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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What should you tell someone about taking nitroglycerin tablets (SE)?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular 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

2. What should you teach your patient about MRI?
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
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.
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
Don't interfere!

3. What are the S&S of pulmonary embolism?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Lung disease
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

4. What should you teach your patient about a cardiac catheterization?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
The physician injects a local anesthetic into the site - inserts a catheter - and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next - a dye is injected which may cause
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
No radial artery punctures if negative

5. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
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
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

6. What is a assessment finding with DVT?

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7. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Only for a few hours
Second left intercostal space

8. 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).
Iodine
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

9. What could happen without immediate intervention for a hematoma?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Poorly controlled hypertension
The patient may suffer significant blood loss or femoral nerve compression.
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

10. What signals an elevated venous pressure based on the internal jugular veins?
Only for a few hours
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Include rest periods prior to any activity.

11. What are the S&S of air embolism?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Only for a few hours
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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!

12. What are the steps for adult 2 rescuer CPR?
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
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.)
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
Vascular - artery disease causing fluid to back up into the lungs.

13. A femoral artery compression device ______be assigned to an NA?
Cannot
Only for a few hours
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).
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

14. What should you do to treat pulmonary edema?
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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
Before

15. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at
NO NSAIDS or ASA.

16. What should you do if the PTT value is 80 for someone on heparin?
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
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
D/C the med and call the doctor.

17. In what locations should you not place electrodes?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
If feel more than 3 shocks in a row or develop signs of infection at the site.
The patient may suffer significant blood loss or femoral nerve compression.
In fatty areas or over major muscles - large breasts - or bony prominences.

18. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Activity intolerance
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).

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

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20. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
Air embolism
Vitamin K (aqua myphiton)
Before

21. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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
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.
Lower left sternal border
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

22. In What time period is the greatest risk of sudden death from an MI?
Second Left intercostal space
In the first 72 hours!!!!!
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

23. What is the hallmark clinical finding associated with pericarditis?
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

24. What is a good diagnosis for someone with right sided HF?
Don't interfere!
Activity intolerance
Second left intercostal space
Poorly controlled hypertension

25. What should happen if someone converts to asystole/flatline?
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

26. What is the treatment for atrial fibrillation?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Don a protective gown - gloves - and goggles - call Dr - hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration - have another nurse firmly press on his nose just below bony part (apply pressure at
Direct current cardioversion and digoxin/propranolol (inderal).

27. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Air embolism

28. For which heart sounds should the bell be used?
Right sided heart failure
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

29. What should you teach someone with arterial insufficiency?

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30. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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.
Activity intolerance
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

31. What is the maintenance for venous access port that isn't being regularly used?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Must be flushed 1x/month with heparin and between treatments.
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
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

32. What is the antidote for coumadin?
Whether the patients ulnar and radial arteries are patent.
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.
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.
Vitamin K (aqua myphiton)

33. Where should you place your stethescope to find the mitral (apex) valve?
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
One large emboli (smaller=better)
No radial artery punctures if negative
Fifth left intercostal space medial to the midclavicular line.

34. How should you palpate the apical pulse?
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.
Air answers (open junctions)
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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

35. What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.

36. Which type of patient shouldn't take nitrates?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.

37. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Only for a few hours
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

38. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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
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.

39. What are all the S&S of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
One at a time to assess the pulse amplitude and contour.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

40. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
0.5-2.0 ng/ml
Pulmonary edema
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.

41. What should you teach your patient about angiography (arteriography)?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.

42. What should you watch for with PICC lines that have been in place for 6 months?
An inflammation of the pericardium. It may result in MI.
Air answers (open junctions)
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
4th left intercostal space lower sternal border

43. What should you teach someone after they have had a pacemaker placed?

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44. What do calcium channel blockers do?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Open up blood vessels

45. What is labile hypertension?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
BP is elevated or decreased depending on activity.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

46. What are the steps for adult/child 1 rescuer CPR?
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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
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

47. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Second right intercostal space
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

48. What SE should you look for with calcium channel blocker use?
Direct current cardioversion and digoxin/propranolol (inderal).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

49. What disease can cause right sided heart failure?
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
Lung disease
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

50. What should you do if you are going to ventilate someone with an ambu bag?
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.
Second right intercostal space
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.