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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 Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.

2. What is important to remember when removing a CVC from a patient?
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
Feeling warm (fire) or tin can taste is expected and will pass.
Nitrates - Beta blockers - and Calcium channel blockers

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

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4. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
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
ST segment elevation (STEMI)
Patient who are unable to tolerate exercise stress testing.

5. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Exercise and use graduated compression devices as directed - don't stand for long period of time - to avoid dislodging blood clots don't rub or massage your legs.
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

6. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Open up blood vessels
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.

7. What is cardiac tamponade? Common causes?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
One at a time to assess the pulse amplitude and contour.

8. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
Old truck driver or someone on bed rest or with pelvic trauma.
The internal jugular veins (external are less reliable).
4th left intercostal space lower sternal border

9. 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.
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
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

10. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Protamine Sulfate
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

11. What type of surgery is done for an aortic dissection?
In fatty areas or over major muscles - large breasts - or bony prominences.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
No radial artery punctures if negative
To inhibit thrombus and clot formation.

12. 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?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

13. What factors place you at risk for HTN?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
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.

14. What is an acute peripheral arterial occlusion?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.)

15. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
If feel more than 3 shocks in a row or develop signs of infection at the site.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

16. What is the hallmark clinical finding associated with pericarditis?
Cannot
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.
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
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.

17. A femoral artery compression device ______be assigned to an NA?
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).
Cannot
Idiopathic

18. What should you observe for in someone on bleeding precautions?
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).
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-
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.

19. How is angina treated?

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20. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
The internal jugular veins (external are less reliable).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

21. What are common risk factors for an MI?
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.

22. What should you remember while taking care of someone with a peripheral arterial occlusion?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

23. What is CVP? Normal?
In the first 72 hours!!!!!
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Pulse before and after giving.
(S1 - S2) Third left intercostal space

24. What should a patient do if they feel chest pain or discomfort?
D/C the med and call the doctor.
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.
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.
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

25. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
(S1 - S2) Third left intercostal space
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

26. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

27. What is characteristic of ventricular fibrillation?
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

28. What is epistaxis?
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A nosebleed
Must be flushed 1x/month with heparin and between treatments.

29. What are the 2 types of pacemakers?
Don't interfere!
Pulmonary edema
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.

30. What should happen if someone converts to asystole/flatline?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Fat - Air - DVT - or Amniotic
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

31. What do calcium channel blockers do?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
One at a time to assess the pulse amplitude and contour.
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.

32. How long is contrast media in the body?
Lower left sternal border
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Only for a few hours
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

33. Should the tubing for a venous access port be included under the dressing site?

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34. What are the four types of pulmonary emboli?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Only for a few hours
D/C the med and call the doctor.
Fat - Air - DVT - or Amniotic

35. What is the treatment for premature ventricular contractions?
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Right sided heart failure
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

36. What are the nursing interventions for a patient in atrial fibrillation?
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

37. What are the steps for infant 1&2 rescuer CPR?
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 drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Nitrates - Beta blockers - and Calcium channel blockers
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

38. Where should you place your stethescope to find the aortic valve?
Protamine Sulfate
Second Right intercostal space.
Lowers BP and makes heart beat stronger. SE: flushed face.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

39. What is characteristic of premature ventricular contractions?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
Maintain BED REST
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

40. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

41. What is the antidote for heparin?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Protamine Sulfate
Patient who are unable to tolerate exercise stress testing.

42. What should you explain to the patient about an impedance cardiography test?
Lowers BP and makes heart beat stronger. SE: flushed face.
Vascular - artery disease causing fluid to back up into the lungs.
Lower left sternal border
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

43. How do you prepare a patient for Impedance cardiography monitoring?
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.
Whether the patients ulnar and radial arteries are patent.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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

44. What causes essential/primary hypertension?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Idiopathic
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

45. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Include rest periods prior to any activity.
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
Maintain BED REST
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

46. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Include rest periods prior to any activity.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
One at a time to assess the pulse amplitude and contour.

47. What are the S&S of cardiac tamponade?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Second Left intercostal space
Vascular - artery disease causing fluid to back up into the lungs.

48. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

49. What should you do immediately if you suspect someone of developing a hematoma?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
BP is elevated or decreased depending on activity.
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.

50. What is superior vena cava syndrome?
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.
Open up blood vessels
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
Pulse before and after giving.