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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 should be taught upon discharge for someone going home on coumadin as a result of a PE?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

2. What should you do to treat pulmonary edema?
Lower left sternal border
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.

3. Where is the right ventricle landmark on the chest?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Left sternal border
4th left intercostal space lower sternal border
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.

4. During an Allen's test don't compress one artery _____ the other.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Before

5. What are the steps to perform the heimlich maneuver?
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.
One at a time to assess the pulse amplitude and contour.
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
(S1 - S2) Third left intercostal space

6. What is superior vena cava syndrome?
Open up blood vessels
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.)
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.
To inhibit thrombus and clot formation.

7. 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.
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.
ST segment elevation (STEMI)
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

8. What is intermittent claudication?
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.
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.
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.
Whether the patients ulnar and radial arteries are patent.

9. Where is the aortic valve landmark on the chest?
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.
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

10. What is the treatment for atrial fibrillation?
Feeling warm (fire) or tin can taste is expected and will pass.
The patient may suffer significant blood loss or femoral nerve compression.
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.
Direct current cardioversion and digoxin/propranolol (inderal).

11. What could happen without immediate intervention for a hematoma?
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 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.
The patient may suffer significant blood loss or femoral nerve compression.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

12. What is a assessment finding with DVT?

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13. What should you do if the PTT value is 80 for someone on heparin?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Nitrates - Beta blockers - and Calcium channel blockers
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
D/C the med and call the doctor.

14. What causes essential/primary 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.
Idiopathic
4th left intercostal space lower sternal border
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.

15. What lab value is used to evaluate a patient on coumadin? What is the normal value?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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 at a time to assess the pulse amplitude and contour.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

16. 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?
Protamine Sulfate
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

17. What is important to remember when taking care of patients with compression devices?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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!

18. For which heart sounds should the bell be used?
Feeling warm (fire) or tin can taste is expected and will pass.
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

19. What should you explain to the patient about an impedance cardiography test?
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 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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
D/C the med and call the doctor.

20. What should you do if the PT value is 45 sec?
The internal jugular veins (external are less reliable).
D/C the med and call the doctor.
Pulse before and after giving.
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

21. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Right sided heart failure
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

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

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23. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Before

24. What are the nursing interventions for a patient in atrial fibrillation?
Fat - Air - DVT - or Amniotic
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
BP is elevated or decreased depending on activity.

25. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
Right sided heart failure
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
No radial artery punctures if negative

26. 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.
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
Second Right intercostal space.
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

27. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
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.
NO because it isn't sterile so keep out.

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

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29. 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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

30. What are examples of calcium channel blockers?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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

31. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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 are the steps for adult/child 1 rescuer CPR?
In fatty areas or over major muscles - large breasts - or bony prominences.
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

33. What is important to remember when removing a CVC from a patient?
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.
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.

34. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Direct current cardioversion and digoxin/propranolol (inderal).
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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.)

35. Test ending in Gram=?
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.
Iodine
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

36. When should you be concerned about premature ventricular contraction?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
One at a time to assess the pulse amplitude and contour.
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.

37. Where should you place your stethescope to find the aortic valve?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Second Right intercostal space.

38. How do you prepare a patient for Impedance cardiography monitoring?
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Open up blood vessels

39. What should a patient do if they feel chest pain or discomfort?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Pneumothorax and will end up with chest tube to help reinflate lung.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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

40. What is a transthoracic echocardiograph (TTE)?
4th left intercostal space lower sternal border
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Pneumothorax and will end up with chest tube to help reinflate lung.
BP is elevated or decreased depending on activity.

41. Where is the pulmonic valve landmark on the chest?
D/C the med and call the doctor.
Nitrates - Beta blockers - and Calcium channel blockers
Second left intercostal space
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

42. What is pericarditis?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
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
An inflammation of the pericardium. It may result in MI.

43. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Second Right intercostal space.

44. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.

45. What is the treatment for someone with right sided HF? How do you know working?
Vitamin K (aqua myphiton)
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Second right intercostal space

46. What should be done immediately if a pulmonary embolism is suspected?
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
The internal jugular veins (external are less reliable).
ST segment elevation (STEMI)
The patient may suffer significant blood loss or femoral nerve compression.

47. What factors place you at risk for HTN?
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.
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.

48. What SE should you look for with calcium channel blocker use?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
An enlarged space indicates fluid accumulation in the pericardial sac.

49. What will a leg with arterial insufficiency look like?
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Left sternal border
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

50. What is an aortic dissection?

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