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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. Test ending in Gram=?
NO because it isn't sterile so keep out.
Iodine
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

2. What is the correct way to insert an oropharyngeal airway?
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
Left sternal border
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

3. What is the treatment for myocardial infarction?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Cannot
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

4. 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.
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.

5. What is the hallmark clinical finding associated with pericarditis?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Vascular - artery disease causing fluid to back up into the lungs.
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.

6. What is a good diagnosis for someone with right sided HF?
Activity intolerance
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
Air answers (open junctions)
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

7. What is Deep Vein Thrombosis (DVT)?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Include rest periods prior to any activity.

8. During an Allen's test don't compress one artery _____ the other.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
NO NSAIDS or ASA.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Before

9. What would make someone more at risk for digoxin toxicity?
NO because it isn't sterile so keep out.
Protamine Sulfate
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

10. What is the antidote for heparin?
Protamine Sulfate
One at a time to assess the pulse amplitude and contour.
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

11. What should be immediately done for a patient experiencing digoxin toxicity?
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Second Left intercostal space

12. What are coumadin and heparin used for?
NO NSAIDS or ASA.
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
To inhibit thrombus and clot formation.
D/C the med and call the doctor.

13. For which heart sounds should the diaphragm be used?
Pulse before and after giving.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
0.5-2.0 ng/ml

14. 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.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
If feel more than 3 shocks in a row or develop signs of infection at the site.

15. 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).
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.
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.

16. What type of EKG change indicates MI?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
ST segment elevation (STEMI)
Vitamin K (aqua myphiton)
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

17. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

18. What are the steps for adult/child 1 rescuer CPR?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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
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

19. What should be checked in a patient on a beta blocker?
Lower left sternal border
Pulse before and after giving.
0.5-2.0 ng/ml
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

20. 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!
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Only for a few hours

21. How does the blood flow through the heart? (valves?)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
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
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!

22. Where should you place your stethescope to find the aortic valve?
Second Right intercostal space.
Before
Chronic arteriosclerotic disease.
Include rest periods prior to any activity.

23. What does an Allen's test determine?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Protamine Sulfate
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Whether the patients ulnar and radial arteries are patent.

24. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.

25. What should be done immediately for someone with PE?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
No radial artery punctures if negative
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.
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.

26. What should you do when applying a femoral artery compression device?
In the first 72 hours!!!!!
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
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
(S1 - S2) Third left intercostal space

27. What should you do if you are going to ventilate someone with an ambu bag?
Second Left intercostal space
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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

28. What are the nursing interventions for a patient in atrial fibrillation?
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).
D/C the med and call the doctor.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

29. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.

30. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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
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.
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
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.

31. Where is the right ventricle landmark on the chest?
Left sternal border
The patient may suffer significant blood loss or femoral nerve compression.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

32. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Second left intercostal space
The internal jugular veins (external are less reliable).
Second Left intercostal space

33. What is Raynauds disease? Tx?
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.
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.
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
Patient who are unable to tolerate exercise stress testing.

34. What is the treatment for someone with right sided HF? How do you know working?
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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!!!!!

35. What is defibrillation?
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.
Right sided heart failure
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
One at a time to assess the pulse amplitude and contour.

36. What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Patient who are unable to tolerate exercise stress testing.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

37. What are the treatments/ S&S of peripheral venous 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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
One large emboli (smaller=better)
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

38. 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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

39. In What time period is the greatest risk of sudden death from an MI?
NO NSAIDS or ASA.
In the first 72 hours!!!!!
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

40. What is superior vena cava syndrome?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.

41. What should you teach someone with arterial insufficiency?

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42. What is an air embolism?
Direct current cardioversion and digoxin/propranolol (inderal).
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

43. What should you teach your patient about an exercise ECG (stress test)?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.
Feeling warm (fire) or tin can taste is expected and will pass.
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-

44. What are the nursing interventions for a patient in complete heart block?
An inflammation of the pericardium. It may result in MI.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.

45. In what locations should you not place electrodes?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
No radial artery punctures if negative
In fatty areas or over major muscles - large breasts - or bony prominences.
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

46. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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.
Fifth left intercostal space medial to the midclavicular line.
Air embolism
(S1 - S2) Third left intercostal space

47. What is angina? Stable vs. unstable?

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48. When should bleeding precautions be implemented?
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.
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

49. What is an aortic dissection?

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50. What needs to be held during the placement of a femoral artery compression device?
Air answers (open junctions)
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
NO NSAIDS or ASA.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.