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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 you teach someone after they have had a pacemaker placed?

2. What should you teach your patient about MRI?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
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
Second Right intercostal space.

3. What should be done immediately if a pulmonary embolism is suspected?
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.
Poorly controlled hypertension
Right sided heart failure
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

4. What are the nursing interventions for a pt. with ventricular tachycardia?
Second left intercostal space
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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

5. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Include rest periods prior to any activity.
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!
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

6. What are the S&S of air embolism?
To inhibit thrombus and clot formation.
Must be flushed 1x/month with heparin and between treatments.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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

7. What is labile hypertension?
An enlarged space indicates fluid accumulation in the pericardial sac.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Lower left sternal border
BP is elevated or decreased depending on activity.

8. When would a nurse use an external femoral artery compression device?
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
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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

9. What should you do if you are going to ventilate someone with an ambu bag?
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
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

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

11. During an Allen's test don't compress one artery _____ the other.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
Before
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

12. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
(S1 - S2) Third left intercostal space
Lower left sternal border
Whether the patients ulnar and radial arteries are patent.

13. What should you observe for in someone on bleeding precautions?
An inflammation of the pericardium. It may result in MI.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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).

14. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
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
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.
BP is elevated or decreased depending on activity.

15. What are all the S&S of pericarditis?
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
(S1 - S2) Third left intercostal space
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

16. What does an Allen's test determine?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Whether the patients ulnar and radial arteries are patent.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
If feel more than 3 shocks in a row or develop signs of infection at the site.

17. What should be immediately done for a patient experiencing digoxin toxicity?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Cannot
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

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

19. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Patient who are unable to tolerate exercise stress testing.
An inflammation of the pericardium. It may result in MI.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

20. What is cardiac tamponade? Common causes?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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
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

21. What is pulsus paradoxus?
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.

22. What is characteristic of ventricular fibrillation?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
BP is elevated or decreased depending on activity.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Fourth or fifth intercostal space at or medial to the midclavicular line.

23. What are the proper steps to changing a central venous catheter dressing?
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
Air embolism
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

24. What needs to be held during the placement of a femoral artery compression device?
One at a time to assess the pulse amplitude and contour.
NO NSAIDS or ASA.
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

25. What is pericarditis?
Fourth or fifth intercostal space at or medial to the midclavicular line.
NO because it isn't sterile so keep out.
An inflammation of the pericardium. It may result in MI.
Open up blood vessels

26. What is the most common cause of arterial insufficiency?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Chronic arteriosclerotic disease.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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

27. What is the treatments for hypertension?
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.
One large emboli (smaller=better)
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.
Air answers (open junctions)

28. What is impedance cardiography?
Lower left sternal border
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
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

29. 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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

30. What is the treatment for premature ventricular contractions?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Iodine
ST segment elevation (STEMI)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

31. What is a major complication of central line placement?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Pneumothorax and will end up with chest tube to help reinflate lung.
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

32. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Lowers BP and makes heart beat stronger. SE: flushed face.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

33. How is angina treated?

34. When should bleeding precautions be implemented?
Only for a few hours
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
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

35. What are the S&S of cardiac tamponade?
Nitrates - Beta blockers - and Calcium channel blockers
ST segment elevation (STEMI)
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

36. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

37. 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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
4th left intercostal space lower sternal border

38. What should you do to treat pulmonary edema?
One at a time to assess the pulse amplitude and contour.
Fifth left intercostal space medial to the midclavicular line.
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
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.

39. What is Deep Vein Thrombosis (DVT)?
Maintain BED REST
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Only for a few hours

40. 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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
An enlarged space indicates fluid accumulation in the pericardial sac.
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.

41. What are the nursing interventions for a patient with premature ventricular contractions?
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).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
4th left intercostal space lower sternal border

42. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

43. Where is the apex/mitral valve landmark on the chest?
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

44. Test ending in Gram=?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Iodine
One at a time to assess the pulse amplitude and contour.
(S1 - S2) Third left intercostal space

45. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
One at a time to assess the pulse amplitude and contour.
Pneumothorax and will end up with chest tube to help reinflate lung.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

46. What is angina? Stable vs. unstable?

47. What are signs and symptoms of an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
The patient may suffer significant blood loss or femoral nerve compression.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

48. What are the signs and symptoms of left sided HF?
The patient may suffer significant blood loss or femoral nerve compression.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

49. 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?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
To inhibit thrombus and clot formation.
In fatty areas or over major muscles - large breasts - or bony prominences.

50. What will a leg with arterial insufficiency look like?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.