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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 be done for someone on bleeding precautions?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
The patient may suffer significant blood loss or femoral nerve compression.

2. What are signs and symptoms of an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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

3. What are the S&S of aortic dissection?
Feeling warm (fire) or tin can taste is expected and will pass.
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

4. What is the goal of treatment for an MI? Treatment?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

5. What causes essential/primary hypertension?
Idiopathic
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
(S1 - S2) Third left intercostal space

6. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
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.
Right sided heart failure
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

7. What should you watch for with PICC lines that have been in place for 6 months?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Include rest periods prior to any activity.
Air answers (open junctions)

8. How long is contrast media in the body?
The patient may suffer significant blood loss or femoral nerve compression.
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Only for a few hours

9. What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

10. What is the antidote for heparin?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Protamine Sulfate

11. What causes secondary hypertension?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Steroid treatment or a pregnant woman who is retaining water.

12. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
Right sided heart failure
Second right intercostal space

13. What do calcium channel blockers do?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Open up blood vessels
If feel more than 3 shocks in a row or develop signs of infection at the site.
Include rest periods prior to any activity.

14. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Vitamin K (aqua myphiton)
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

15. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
Only for a few hours
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

16. 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.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
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.)

17. What is INR?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Fat - Air - DVT - or Amniotic
Lung disease

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

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19. During an Allen's test don't compress one artery _____ the other.
Patient who are unable to tolerate exercise stress testing.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Before

20. For which heart sounds should the bell be used?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

21. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

22. What are the four types of pulmonary emboli?
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.
Idiopathic
NO because it isn't sterile so keep out.
Fat - Air - DVT - or Amniotic

23. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Second Left intercostal space

24. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
An inflammation of the pericardium. It may result in MI.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.

25. Where should you place your stethescope to find the pulmonic valve?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Second Left intercostal space

26. What places someone at risk for an aortic dissection?
Must be flushed 1x/month with heparin and between treatments.
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
Poorly controlled hypertension
Before

27. 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.
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.
Poorly controlled hypertension
Second Right intercostal space.

28. What should you teach someone with arterial insufficiency?

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29. What should you not allow if a patient has a negative Allen's test?
Right sided heart failure
To inhibit thrombus and clot formation.
No radial artery punctures if negative
Pneumothorax and will end up with chest tube to help reinflate lung.

30. How should you palpate the apical pulse?
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

31. What should you teach your patient about MRI?
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
Lung disease
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

32. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Must be flushed 1x/month with heparin and between treatments.

33. What is important to remember when taking care of patients with compression devices?
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.)
D/C the med and call the doctor.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

34. What is the treatment for atrial fibrillation?
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
Include rest periods prior to any activity.
D/C the med and call the doctor.
Direct current cardioversion and digoxin/propranolol (inderal).

35. What is pericarditis?
If feel more than 3 shocks in a row or develop signs of infection at the site.
NO because it isn't sterile so keep out.
An inflammation of the pericardium. It may result in MI.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

36. What things should you do to assess cardiovascular status?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

37. What should you teach someone about iodine?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Feeling warm (fire) or tin can taste is expected and will pass.
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

38. What should you tell someone about taking nitroglycerin tablets (SE)?
They may feel a slight stinging under there tongue when they are dissolving - and they should get a HA (if no HA may not be good bc the pills only last for 6 months). Keep with you at all times.
Activity intolerance
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.

39. What is an acute peripheral arterial occlusion?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Pulmonary edema
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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

40. What is a good diagnosis for someone with right sided HF?
BP is elevated or decreased depending on activity.
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.
Activity intolerance
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

41. What is the correct way to insert an oropharyngeal airway?
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
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
Whether the patients ulnar and radial arteries are patent.
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the

42. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Right sided heart failure
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
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.
To inhibit thrombus and clot formation.

43. What should you do to treat pulmonary edema?
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
In the first 72 hours!!!!!
NO NSAIDS or ASA.
BP is elevated or decreased depending on activity.

44. What is a assessment finding with DVT?

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45. What type of EKG change indicates MI?
ST segment elevation (STEMI)
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.
Left sternal border
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

46. What signals an elevated venous pressure based on the internal jugular veins?
Second Right intercostal space.
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.
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

47. How do you prepare a patient for Impedance cardiography monitoring?
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.
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.

48. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
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

49. What is characteristic of ventricular fibrillation?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
In the first 72 hours!!!!!
An enlarged space indicates fluid accumulation in the pericardial sac.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

50. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Pulmonary edema
Patient who are unable to tolerate exercise stress testing.