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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 teach your patient about a holter monitor?

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2. What are the signs and symptoms of left sided HF?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Iodine

3. What usually triggers angina pain?
In fatty areas or over major muscles - large breasts - or bony prominences.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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.

4. How long is contrast media in the body?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
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.
Only for a few hours

5. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
4th left intercostal space lower sternal border
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

6. What causes essential/primary hypertension?
Open up blood vessels
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
A nosebleed
Idiopathic

7. What is a major complication of central line placement?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Pneumothorax and will end up with chest tube to help reinflate lung.
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.

8. Where do the internal jugular veins lie?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.
Before
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

9. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
0.5-2.0 ng/ml
Vitamin K (aqua myphiton)
An inflammation of the pericardium. It may result in MI.

10. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Must be flushed 1x/month with heparin and between treatments.
The internal jugular veins (external are less reliable).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

11. What should you do if the PTT value is 80 for someone on heparin?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
ST segment elevation (STEMI)
D/C the med and call the doctor.

12. In what locations should you not place electrodes?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
Lower left sternal border
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

13. What is labile hypertension?
BP is elevated or decreased depending on activity.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

14. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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.
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
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.

15. 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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Before
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

16. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
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.
One at a time to assess the pulse amplitude and contour.
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

17. What is CVP? Normal?
An inflammation of the pericardium. It may result in MI.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Cannot
Second Left intercostal space

18. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
An inflammation of the pericardium. It may result in MI.
D/C the med and call the doctor.

19. What should you teach someone with arterial insufficiency?

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20. What signals an elevated venous pressure based on the internal jugular veins?
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.
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Pulse before and after giving.

21. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Lowers BP and makes heart beat stronger. SE: flushed face.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Second left intercostal space
Pulmonary edema

22. What would make someone more at risk for digoxin toxicity?
Pulse before and after giving.
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.
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.
Second Right intercostal space.

23. What should you go when applying nitroglycerin ointment for angina?
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
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.
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

24. What are the nursing interventions for a patient in atrial fibrillation?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Air answers (open junctions)
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

25. What is characteristic of atrial fibrillation?
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Only for a few hours
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

26. Where is the pulmonic valve landmark on the chest?
NO NSAIDS or ASA.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Second left intercostal space
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

27. A femoral artery compression device ______be assigned to an NA?
Poorly controlled hypertension
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.
Cannot
Must be flushed 1x/month with heparin and between treatments.

28. What should you tell someone about taking nitroglycerin tablets (SE)?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
To inhibit thrombus and clot formation.

29. What should be checked in a patient on a beta blocker?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Chronic arteriosclerotic disease.
Pulse before and after giving.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

30. What nursing interventions are associated with a pt. experiencing ventricular 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.
Activity intolerance
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

31. What are the S&S associated with right sided heart failure?
Right sided heart failure
Protamine Sulfate
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

32. What should you explain to the patient about an impedance cardiography test?
Air embolism
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.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

33. What should be done for someone on bleeding precautions?
No radial artery punctures if negative
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Right sided heart failure

34. What is important to remember when taking care of patients with compression devices?
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Pneumothorax and will end up with chest tube to help reinflate lung.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

35. What causes secondary hypertension?
Nitrates - Beta blockers - and Calcium channel blockers
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Steroid treatment or a pregnant woman who is retaining water.
Pulmonary edema

36. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

37. What is a chemical stress test (persantine stress test)?
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
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-
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
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

38. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Vascular - artery disease causing fluid to back up into the lungs.
BP is elevated or decreased depending on activity.
An enlarged space indicates fluid accumulation in the pericardial sac.

39. What should you remember while taking care of someone with a peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

40. What are the S&S of air embolism?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Iodine

41. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
If feel more than 3 shocks in a row or develop signs of infection at the site.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

42. What is the treatment for atrial fibrillation?
In fatty areas or over major muscles - large breasts - or bony prominences.
Second left intercostal space
Direct current cardioversion and digoxin/propranolol (inderal).
Iodine

43. What is the antidote for heparin?
The internal jugular veins (external are less reliable).
Protamine Sulfate
Second right intercostal space
4th left intercostal space lower sternal border

44. What should you teach your patient about an exercise ECG (stress test)?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Whether the patients ulnar and radial arteries are patent.
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-

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

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46. What are the S&S of pulmonary embolism?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

47. What should you not allow if a patient has a negative Allen's test?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Don't interfere!
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
No radial artery punctures if negative

48. What should you teach your patient about angiography (arteriography)?
Include rest periods prior to any activity.
In fatty areas or over major muscles - large breasts - or bony prominences.
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
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

49. For which heart sounds should the bell be used?
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.
(S1 - S2) Third left intercostal space
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Fat - Air - DVT - or Amniotic

50. What is a transthoracic echocardiograph (TTE)?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Pulse before and after giving.