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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 do to treat pulmonary edema?
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
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Air answers (open junctions)

2. Where do the internal jugular veins lie?
One large emboli (smaller=better)
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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

3. What are the nursing interventions for a patient in atrial fibrillation?
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

4. What are the treatments/ S&S of peripheral venous disease?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

5. What is labile hypertension?
Patient who are unable to tolerate exercise stress testing.
BP is elevated or decreased depending on activity.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
An enlarged space indicates fluid accumulation in the pericardial sac.

6. What should be done for someone on bleeding precautions?
Maintain BED REST
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

7. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Patient who are unable to tolerate exercise stress testing.

8. What is the antidote for coumadin?
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
Air embolism
Vitamin K (aqua myphiton)
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

9. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
Lowers BP and makes heart beat stronger. SE: flushed face.
Don't interfere!
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

10. When would a nurse use an external femoral artery compression device?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
In fatty areas or over major muscles - large breasts - or bony prominences.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Maintain BED REST

11. What is cardioversion?

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

13. What are the S&S associated with right sided heart failure?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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

14. What is characteristic of ventricular tachycardia?
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

15. How is angina treated?

16. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
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.
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Iodine

17. What is defibrillation?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Old truck driver or someone on bed rest or with pelvic trauma.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.

18. What are the S&S of cardiac tamponade?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
The patient may suffer significant blood loss or femoral nerve compression.
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

19. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
Old truck driver or someone on bed rest or with pelvic trauma.

20. What is the treatments for hypertension?
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.
Second right intercostal space
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.
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.

21. What is characteristic of premature ventricular contractions?
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.
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.)
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.

22. What is a major complication of central line placement?
Fifth left intercostal space medial to the midclavicular line.
One at a time to assess the pulse amplitude and contour.
Pneumothorax and will end up with chest tube to help reinflate lung.
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

23. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

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

25. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Maintain BED REST
Second Left intercostal space
Include rest periods prior to any activity.
Left sternal border

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

27. What should you not allow if a patient has a negative Allen's test?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Direct current cardioversion and digoxin/propranolol (inderal).
No radial artery punctures if negative
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

28. What can result from left sided heart failure if left untreated?
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.
NO NSAIDS or ASA.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Pulmonary edema

29. What are the nursing interventions for a pt. with ventricular tachycardia?
Patient who are unable to tolerate exercise stress testing.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Activity intolerance

30. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
To inhibit thrombus and clot formation.

31. What would make someone more at risk for digoxin toxicity?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
To inhibit thrombus and clot formation.

32. What should you teach your patient about an exercise ECG (stress test)?
An enlarged space indicates fluid accumulation in the pericardial sac.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Lung disease
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-

33. What is important to remember when removing a CVC from a patient?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.

34. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Cannot
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the
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

35. What type of surgery is done for an aortic dissection?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
An inflammation of the pericardium. It may result in MI.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

36. What should be immediately done for a patient experiencing digoxin toxicity?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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

37. Where should you place your stethescope to find the mitral (apex) valve?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Fifth left intercostal space medial to the midclavicular line.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.

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

39. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
A nosebleed

40. What is the treatment for myocardial infarction?
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
In fatty areas or over major muscles - large breasts - or bony prominences.

41. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
Steroid treatment or a pregnant woman who is retaining water.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

42. Where is the aortic valve landmark on the chest?
Second right intercostal space
Only for a few hours
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.
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.

43. What things should you do to assess cardiovascular status?
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.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

44. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Feeling warm (fire) or tin can taste is expected and will pass.
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
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

45. Where should you place your stethescope to find the tricuspid valve?
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
(S1 - S2) Third left intercostal space
4th left intercostal space lower sternal border
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

46. What is INR?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.

47. What should you teach someone with arterial insufficiency?

48. What should you observe for in someone on bleeding precautions?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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).
Open up blood vessels
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.

49. What is intermittent claudication?
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
Pneumothorax and will end up with chest tube to help reinflate lung.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.

50. What are the nursing interventions for a patient with premature ventricular contractions?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Cannot