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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 cardioversion?

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2. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
0.5-2.0 ng/ml
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.
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.
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

3. What are the two common complications of pericarditis?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.

4. What is a nursing diagnosis for arterial occlusion? Tx
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

5. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

6. What should you do if you are going to ventilate someone with an ambu bag?
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.
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.)
Vitamin K (aqua myphiton)
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

7. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
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.
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.
Patient who are unable to tolerate exercise stress testing.

8. What do calcium channel blockers do?
Iodine
Open up blood vessels
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

9. If a victim is choking but can cough - speak - or breath what should you do?

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10. What is Raynauds disease? Tx?
An enlarged space indicates fluid accumulation in the pericardial sac.
Include rest periods prior to any activity.
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

11. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

12. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
Lung disease

13. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Feeling warm (fire) or tin can taste is expected and will pass.
Nitrates - Beta blockers - and Calcium channel blockers
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

14. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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.
Pulse before and after giving.

15. How should you palpate the apical pulse?
Left sternal border
Second Left intercostal space
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Fourth or fifth intercostal space at or medial to the midclavicular line.

16. What is the treatment for myocardial infarction?
Fat - Air - DVT - or Amniotic
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
A nosebleed
D/C the med and call the doctor.

17. 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
Nitrates - Beta blockers - and Calcium channel blockers
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.

18. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
The internal jugular veins (external are less reliable).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Fifth left intercostal space medial to the midclavicular line.

19. What places someone at risk for an aortic dissection?
An inflammation of the pericardium. It may result in MI.
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
(S1 - S2) Third left intercostal space
Poorly controlled hypertension

20. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
Steroid treatment or a pregnant woman who is retaining water.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

21. What is INR?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

22. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
One at a time to assess the pulse amplitude and contour.
NO NSAIDS or ASA.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

23. Where should you place your stethescope to find the aortic valve?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Second Right intercostal space.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

24. What are the 2 types of pacemakers?
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.
Before
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.

25. What type of surgery is done for an aortic dissection?
NO NSAIDS or ASA.
Lower left sternal border
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

26. Where should you place your stethescope to find the pulmonic valve?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Second Left intercostal space
Left sternal border
Whether the patients ulnar and radial arteries are patent.

27. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
A nosebleed
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
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.

28. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
No radial artery punctures if negative
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

29. What can result from left sided heart failure if left untreated?
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
Don't interfere!
Pulmonary edema
One large emboli (smaller=better)

30. 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?
Cannot
Before
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

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

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32. What is the treatment for premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

33. What type of EKG change indicates MI?
An enlarged space indicates fluid accumulation in the pericardial sac.
Steroid treatment or a pregnant woman who is retaining water.
ST segment elevation (STEMI)
One at a time to assess the pulse amplitude and contour.

34. What is a assessment finding with DVT?

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35. Where is the tricuspid valve landmark on the chest?
0.5-2.0 ng/ml
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Lower left sternal border
Activity intolerance

36. In What time period is the greatest risk of sudden death from an MI?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
In the first 72 hours!!!!!
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

37. How is the Allen's test done?
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
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
D/C the med and call the doctor.
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

38. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
NO because it isn't sterile so keep out.

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.
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
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
An enlarged space indicates fluid accumulation in the pericardial sac.

40. Where is the pulmonic valve landmark on the chest?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Second left intercostal space
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.
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.

41. What should you remember while taking care of someone with a peripheral arterial occlusion?
Second Left intercostal space
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.
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

42. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

43. What is the antidote for heparin?
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
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
Protamine Sulfate
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

44. What is the antidote for coumadin?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
4th left intercostal space lower sternal border
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Vitamin K (aqua myphiton)

45. What should you teach your patient about an abdominal ultrasonography?
In the first 72 hours!!!!!
NO because it isn't sterile so keep out.
Lowers BP and makes heart beat stronger. SE: flushed face.
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

46. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare 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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

47. What is a transthoracic echocardiograph (TTE)?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

48. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the
Rescuer arrives with AED - turn AED on - select proper pads and apply - clear victim to analyze - clear victim to shock/press shock - resume chest compressions after 1 shock - delivers cycle of compressions at correct rate - pause to allow other resc
(S1 - S2) Third left intercostal space

49. What landmarks should you be looking for on someone's chest?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

50. How does the blood flow through the heart? (valves?)
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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!
The internal jugular veins (external are less reliable).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.