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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 is the nursing care associated with chemical stress tests (persantine stress test)?
Maintain BED REST
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
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
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.

2. For which heart sounds should the bell be used?
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.
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

3. What is the maintenance for venous access port that isn't being regularly used?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Must be flushed 1x/month with heparin and between treatments.
Activity intolerance

4. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
The internal jugular veins (external are less reliable).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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.

5. What should you do immediately if you suspect someone of developing a hematoma?
Fourth or fifth intercostal space at or medial to the midclavicular line.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.

6. What are coumadin and heparin used for?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Direct current cardioversion and digoxin/propranolol (inderal).
To inhibit thrombus and clot formation.
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.

7. What condition can cause left sided heart failure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
A nosebleed
Vascular - artery disease causing fluid to back up into the lungs.
NO NSAIDS or ASA.

8. What usually triggers angina pain?
Protamine Sulfate
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
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

9. When would a nurse use an external femoral artery compression device?
Before
Pneumothorax and will end up with chest tube to help reinflate lung.
Second Right intercostal space.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

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

11. How does the blood flow through the heart? (valves?)
Second left intercostal space
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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!
An enlarged space indicates fluid accumulation in the pericardial sac.

12. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
Right sided heart failure
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

13. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Maintain BED REST
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pulmonary edema
Old truck driver or someone on bed rest or with pelvic trauma.

14. What are the treatments/ S&S of peripheral venous disease?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Air embolism

15. What should you teach someone with arterial insufficiency?

16. What is the treatment for atrial fibrillation?
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-
Old truck driver or someone on bed rest or with pelvic trauma.
Direct current cardioversion and digoxin/propranolol (inderal).
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

17. What is Raynauds disease? Tx?
Iodine
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.

18. What are the S&S of air embolism?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
BP is elevated or decreased depending on activity.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
One at a time to assess the pulse amplitude and contour.

19. What are the signs and symptoms of left sided HF?
Protamine Sulfate
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.

20. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
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.
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-
0.5-2.0 ng/ml

21. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
An inflammation of the pericardium. It may result in MI.
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

22. How is angina treated?

23. What body systems are affected by digoxin toxicity? S&S?
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.
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 usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

24. What does the device for impedance cardiography consist of?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
D/C the med and call the doctor.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
A monitor with four dual electrodes that are applied to the patients neck and thorax.

25. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

26. What is INR?
Right sided heart failure
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

27. What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Before

28. What is characteristic of premature ventricular contractions?
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.
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.

29. What should you tell someone about taking nitroglycerin tablets (SE)?
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

30. What is labile hypertension?
One at a time to assess the pulse amplitude and contour.
BP is elevated or decreased depending on activity.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.

31. What is pericarditis?
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.
An inflammation of the pericardium. It may result in MI.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

32. Where is the aortic valve landmark on the chest?
Second right intercostal space
In fatty areas or over major muscles - large breasts - or bony prominences.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

33. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
(S1 - S2) Third left intercostal space
Don't interfere!
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.
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.

34. What type of surgery is done for an aortic dissection?
NO NSAIDS or ASA.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Lung disease

35. What is an air embolism?
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
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 a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.

36. What is an acute peripheral arterial occlusion?
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

37. What should be immediately done for a patient experiencing digoxin toxicity?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Direct current cardioversion and digoxin/propranolol (inderal).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

38. What is the treatment for someone with right sided HF? How do you know working?
Lower left sternal border
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

39. What is more harmful a lot of little emboli or one large emboli?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
One large emboli (smaller=better)
Patient who are unable to tolerate exercise stress testing.

40. In What time period is the greatest risk of sudden death from an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
In the first 72 hours!!!!!
Right sided heart failure
Vitamin K (aqua myphiton)

41. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Right sided heart failure
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Steroid treatment or a pregnant woman who is retaining water.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

42. What are the steps for adult/child 1 rescuer CPR?
Fifth left intercostal space medial to the midclavicular line.
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.
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
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

43. What drugs are most commonly used for angina?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Nitrates - Beta blockers - and Calcium channel blockers
To inhibit thrombus and clot formation.

44. What is defibrillation?
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
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.

45. What is the purpose of compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

46. What are the indications for a chemical stress test (persantine stress test)?
Must be flushed 1x/month with heparin and between treatments.
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.
Patient who are unable to tolerate exercise stress testing.
Maintain BED REST

47. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
One at a time to assess the pulse amplitude and contour.
Activity intolerance
The internal jugular veins (external are less reliable).

48. When should bleeding precautions be implemented?
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table
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.
Lung disease
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

49. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
The internal jugular veins (external are less reliable).
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.

50. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
4th left intercostal space lower sternal border
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.
Lower left sternal border