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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 is an air embolism?
A nosebleed
Lung disease
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

2. What are the four types of pulmonary emboli?
Second Right intercostal space.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Fat - Air - DVT - or Amniotic
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 is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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).
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.
Poorly controlled hypertension

4. How is angina treated?

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5. How long is contrast media in the body?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Only for a few hours
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

6. What are common risk factors for an MI?
Iodine
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Lung disease
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

7. What should be done for someone on bleeding precautions?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
(S1 - S2) Third left intercostal space
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 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.
A nosebleed
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
Second Right intercostal space.

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?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

10. In what locations should you not place electrodes?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
In fatty areas or over major muscles - large breasts - or bony prominences.

11. What needs to be held during the placement of a femoral artery compression device?
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
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-
NO NSAIDS or ASA.
One large emboli (smaller=better)

12. What is CVP? Normal?
Nitrates - Beta blockers - and Calcium channel blockers
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.
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.

13. What are the S&S associated with right sided heart failure?
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

14. What should you do if the PTT value is 80 for someone on heparin?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
D/C the med and call the doctor.
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.

15. What should you teach your patient about an electrocardiogram (ECG)?
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
The patient may suffer significant blood loss or femoral nerve compression.
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

16. What is INR?
D/C the med and call the doctor.
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Protamine Sulfate

17. What causes essential/primary hypertension?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Idiopathic
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

18. What is the maintenance for venous access port that isn't being regularly used?
Cannot
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Must be flushed 1x/month with heparin and between treatments.
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.

19. What should you do if the PT value is 45 sec?
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
Protamine Sulfate
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
D/C the med and call the doctor.

20. What are the treatments/ S&S of peripheral venous disease?
Only for a few hours
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

21. A femoral artery compression device ______be assigned to an NA?
Cannot
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
Lower left sternal border

22. What is characteristic of ventricular fibrillation?
Idiopathic
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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

23. What is pericarditis?
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.
An inflammation of the pericardium. It may result in MI.
Whether the patients ulnar and radial arteries are patent.
Left sternal border

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

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25. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Maintain BED REST
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.
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.
Don't interfere!

26. What will a leg with arterial insufficiency look like?
0.5-2.0 ng/ml
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.
Vascular - artery disease causing fluid to back up into the lungs.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

27. What is epistaxis?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
A nosebleed

28. What is the nursing care associated with chemical stress tests (persantine stress test)?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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 nosebleed
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.

29. What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Air answers (open junctions)
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

30. How does the blood flow through the heart? (valves?)
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
ST segment elevation (STEMI)
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!
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.

31. What is characteristic of premature ventricular contractions?
No radial artery punctures if negative
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).
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.
Patient who are unable to tolerate exercise stress testing.

32. What makes the symptoms of superior vena cava syndrome better? Worse?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.)
Protamine Sulfate

33. What is impedance cardiography?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

34. What should you teach your patient about MRI?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.)
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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

35. 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).
NO NSAIDS or ASA.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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).

36. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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).
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.
Right sided heart failure
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

37. What should you remember while taking care of someone with a peripheral arterial occlusion?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

38. What is characteristic of atrial fibrillation?
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

39. What should you teach your patient about angiography (arteriography)?
Air embolism
Activity intolerance
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.
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

40. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Lung disease
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
In fatty areas or over major muscles - large breasts - or bony prominences.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

41. What are the S&S of cardiac tamponade?
D/C the med and call the doctor.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Don't interfere!

42. What is labile hypertension?
BP is elevated or decreased depending on activity.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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
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.

43. What can result from left sided heart failure if left untreated?
One large emboli (smaller=better)
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Pulmonary edema
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

44. What is an acute peripheral arterial occlusion?
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

45. What is characteristic of complete heart block?
Lung disease
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.
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

46. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.)
Fourth or fifth intercostal space at or medial to the midclavicular line.
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

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

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48. Who would most likely have peripheral venous disease?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
Old truck driver or someone on bed rest or with pelvic trauma.
Iodine

49. What SE should you look for with calcium channel blocker use?
Lower left sternal border
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-
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

50. What should you explain to the patient about an impedance cardiography test?
Patient who are unable to tolerate exercise stress testing.
Lowers BP and makes heart beat stronger. SE: flushed face.
Left sternal border
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.