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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. Which type of patient shouldn't take nitrates?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Lung disease
Direct current cardioversion and digoxin/propranolol (inderal).

2. What should you observe for in someone on bleeding precautions?
One large emboli (smaller=better)
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).
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
Lowers BP and makes heart beat stronger. SE: flushed face.

3. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
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
Patient who are unable to tolerate exercise stress testing.
Iodine

4. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Patient who are unable to tolerate exercise stress testing.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
BP is elevated or decreased depending on activity.

5. What is important to remember when taking care of patients with compression devices?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
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

6. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
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.
Nitrates - Beta blockers - and Calcium channel blockers
ST segment elevation (STEMI)

7. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Nitrates - Beta blockers - and Calcium channel blockers
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

8. What is characteristic of ventricular tachycardia?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Maintain BED REST
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

9. 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?
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.
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

10. What is a assessment finding with DVT?

11. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
NO because it isn't sterile so keep out.
Maintain BED REST
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.

12. What are the nursing interventions for a patient in complete heart block?
NO because it isn't sterile so keep out.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

13. What should a patient do if they feel chest pain or discomfort?
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.
Lower left sternal border
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

14. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Air embolism
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

15. What disease can cause right sided heart failure?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Lung disease
A nosebleed
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.

16. Where is the aortic valve landmark on the chest?
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Second right intercostal space

17. What type of EKG change indicates MI?
Protamine Sulfate
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
ST segment elevation (STEMI)
Only for a few hours

18. Where is the pulmonic valve landmark on the chest?
Pneumothorax and will end up with chest tube to help reinflate lung.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Second left intercostal space

19. What is superior vena cava syndrome?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Steroid treatment or a pregnant woman who is retaining water.
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.
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.

20. What is characteristic of ventricular fibrillation?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Don't interfere!
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

21. During an Allen's test don't compress one artery _____ the other.
Before
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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

22. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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
Air embolism
Pulse before and after giving.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

23. What is intermittent claudication?
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.
Left sternal border
Feeling warm (fire) or tin can taste is expected and will pass.
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).

24. What landmarks should you be looking for on someone's chest?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

25. What can result from left sided heart failure if left untreated?
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.
Air answers (open junctions)
Pulmonary edema
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

26. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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.
Vitamin K (aqua myphiton)
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

27. What are the steps for infant 1&2 rescuer CPR?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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
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

28. What is labile hypertension?
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.
(S1 - S2) Third left intercostal space
BP is elevated or decreased depending on activity.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

29. What should you teach your patient about angiography (arteriography)?
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
Activity intolerance
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
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

30. What are signs and symptoms of an MI?
Lowers BP and makes heart beat stronger. SE: flushed face.
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

31. What are the S&S of air embolism?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.
Idiopathic

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

33. What are the nursing interventions for a patient in atrial fibrillation?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

34. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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

35. What is characteristic of complete heart block?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
(S1 - S2) Third left intercostal space
Fifth left intercostal space medial to the midclavicular line.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

36. What should be done immediately for someone with PE?
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
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Fifth left intercostal space medial to the midclavicular line.

37. What drugs are most commonly used for angina?
Lowers BP and makes heart beat stronger. SE: flushed face.
Iodine
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Nitrates - Beta blockers - and Calcium channel blockers

38. Where is the right ventricle landmark on the chest?
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
Left sternal border
Open up blood vessels
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

39. What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
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
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.
Fat - Air - DVT - or Amniotic

40. In what locations should you not place electrodes?
Pulse before and after giving.
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

41. What would make someone more at risk for digoxin toxicity?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.

42. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
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
The patient may suffer significant blood loss or femoral nerve compression.

43. How long is contrast media in the body?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
Only for a few hours
Fat - Air - DVT - or Amniotic

44. What is a nursing diagnosis for arterial occlusion? Tx
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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.

45. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.

46. What are common risk factors for an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Left sternal border

47. What should you tell someone about taking nitroglycerin tablets (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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Left sternal border

48. What is defibrillation?
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.
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.
Feeling warm (fire) or tin can taste is expected and will pass.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

49. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
0.5-2.0 ng/ml
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Maintain BED REST

50. 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!
Fat - Air - DVT - or Amniotic
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Open up blood vessels