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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 teach someone after they have had a pacemaker placed?

2. What is the purpose of compression devices?
Patient who are unable to tolerate exercise stress testing.
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

3. What should be done immediately if a pulmonary embolism is suspected?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Chronic arteriosclerotic disease.
Close the open catheter lumen with the clamp - and place the pt on their left side in trendelenburg to move the air embolus away from the pulmonic valve. If you hear a churning sound in his chest (a classic sign of air embolus) and the patient starts
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

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

5. What should you teach a patient regarding discharge after a DVT?

6. What condition can cause left sided heart failure?
The internal jugular veins (external are less reliable).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Vascular - artery disease causing fluid to back up into the lungs.
Second Left intercostal space

7. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
To inhibit thrombus and clot formation.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

8. In What time period is the greatest risk of sudden death from an MI?
Air embolism
In the first 72 hours!!!!!
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Second right intercostal space

9. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
One large emboli (smaller=better)
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
Activity intolerance

10. What does the device for impedance cardiography consist of?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.

11. What are the steps for adult/child 1 rescuer CPR?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
Check for response - activate ERS and AED - open airway with head tilt chin lift - checking breathing (5-10 sec) - give 2 breaths (1 sec each) - check carotid pulse (5-10 sec) - locate CPR hand position - deliver first cycle of compressions (30 compr
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

12. What should you teach your patient about an electrocardiogram (ECG)?
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.
Vascular - artery disease causing fluid to back up into the lungs.
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

13. What does vasotec (Enalapril Maleate) do/SE?
Second right intercostal space
In the first 72 hours!!!!!
Lowers BP and makes heart beat stronger. SE: flushed face.
Iodine

14. Where should you place your stethescope to find the mitral (apex) valve?
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Fifth left intercostal space medial to the midclavicular line.
Direct current cardioversion and digoxin/propranolol (inderal).

15. How is the Allen's test done?
(S1 - S2) Third left intercostal space
Idiopathic
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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

16. What is an acute peripheral arterial occlusion?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

17. What are the five areas for listening to the heart?

18. What are the steps for adult 2 rescuer CPR?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

19. What is a major complication of central line placement?
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
BP is elevated or decreased depending on activity.
Pneumothorax and will end up with chest tube to help reinflate lung.

20. What should you explain to the patient about an impedance cardiography test?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Pulse before and after giving.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Direct current cardioversion and digoxin/propranolol (inderal).

21. Test ending in Gram=?
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
Iodine
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

22. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
Include rest periods prior to any activity.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

23. What is the treatment for someone with right sided HF? How do you know working?
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
When: using anticoagulants - liver disease - decrease in platelets (less than 150 -000) - hemophilia - using thrombolytic meds - DIC - CA - HIV - chemo - bone marrow problems - and ASA/NSAIDS.

24. How does the blood flow through the heart? (valves?)
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.
NO NSAIDS or ASA.
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!
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

25. What causes essential/primary hypertension?
The patient may suffer significant blood loss or femoral nerve compression.
Idiopathic
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.
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

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

27. What is the treatment for a patient in complete heart block?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
ST segment elevation (STEMI)

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

29. What should you teach your patient about an exercise ECG (stress test)?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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-
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

30. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
A nosebleed

31. What is cardioversion?

32. 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.
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.
Activity intolerance
(S1 - S2) Third left intercostal space

33. What should you teach someone with arterial insufficiency?

34. Where is the tricuspid valve landmark on the chest?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Lower left sternal border
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Second right intercostal space

35. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Idiopathic

36. What is defibrillation?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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.
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.
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.

37. What is Deep Vein Thrombosis (DVT)?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.
One large emboli (smaller=better)

38. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
BP is elevated or decreased depending on activity.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

39. What is the treatment for someone in ventricular fibrillation?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

40. Where should you place your stethescope to find the aortic valve?
Include rest periods prior to any activity.
BP is elevated or decreased depending on activity.
Second Right intercostal space.
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

41. How should you palpate the apical pulse?
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.
0.5-2.0 ng/ml
NO because it isn't sterile so keep out.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

42. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Protamine Sulfate
Air embolism
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

43. What disease can cause right sided heart failure?
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.
Lung disease
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.
Second Right intercostal space.

44. What is the antidote for heparin?
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
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.
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
Protamine Sulfate

45. What is characteristic of complete heart block?
NO because it isn't sterile so keep out.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Close the open catheter lumen with the clamp - and place the pt on their left side in trendelenburg to move the air embolus away from the pulmonic valve. If you hear a churning sound in his chest (a classic sign of air embolus) and the patient starts

46. What should be done for someone on bleeding precautions?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
Include rest periods prior to any activity.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

47. What things should you do to assess cardiovascular status?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

48. What is more harmful a lot of little emboli or one large emboli?
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
D/C the med and call the doctor.
One large emboli (smaller=better)
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!

49. What should you go when applying nitroglycerin ointment for angina?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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

50. What are the nursing interventions for a pt. with ventricular tachycardia?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.