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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 the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

2. Should the tubing for a venous access port be included under the dressing site?

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3. What should you teach your patient about MRI?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
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
Before

4. What is important to remember when taking care of patients with compression devices?
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.

5. What is more harmful a lot of little emboli or one large emboli?
Lower left sternal border
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
One large emboli (smaller=better)

6. A femoral artery compression device ______be assigned to an NA?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
An enlarged space indicates fluid accumulation in the pericardial sac.
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).
Cannot

7. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
4th left intercostal space lower sternal border
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

8. What should be done immediately if a pulmonary embolism is suspected?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

9. What does vasotec (Enalapril Maleate) do/SE?
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.
Don't interfere!
Lowers BP and makes heart beat stronger. SE: flushed face.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

10. What should be checked in a patient on a beta blocker?
Before
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
Pulse before and after giving.

11. What should you do immediately if you suspect someone of developing a hematoma?
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.

12. 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.
Right sided heart failure
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

13. What is Deep Vein Thrombosis (DVT)?
An enlarged space indicates fluid accumulation in the pericardial sac.
NO because it isn't sterile so keep out.
Patient who are unable to tolerate exercise stress testing.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

14. Where is the pulmonic valve landmark on the chest?
Pulmonary edema
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
Second left intercostal space

15. How is the Allen's test done?
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
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

16. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
An enlarged space indicates fluid accumulation in the pericardial sac.
Nitrates - Beta blockers - and Calcium channel blockers
If feel more than 3 shocks in a row or develop signs of infection at the site.
Whether the patients ulnar and radial arteries are patent.

17. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
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!
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.

18. What causes essential/primary hypertension?
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.
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.
Idiopathic

19. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
One large emboli (smaller=better)

20. What is a assessment finding with DVT?

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21. What are the steps for adult/child 1 rescuer CPR?
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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
Lower left sternal border

22. What is a major complication of central line placement?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Pneumothorax and will end up with chest tube to help reinflate lung.
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!

23. How does the blood flow through the heart? (valves?)
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!
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

24. What signals an elevated venous pressure based on the internal jugular veins?
Second left intercostal space
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Identify the highest point of pulsation and measure from this point to the sternal angle. A measurement of greater than 3 cm= an elevated venous pressure.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

25. What could happen without immediate intervention for a hematoma?
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
The patient may suffer significant blood loss or femoral nerve compression.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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

26. What does an Allen's test determine?
Vitamin K (aqua myphiton)
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Whether the patients ulnar and radial arteries are patent.
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

27. What is the goal of treatment for an MI? Treatment?
Second left intercostal space
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

28. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

29. Where is the aortic valve landmark on the chest?
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
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
Second right intercostal space
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

30. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Open up blood vessels
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
NO because it isn't sterile so keep out.

31. How should you palpate the apical pulse?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Second right intercostal space

32. What should you teach your patient about a holter monitor?

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33. What is characteristic of complete heart block?
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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

34. What is cardiac tamponade? Common causes?
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Second Right intercostal space.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

35. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
An enlarged space indicates fluid accumulation in the pericardial sac.

36. What are the S&S of pulmonary embolism?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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

37. What should you do when applying a femoral artery compression device?
Activity intolerance
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
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

38. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
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.

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.
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

40. What can result from left sided heart failure if left untreated?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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 is the treatment for atrial fibrillation?
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.
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).
Direct current cardioversion and digoxin/propranolol (inderal).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

42. For what disease should you do the Allen's test?

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43. Where should you place your stethescope to find the pulmonic valve?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
An inflammation of the pericardium. It may result in MI.
Second Left intercostal space

44. What should you tell someone about taking nitroglycerin tablets (SE)?
A nosebleed
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
The internal jugular veins (external are less reliable).

45. What are the two common complications of pericarditis?
Second right intercostal space
(S1 - S2) Third left intercostal space
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

46. What is the treatment for someone with right sided HF? How do you know working?
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Second Right intercostal space.

47. How do you prepare a patient for Impedance cardiography monitoring?
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.
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
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.
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

48. 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
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
An inflammation of the pericardium. It may result in MI.

49. What is an air embolism?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
In the first 72 hours!!!!!
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

50. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.