. Where is the tricuspid valve landmark on the chest?
Fat - Air - DVT - or Amniotic
Lower left sternal border
Second Right intercostal space.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

31. What should you observe for in someone on bleeding precautions?
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).
BP is elevated or decreased depending on activity.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Fat - Air - DVT - or Amniotic

32. What lab value is used to evaluate a patient on coumadin? What is the normal value?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.
One large emboli (smaller=better)

33. For which heart sounds should the bell be used?
D/C the med and call the doctor.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

34. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

35. How long is contrast media in the body?
Only for a few hours
Lower left sternal border
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Feeling warm (fire) or tin can taste is expected and will pass.

36. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
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

37. What is CVP? Normal?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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
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!
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

38. What is the most common cause of arterial insufficiency?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Before
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.

39. What body systems are affected by digoxin toxicity? S&S?
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

40. 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.
D/C the med and call the doctor.
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.
A nosebleed

41. What is the treatment for premature ventricular contractions?
4th left intercostal space lower sternal border
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

42. What is characteristic of atrial fibrillation?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Pulmonary edema
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

43. What is a therapeutic digoxin level?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
0.5-2.0 ng/ml
Cannot

44. What are the S&S of superior vena cava syndrome?
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.
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
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
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.

45. How do you prepare a patient for Impedance cardiography monitoring?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
Steroid treatment or a pregnant woman who is retaining water.
Fifth left intercostal space medial to the midclavicular line.

46. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
The patient may suffer significant blood loss or femoral nerve compression.
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.

47. How does the blood flow through the heart? (valves?)
NO because it isn't sterile so keep out.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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!

48. What do calcium channel blockers do?
Open up blood vessels
ST segment elevation (STEMI)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
(S1 - S2) Third left intercostal space

49. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Fat - Air - DVT - or Amniotic
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

50. When should bleeding precautions be implemented?
0.5-2.0 ng/ml
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.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

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NCLEX Cardiac

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