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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 could happen without immediate intervention for a hematoma?
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.
The patient may suffer significant blood loss or femoral nerve compression.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

2. What is the correct way to insert an oropharyngeal airway?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Poorly controlled hypertension
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
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

3. What should you teach your patient about an exercise ECG (stress test)?
Air answers (open junctions)
To inhibit thrombus and clot formation.
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
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-

4. What will a leg with arterial insufficiency look like?
Fifth left intercostal space medial to the midclavicular line.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

5. 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).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

6. What should be done for someone on bleeding precautions?
Air embolism
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Cannot

7. What SE should you look for with calcium channel blocker use?
In fatty areas or over major muscles - large breasts - or bony prominences.
NO NSAIDS or ASA.
Second left intercostal space
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

8. What needs to be held during the placement of a femoral artery compression device?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
NO NSAIDS or ASA.
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
D/C the med and call the doctor.

9. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
(S1 - S2) Third left intercostal space

10. What is impedance cardiography?
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.

11. What should you observe for in someone on bleeding precautions?
Second right intercostal space
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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).

12. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Activity intolerance
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

13. What can result from left sided heart failure if left untreated?
Pulmonary edema
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

14. What is angina? Stable vs. unstable?

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15. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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.
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.
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

16. What are the two common complications of pericarditis?
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

17. Where should you place your stethescope to find the tricuspid valve?
Lowers BP and makes heart beat stronger. SE: flushed face.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
4th left intercostal space lower sternal border
BP is elevated or decreased depending on activity.

18. What are the nursing interventions for a patient in complete heart block?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Patient who are unable to tolerate exercise stress testing.

19. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
D/C the med and call the doctor.
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.
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

20. What is the goal of treatment for an MI? Treatment?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

21. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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.
The internal jugular veins (external are less reliable).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

22. What is labile hypertension?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
BP is elevated or decreased depending on activity.

23. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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 the client for signs of decreased cardiac output and Notify the physician (2nd).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

24. What is a good diagnosis for someone with right sided HF?
Activity intolerance
A nosebleed
The patient may suffer significant blood loss or femoral nerve compression.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

25. Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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

26. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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
NO NSAIDS or ASA.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

27. How long is contrast media in the body?
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Only for a few hours
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

28. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

29. Which type of patient shouldn't take nitrates?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.

30. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
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.

31. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
Iodine
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.
One at a time to assess the pulse amplitude and contour.

32. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
No radial artery punctures if negative

33. What is the treatment for atrial fibrillation?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
The patient may suffer significant blood loss or femoral nerve compression.
Direct current cardioversion and digoxin/propranolol (inderal).
Maintain BED REST

34. What is the antidote for heparin?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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
Protamine Sulfate
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

35. Where do the internal jugular veins lie?
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.)
0.5-2.0 ng/ml
Air embolism
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

36. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Pulse before and after giving.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.

37. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
Check for response - activate ERS - open airway head tilt chin lift - check breathing (5-10 sec) - give 2 breaths (1 sec) with visible chest rise - checks brachial pulse (5-10 sec) - locates CPR finger position - deliver 1st cycle of compressions (30
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
4th left intercostal space lower sternal border

38. When should bleeding precautions be implemented?
The internal jugular veins (external are less reliable).
D/C the med and call the doctor.
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

39. What are the indications for a chemical stress test (persantine stress test)?
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Patient who are unable to tolerate exercise stress testing.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

40. What is the purpose of compression devices?
4th left intercostal space lower sternal border
Air embolism
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Must be flushed 1x/month with heparin and between treatments.

41. What are the steps for infant 1&2 rescuer CPR?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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
Check for response - activate ERS - open airway head tilt chin lift - check breathing (5-10 sec) - give 2 breaths (1 sec) with visible chest rise - checks brachial pulse (5-10 sec) - locates CPR finger position - deliver 1st cycle of compressions (30
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

42. What should you watch for with PICC lines that have been in place for 6 months?
Pneumothorax and will end up with chest tube to help reinflate lung.
Old truck driver or someone on bed rest or with pelvic trauma.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Air answers (open junctions)

43. What are the proper steps to changing a central venous catheter dressing?
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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!

44. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
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
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.
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

45. What is an aortic dissection?

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46. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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

47. What should you teach someone with arterial insufficiency?

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48. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Activity intolerance
Before
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

49. What is the treatment for myocardial infarction?
NO NSAIDS or ASA.
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

50. 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?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Only for a few hours
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)