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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 are common risk factors for an MI?
NO because it isn't sterile so keep out.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

2. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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
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.)
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.

3. What are the nursing interventions for a pt. with ventricular tachycardia?
D/C the med and call the doctor.
BP is elevated or decreased depending on activity.
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

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

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5. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Old truck driver or someone on bed rest or with pelvic trauma.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

6. What would make someone more at risk for digoxin toxicity?
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.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

7. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Right sided heart failure
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

8. What is labile hypertension?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
Air embolism

9. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Lung disease
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Idiopathic

10. When would a nurse use an external femoral artery compression device?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.

11. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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
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.
(S1 - S2) Third left intercostal space

12. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
If feel more than 3 shocks in a row or develop signs of infection at the site.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

13. Where is the pulmonic valve landmark on the chest?
An enlarged space indicates fluid accumulation in the pericardial sac.
The patient may suffer significant blood loss or femoral nerve compression.
Second right intercostal space
Second left intercostal space

14. How long is contrast media in the body?
Only for a few hours
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
An enlarged space indicates fluid accumulation in the pericardial sac.
Poorly controlled hypertension

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

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16. What can result from left sided heart failure if left untreated?
Fat - Air - DVT - or Amniotic
The internal jugular veins (external are less reliable).
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
Pulmonary edema

17. What should you do if you are going to ventilate someone with an ambu bag?
One at a time to assess the pulse amplitude and contour.
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
ST segment elevation (STEMI)
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

18. What is pulsus paradoxus?
One at a time to assess the pulse amplitude and contour.
Second Right intercostal space.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Protamine Sulfate

19. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Second Left intercostal space
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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

20. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Nitrates - Beta blockers - and Calcium channel blockers
One large emboli (smaller=better)
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

21. What is characteristic of atrial fibrillation?
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
Vascular - artery disease causing fluid to back up into the lungs.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

22. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

23. What is a chemical stress test (persantine stress test)?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

24. What is epistaxis?
The internal jugular veins (external are less reliable).
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
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
A nosebleed

25. What is the treatments for hypertension?
Don't interfere!
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
The internal jugular veins (external are less reliable).

26. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
Old truck driver or someone on bed rest or with pelvic trauma.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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

27. 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.
Don't interfere!
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

28. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

29. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

30. What should you teach your patient about an exercise ECG (stress test)?
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.
Vitamin K (aqua myphiton)
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-
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. What are the nursing interventions for a patient in atrial fibrillation?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

32. What should you teach your patient about MRI?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
Lung disease
4th left intercostal space lower sternal border

33. What should you teach your patient about an abdominal ultrasonography?
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
In fatty areas or over major muscles - large breasts - or bony prominences.
Whether the patients ulnar and radial arteries are patent.

34. What should you watch for with PICC lines that have been in place for 6 months?
D/C the med and call the doctor.
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.
Air answers (open junctions)
4th left intercostal space lower sternal border

35. What does a swan ganz measure?
Nitrates - Beta blockers - and Calcium channel blockers
Right sided heart failure
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

36. What is important to remember when removing a CVC from a patient?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

37. How is the Allen's test done?
Air answers (open junctions)
Pneumothorax and will end up with chest tube to help reinflate lung.
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
Must be flushed 1x/month with heparin and between treatments.

38. What SE should you look for with calcium channel blocker use?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Idiopathic
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

39. Where is the tricuspid valve landmark on the chest?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
Lower left sternal border

40. Which type of patient shouldn't take nitrates?
Exercise and use graduated compression devices as directed - don't stand for long period of time - to avoid dislodging blood clots don't rub or massage your legs.
It is a 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
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

41. What do calcium channel blockers do?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
Open up blood vessels
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

42. Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Poorly controlled hypertension
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.
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

43. What are the S&S of cardiac tamponade?
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

44. What is INR?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

45. For which heart sounds should the bell be used?
Protamine Sulfate
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

46. What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
ST segment elevation (STEMI)
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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

47. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Fifth left intercostal space medial to the midclavicular line.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

48. What is intermittent claudication?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

49. What does an Allen's test determine?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Whether the patients ulnar and radial arteries are patent.

50. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Cannot
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Air embolism
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.