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NCLEX Cardiac
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Subjects
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nclex
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health-sciences
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nursing
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
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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 about iodine?
(S1 - S2) Third left intercostal space
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Feeling warm (fire) or tin can taste is expected and will pass.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
2. What makes the symptoms of superior vena cava syndrome better? Worse?
If feel more than 3 shocks in a row or develop signs of infection at the site.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Chronic arteriosclerotic disease.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
3. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
4. What landmarks should you be looking for on someone's chest?
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.
Pulmonary edema
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
5. What should you teach your patient about a holter monitor?
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6. What is labile hypertension?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
BP is elevated or decreased depending on activity.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Vitamin K (aqua myphiton)
7. What are the five areas for listening to the heart?
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8. What places someone at risk for an aortic dissection?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Poorly controlled hypertension
Second Left intercostal space
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
9. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
Right sided heart failure
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
10. What should you not allow if a patient has a negative Allen's test?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
No radial artery punctures if negative
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.
11. What are the nursing interventions for a patient in complete heart block?
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
12. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
13. Where is the apex/mitral valve landmark on the chest?
0.5-2.0 ng/ml
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Fourth or fifth intercostal space at or medial to the midclavicular line.
Vitamin K (aqua myphiton)
14. What is more harmful a lot of little emboli or one large emboli?
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
Lowers BP and makes heart beat stronger. SE: flushed face.
One large emboli (smaller=better)
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
15. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
16. What is the hallmark clinical finding associated with pericarditis?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
NO because it isn't sterile so keep out.
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.
Maintain BED REST
17. 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.
Before
(S1 - S2) Third left intercostal space
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
18. What usually triggers angina pain?
Lowers BP and makes heart beat stronger. SE: flushed face.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Second right intercostal space
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
19. What are the S&S of superior vena cava syndrome?
0.5-2.0 ng/ml
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Pulmonary edema
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
20. What type of EKG change indicates MI?
ST segment elevation (STEMI)
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).
Lower left sternal border
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.
21. In what locations should you not place electrodes?
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
Chronic arteriosclerotic disease.
In fatty areas or over major muscles - large breasts - or bony prominences.
0.5-2.0 ng/ml
22. For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
NO because it isn't sterile so keep out.
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
23. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
It is a noninvasive test that takes 15 mins. Electrodes are applied to sites on your body. You must lie still - relax - and breathe normally and remain quiet. Talking or moving distorts the images
Poorly controlled hypertension
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
24. What signals an elevated venous pressure based on the internal jugular veins?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Don't interfere!
25. What should you teach your patient about MRI?
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
Protamine Sulfate
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.
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
26. What is characteristic of premature ventricular contractions?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
NO NSAIDS or ASA.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
27. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
The internal jugular veins (external are less reliable).
4th left intercostal space lower sternal border
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
28. What should you do if the PT value is 45 sec?
It is noninvasive. You must not eat - smoke - or drink alcohol for 3 hours before the test. WEAR COMFORTABLE SHOES And LOOSE LIGHTWEIGHT SHORTS OR SLACKS - YOU MAY GET AN INJECTION of THAllIUM - after your blood pressure and ECG are monitored for 10-
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.
Second left intercostal space
D/C the med and call the doctor.
29. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Don't interfere!
Include rest periods prior to any activity.
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
Decrease in weight - diuretics (watch K loss) - aldactone (k sparing but check renal fx) - inderal (do Not give to asthma patients or diabetic patients) - more exercise - no smoking - and decreased Na intake.
30. If a victim is choking but can cough - speak - or breath what should you do?
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31. What is an air embolism?
D/C the med and call the doctor.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
32. When should you be concerned about premature ventricular contraction?
NO NSAIDS or ASA.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Include rest periods prior to any activity.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
33. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Before
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
34. What body systems are affected by digoxin toxicity? S&S?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
ST segment elevation (STEMI)
Second left intercostal space
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
35. What should you teach your patient about an electrocardiogram (ECG)?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Don't interfere!
It is a noninvasive test that takes 15 mins. Electrodes are applied to sites on your body. You must lie still - relax - and breathe normally and remain quiet. Talking or moving distorts the images
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.
36. What is pulsus paradoxus?
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
Second left intercostal space
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
37. What is a assessment finding with DVT?
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38. What is the nursing care associated with chemical stress tests (persantine stress test)?
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
D/C the med and call the doctor.
39. What does vasotec (Enalapril Maleate) do/SE?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Lowers BP and makes heart beat stronger. SE: flushed face.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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.
40. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
A nosebleed
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.
An inflammation of the pericardium. It may result in MI.
41. What should you do immediately if you suspect someone of developing a hematoma?
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
Iodine
Maintain BED REST
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.
42. What should you do when applying a femoral artery compression device?
Before
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Don't interfere!
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
43. What should you do if you are going to ventilate someone with an ambu bag?
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
44. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
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
Protamine Sulfate
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
45. What is epistaxis?
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
The patient may suffer significant blood loss or femoral nerve compression.
Only for a few hours
A nosebleed
46. What is the treatment for a pt. with ventricular tachycardia?
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
D/C the med and call the doctor.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
47. What causes secondary hypertension?
The internal jugular veins (external are less reliable).
Steroid treatment or a pregnant woman who is retaining water.
0.5-2.0 ng/ml
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
48. What is defibrillation?
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
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.
NO because it isn't sterile so keep out.
49. Where should you place your stethescope to find the tricuspid valve?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.
4th left intercostal space lower sternal border
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
50. What should you do if the PTT value is 80 for someone on heparin?
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
D/C the med and call the doctor.
Old truck driver or someone on bed rest or with pelvic trauma.
Sorry!:) No result found.
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