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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 would make someone more at risk for digoxin toxicity?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

2. What should you go when applying nitroglycerin ointment for angina?
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
D/C the med and call the doctor.
ST segment elevation (STEMI)
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

3. What should you do if the PTT value is 80 for someone on heparin?
To inhibit thrombus and clot formation.
File toe nails - if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
D/C the med and call the doctor.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

4. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Fat - Air - DVT - or Amniotic
An enlarged space indicates fluid accumulation in the pericardial sac.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

5. What makes the symptoms of superior vena cava syndrome better? Worse?
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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

6. What is Deep Vein Thrombosis (DVT)?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Vascular - artery disease causing fluid to back up into the lungs.

7. 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!
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.
Only for a few hours
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

8. What should be done immediately for someone with PE?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.

9. What is important to remember when removing a CVC from a patient?
The patient may suffer significant blood loss or femoral nerve compression.
Steroid treatment or a pregnant woman who is retaining water.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.

10. What is pulsus paradoxus?
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 drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Before
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

11. How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
An enlarged space indicates fluid accumulation in the pericardial sac.

12. What are the steps for infant 1&2 rescuer CPR?
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
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!
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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

13. Where should you place your stethescope to find the mitral (apex) valve?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Patient who are unable to tolerate exercise stress testing.
Fifth left intercostal space medial to the midclavicular line.
Steroid treatment or a pregnant woman who is retaining water.

14. What are signs and symptoms of an MI?
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits - leans forward - and breaths out.

15. What body systems are affected by digoxin toxicity? S&S?
An inflammation of the pericardium. It may result in MI.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
BP is elevated or decreased depending on activity.

16. What disease can cause right sided heart failure?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Pulse before and after giving.
Lung disease

17. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
The patient may suffer significant blood loss or femoral nerve compression.
Cannot

18. How does the blood flow through the heart? (valves?)
D/C the med and call the doctor.
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!
Old truck driver or someone on bed rest or with pelvic trauma.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

19. What is angina? Stable vs. unstable?

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20. What is impedance cardiography?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

21. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

22. What should be immediately done for a patient experiencing digoxin toxicity?
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
It is a noninvasive test that takes 15 mins. Electrodes are applied to sites on your body. You must lie still - relax - and breathe normally and remain quiet. Talking or moving distorts the images
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.

23. What is an aortic dissection?

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24. What should you teach your patient about an electrocardiogram (ECG)?
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.
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!
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
It is a noninvasive test that takes 15 mins. Electrodes are applied to sites on your body. You must lie still - relax - and breathe normally and remain quiet. Talking or moving distorts the images

25. Where is the aortic valve landmark on the chest?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Second right intercostal space
Pneumothorax and will end up with chest tube to help reinflate lung.

26. What are the steps for adult/child 1 rescuer CPR?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
NO because it isn't sterile so keep out.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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

27. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Include rest periods prior to any activity.
Direct current cardioversion and digoxin/propranolol (inderal).

28. When would a nurse use an external femoral artery compression device?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Vitamin K (aqua myphiton)

29. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Air embolism
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

30. What is the treatment for a patient in complete heart block?
Nitrates - Beta blockers - and Calcium channel blockers
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

31. How is angina treated?

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32. How long is contrast media in the body?
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 because it isn't sterile so keep out.
Only for a few hours
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

33. How should you palpate the apical pulse?
Vascular - artery disease causing fluid to back up into the lungs.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Lower left sternal border

34. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

35. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
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

36. What is intermittent claudication?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
Feeling warm (fire) or tin can taste is expected and will pass.
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.

37. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.
ST segment elevation (STEMI)

38. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Maintain BED REST
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.

39. What should happen if someone converts to asystole/flatline?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

40. What is the treatment for someone with right sided HF? How do you know working?
Include rest periods prior to any activity.
An inflammation of the pericardium. It may result in MI.
Idiopathic
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

41. What does a swan ganz measure?
Maintain BED REST
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.

42. During an Allen's test don't compress one artery _____ the other.
Before
Vitamin K (aqua myphiton)
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
Right sided heart failure

43. In what locations should you not place electrodes?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Second left intercostal space
In fatty areas or over major muscles - large breasts - or bony prominences.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

44. What are common risk factors for an MI?
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-
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
The internal jugular veins (external are less reliable).
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

45. What are the treatments/ S&S of peripheral venous disease?
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.
Vitamin K (aqua myphiton)
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.

46. What does vasotec (Enalapril Maleate) do/SE?
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.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
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.

47. What should you do when applying a femoral artery compression device?
Protamine Sulfate
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
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.

48. What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
In the first 72 hours!!!!!
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

49. What lab value is used to evaluate a patient on coumadin? What is the normal value?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
Only for a few hours
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

50. What is characteristic of premature ventricular contractions?
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.
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.
One large emboli (smaller=better)
Fourth or fifth intercostal space at or medial to the midclavicular line.