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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 will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Cannot
An enlarged space indicates fluid accumulation in the pericardial sac.

2. What should you teach your patient about angiography (arteriography)?
Cannot
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.
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
Poorly controlled hypertension

3. What is important to remember when removing a CVC from a patient?
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
ST segment elevation (STEMI)
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.
(S1 - S2) Third left intercostal space

4. What could happen without immediate intervention for a hematoma?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
The patient may suffer significant blood loss or femoral nerve compression.
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

5. What is a nursing diagnosis for arterial occlusion? Tx
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

6. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.

7. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
Include rest periods prior to any activity.
Vitamin K (aqua myphiton)
Second Left intercostal space

8. What SE should you look for with calcium channel blocker use?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
The internal jugular veins (external are less reliable).

9. What is characteristic of atrial fibrillation?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

10. What does a swan ganz measure?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

11. What are the nursing interventions for a patient with premature ventricular contractions?
(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.
4th left intercostal space lower sternal border
ST segment elevation (STEMI)

12. What is a therapeutic digoxin level?
Air embolism
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
0.5-2.0 ng/ml

13. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
ST segment elevation (STEMI)
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

14. What are the steps for infant 1&2 rescuer CPR?
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
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.

15. Where should you place your stethescope to find the mitral (apex) valve?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Fifth left intercostal space medial to the midclavicular line.
Lung disease
Pulmonary edema

16. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Poorly controlled hypertension
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.

17. What are common risk factors for an MI?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Second Right intercostal space.

18. Where is the pulmonic valve landmark on the chest?
Only for a few hours
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Second left intercostal space

19. What is characteristic of premature ventricular contractions?
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.
Lung disease
Feeling warm (fire) or tin can taste is expected and will pass.
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.

20. What should you teach someone about iodine?
Fifth left intercostal space medial to the midclavicular line.
(S1 - S2) Third left intercostal space
Feeling warm (fire) or tin can taste is expected and will pass.
Second right intercostal space

21. What should you do immediately if you suspect someone of developing a hematoma?
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.
Air answers (open junctions)
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

22. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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

23. 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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

24. Where is the apex/mitral valve landmark on the chest?
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Activity intolerance

25. What is defibrillation?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
Left sternal border
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

26. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

27. Where is the right ventricle landmark on the chest?
Left sternal border
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Don't interfere!

28. What should you teach someone with arterial insufficiency?

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29. What is epistaxis?
An inflammation of the pericardium. It may result in MI.
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A nosebleed

30. What should be done immediately for someone with PE?
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

31. What is pericarditis?
ST segment elevation (STEMI)
An inflammation of the pericardium. It may result in MI.
Activity intolerance
Left sternal border

32. During an Allen's test don't compress one artery _____ the other.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Patient who are unable to tolerate exercise stress testing.
Before
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

33. What are the S&S of superior vena cava syndrome?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
NO NSAIDS or ASA.
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.
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

34. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Second right intercostal space

35. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

36. 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.
D/C the med and call the doctor.
Must be flushed 1x/month with heparin and between treatments.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

37. What is a good diagnosis for someone with right sided HF?
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at
Activity intolerance

38. 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.
Direct current cardioversion and digoxin/propranolol (inderal).
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

39. What is INR?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
4th left intercostal space lower sternal border
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

40. What should happen if someone converts to asystole/flatline?
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
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
To inhibit thrombus and clot formation.

41. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
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
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

42. What is characteristic of ventricular tachycardia?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

43. What should you teach someone after they have had a pacemaker placed?

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44. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
The internal jugular veins (external are less reliable).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
ST segment elevation (STEMI)
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

45. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
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).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

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

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47. What is a major complication of central line placement?
4th left intercostal space lower sternal border
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Must be flushed 1x/month with heparin and between treatments.
Pneumothorax and will end up with chest tube to help reinflate lung.

48. What does vasotec (Enalapril Maleate) do/SE?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Fat - Air - DVT - or Amniotic
Only for a few hours
Lowers BP and makes heart beat stronger. SE: flushed face.

49. What factors place you at risk for HTN?
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.
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
Second left intercostal space
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

50. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
(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.
The internal jugular veins (external are less reliable).