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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 immediately done for a patient experiencing digoxin toxicity?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
In fatty areas or over major muscles - large breasts - or bony prominences.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

2. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Nitrates - Beta blockers - and Calcium channel blockers

3. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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
NO NSAIDS or ASA.

4. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
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.

5. What should you do when applying a femoral artery compression device?
Lowers BP and makes heart beat stronger. SE: flushed face.
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
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.)
Protamine Sulfate

6. What type of surgery is done for an aortic dissection?
Before
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Lower left sternal border

7. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
BP is elevated or decreased depending on activity.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
To inhibit thrombus and clot formation.

8. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
NO NSAIDS or ASA.
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

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

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10. What signals an elevated venous pressure based on the internal jugular veins?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
Direct current cardioversion and digoxin/propranolol (inderal).
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.

11. 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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Include rest periods prior to any activity.

12. What type of EKG change indicates MI?
ST segment elevation (STEMI)
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!
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

13. 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?
NO because it isn't sterile so keep out.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Idiopathic

14. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
NO because it isn't sterile so keep out.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

15. What should you do to treat pulmonary edema?
(S1 - S2) Third left intercostal space
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
Fat - Air - DVT - or Amniotic
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

16. What should you teach your patient about an electrocardiogram (ECG)?
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.
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

17. What are examples of calcium channel blockers?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
No radial artery punctures if negative
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

18. A femoral artery compression device ______be assigned to an NA?
Cannot
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
ST segment elevation (STEMI)
One at a time to assess the pulse amplitude and contour.

19. 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?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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
In fatty areas or over major muscles - large breasts - or bony prominences.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

20. What do calcium channel blockers do?
Idiopathic
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!
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
Open up blood vessels

21. If a victim is choking but can cough - speak - or breath what should you do?

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22. What landmarks should you be looking for on someone's chest?
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.
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
An inflammation of the pericardium. It may result in MI.

23. 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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
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.

24. What are signs and symptoms of an MI?
Nitrates - Beta blockers - and Calcium channel blockers
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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-
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

25. What does an Allen's test determine?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Whether the patients ulnar and radial arteries are patent.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.

26. What usually triggers angina pain?
Steroid treatment or a pregnant woman who is retaining water.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Second right intercostal space

27. What are the two common complications of pericarditis?
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
NO NSAIDS or ASA.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

28. Test ending in Gram=?
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.
Fat - Air - DVT - or Amniotic
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Iodine

29. What are the indications for a chemical stress test (persantine stress test)?
Left sternal border
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Patient who are unable to tolerate exercise stress testing.
An inflammation of the pericardium. It may result in MI.

30. What are the nursing interventions for a patient in atrial fibrillation?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

31. What could happen without immediate intervention for a hematoma?
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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
The patient may suffer significant blood loss or femoral nerve compression.
Pulse before and after giving.

32. What is the treatment for atrial fibrillation?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Direct current cardioversion and digoxin/propranolol (inderal).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Left sternal border

33. What does vasotec (Enalapril Maleate) do/SE?
Feeling warm (fire) or tin can taste is expected and will pass.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Lowers BP and makes heart beat stronger. SE: flushed face.

34. What is the maintenance for venous access port that isn't being regularly used?
Iodine
Must be flushed 1x/month with heparin and between treatments.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Vitamin K (aqua myphiton)

35. What are the S&S of pulmonary embolism?
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.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Poorly controlled hypertension

36. What makes the symptoms of superior vena cava syndrome better? Worse?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(S1 - S2) Third left intercostal space
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

37. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Maintain BED REST
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

38. What does the device for impedance cardiography consist of?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Direct current cardioversion and digoxin/propranolol (inderal).

39. What is the correct way to insert an oropharyngeal airway?
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 NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Second Left intercostal space
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

40. What is the purpose of compression devices?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
BP is elevated or decreased depending on activity.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

41. What is pericarditis?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
An inflammation of the pericardium. It may result in MI.
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

42. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Fourth or fifth intercostal space at or medial to the midclavicular line.

43. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Protamine Sulfate
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Second Right intercostal space.
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

44. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

45. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Include rest periods prior to any activity.
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

46. What is the treatment for someone in ventricular fibrillation?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
File toe nails - if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.

47. What are common risk factors for an MI?
Second left intercostal space
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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

48. What is impedance cardiography?
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.
Fat - Air - DVT - or Amniotic
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

49. What should you observe for in someone on bleeding precautions?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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

50. What is a nursing diagnosis for arterial occlusion? Tx
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Fifth left intercostal space medial to the midclavicular line.
Second left intercostal space
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.