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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 tell someone about taking nitroglycerin tablets (SE)?
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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-
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

2. What is the hallmark clinical finding associated with pericarditis?
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.
D/C the med and call the doctor.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.

3. What will be the treatment for an acute episode of life threatening tamponade?
Use sterile gloves and aseptic technique - clean skin over port with alcohol or iodine - insert a 21 or 22 gauge HUBER needle (noncoring - won't break apart) attached to syringe or tubing into the middle of the port until rigid back of port is palpab
Old truck driver or someone on bed rest or with pelvic trauma.
A nosebleed
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

4. What condition can cause left sided heart failure?
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
In fatty areas or over major muscles - large breasts - or bony prominences.
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
Vascular - artery disease causing fluid to back up into the lungs.

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

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6. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
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 arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

7. How is the Allen's test done?
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
Awake and alert: IV lidocaine bolus and drip Unconscious - hypotensive - or S&S of angina/CHF: Direct current cardioversion and IV Lidocaine bolus and drip.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

8. What is cardiac tamponade? Common causes?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

9. What makes the symptoms of superior vena cava syndrome better? Worse?
To inhibit thrombus and clot formation.
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
Protamine Sulfate
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

10. What causes essential/primary hypertension?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
Idiopathic
Old truck driver or someone on bed rest or with pelvic trauma.

11. What type of surgery is done for an aortic dissection?
An inflammation of the pericardium. It may result in MI.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
Activity intolerance

12. What should you teach someone about iodine?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Feeling warm (fire) or tin can taste is expected and will pass.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

13. For what disease should you do the Allen's test?

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14. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
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.
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) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

15. What factors place you at risk for HTN?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

16. When should bleeding precautions be implemented?
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
Feeling warm (fire) or tin can taste is expected and will pass.
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.
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

17. What is pericarditis?
(S1 - S2) Third left intercostal space
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.
An inflammation of the pericardium. It may result in MI.
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.

18. What is the nursing care associated with chemical stress tests (persantine stress test)?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
No radial artery punctures if negative

19. What is characteristic of atrial fibrillation?
Old truck driver or someone on bed rest or with pelvic trauma.
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

20. Where is the tricuspid valve landmark on the chest?
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
Lower left sternal border
One at a time to assess the pulse amplitude and contour.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

21. Which type of patient shouldn't take nitrates?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
Vascular - artery disease causing fluid to back up into the lungs.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

22. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Activity intolerance
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

23. What is a therapeutic digoxin level?
Lowers BP and makes heart beat stronger. SE: flushed face.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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
0.5-2.0 ng/ml

24. In what locations should you not place electrodes?
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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
In fatty areas or over major muscles - large breasts - or bony prominences.

25. Where should you place your stethescope to find the pulmonic valve?
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.
Second Left intercostal space
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

26. What should you observe for in someone on bleeding precautions?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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).
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
Open up blood vessels

27. Where is the apex/mitral valve landmark on the chest?
Patient who are unable to tolerate exercise stress testing.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Second right intercostal space
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

28. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
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.
D/C the med and call the doctor.
In the first 72 hours!!!!!

29. What should happen if someone converts to asystole/flatline?
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Open up blood vessels
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

30. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
A nosebleed
Fourth or fifth intercostal space at or medial to the midclavicular line.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

31. What are the two common complications of pericarditis?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Left sternal border
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.)

32. What should you do when applying a femoral artery compression device?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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
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
4th left intercostal space lower sternal border

33. What is angina? Stable vs. unstable?

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34. What should be done for someone on bleeding precautions?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
Vascular - artery disease causing fluid to back up into the lungs.

35. What is a chemical stress test (persantine stress test)?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

36. Where is the aortic valve landmark on the chest?
D/C the med and call the doctor.
Patient who are unable to tolerate exercise stress testing.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Second right intercostal space

37. What is the most common cause of arterial insufficiency?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Direct current cardioversion and digoxin/propranolol (inderal).
Use sterile gloves and aseptic technique - clean skin over port with alcohol or iodine - insert a 21 or 22 gauge HUBER needle (noncoring - won't break apart) attached to syringe or tubing into the middle of the port until rigid back of port is palpab
Chronic arteriosclerotic disease.

38. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Second Right intercostal space.
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

39. When should you be concerned about premature ventricular contraction?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

40. What does plan of care include?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Left sternal border
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

41. What should be done immediately for someone with PE?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Whether the patients ulnar and radial arteries are patent.

42. 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.
Iodine
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

43. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Lung disease
(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
Include rest periods prior to any activity.

44. What is the treatments for hypertension?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
D/C the med and call the doctor.
Second right intercostal space
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.

45. What is defibrillation?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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-
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

46. What are the nursing interventions for a patient in complete heart block?
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
(1st) Assess the client for S&S of decreased cardiac output 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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

47. What disease can cause right sided heart failure?
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.
One large emboli (smaller=better)
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.
Lung disease

48. What are the S&S of cardiac tamponade?
Open up blood vessels
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
An inflammation of the pericardium. It may result in MI.

49. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Protamine Sulfate
One large emboli (smaller=better)
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Right sided heart failure

50. What is the treatment for myocardial infarction?
Lowers BP and makes heart beat stronger. SE: flushed face.
Before
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).