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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is characteristic of ventricular fibrillation?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
In fatty areas or over major muscles - large breasts - or bony prominences.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Protamine Sulfate

2. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
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.
Pneumothorax and will end up with chest tube to help reinflate lung.

3. What should you teach your patient about MRI?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
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.

4. What is the treatments for hypertension?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

5. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Cannot

6. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

7. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
In fatty areas or over major muscles - large breasts - or bony prominences.
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
An enlarged space indicates fluid accumulation in the pericardial sac.

8. What is a assessment finding with DVT?

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9. What is the antidote for heparin?
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
Vitamin K (aqua myphiton)
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

10. What should you observe for in someone on bleeding precautions?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Vascular - artery disease causing fluid to back up into the lungs.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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).

11. What are the signs and symptoms of left sided HF?
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Lowers BP and makes heart beat stronger. SE: flushed face.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

12. What is Raynauds disease? Tx?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
Patient who are unable to tolerate exercise stress testing.

13. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
An inflammation of the pericardium. It may result in MI.
The internal jugular veins (external are less reliable).
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
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.

14. What is the nursing care associated with chemical stress tests (persantine stress test)?
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).
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
Open up blood vessels
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

15. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Maintain BED REST

16. Which type of patient shouldn't take nitrates?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
Activity intolerance

17. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
The patient may suffer significant blood loss or femoral nerve compression.
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.
Include rest periods prior to any activity.

18. What is a therapeutic digoxin level?
Lowers BP and makes heart beat stronger. SE: flushed face.
0.5-2.0 ng/ml
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
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.)

19. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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!
D/C the med and call the doctor.

20. What is the antidote for coumadin?
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Second Right intercostal space.
Vitamin K (aqua myphiton)

21. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.
If feel more than 3 shocks in a row or develop signs of infection at the site.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

22. What is a transthoracic echocardiograph (TTE)?
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
NO because it isn't sterile so keep out.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Second left intercostal space

23. What is the treatment for premature ventricular contractions?
One at a time to assess the pulse amplitude and contour.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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
Poorly controlled hypertension

24. What should you do immediately if you suspect someone of developing a hematoma?
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
Vitamin K (aqua myphiton)
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

25. What should be done immediately for someone with PE?
(S1 - S2) Third left intercostal space
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

26. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Include rest periods prior to any activity.

27. What is Deep Vein Thrombosis (DVT)?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

28. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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.
The internal jugular veins (external are less reliable).
Include rest periods prior to any activity.
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

29. What is more harmful a lot of little emboli or one large emboli?
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
One large emboli (smaller=better)
Only for a few hours
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

30. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

31. What are the four types of pulmonary emboli?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Fat - Air - DVT - or Amniotic
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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

32. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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 monitor with four dual electrodes that are applied to the patients neck and thorax.
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.

33. What should you not allow if a patient has a negative Allen's test?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
No radial artery punctures if negative
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Right sided heart failure

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

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35. How should you palpate the carotid arteries?
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!
One at a time to assess the pulse amplitude and contour.
Left sternal border
Include rest periods prior to any activity.

36. What is epistaxis?
Include rest periods prior to any activity.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Air embolism
A nosebleed

37. 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).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Nitrates - Beta blockers - and Calcium channel blockers

38. 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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.
(S1 - S2) Third left intercostal space

39. What is a good diagnosis for someone with right sided HF?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Activity intolerance
Lower left sternal border

40. What should you teach someone after they have had a pacemaker placed?

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41. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
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.
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
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

42. Where should you place your stethescope to find the mitral (apex) valve?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Fifth left intercostal space medial to the midclavicular line.
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

43. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
The internal jugular veins (external are less reliable).
BP is elevated or decreased depending on activity.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

44. How do you prepare a patient for Impedance cardiography monitoring?
In fatty areas or over major muscles - large breasts - or bony prominences.
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
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

45. A femoral artery compression device ______be assigned to an NA?
(S1 - S2) Third left intercostal space
Cannot
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Second left intercostal space

46. What should you teach your patient about a cardiac catheterization?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Before
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
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.

47. What landmarks should you be looking for on someone's chest?
One at a time to assess the pulse amplitude and contour.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

48. What factors place you at risk for HTN?
Second right intercostal space
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
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

49. Where is the right ventricle landmark on the chest?
Iodine
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Left sternal border
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.

50. Where is the tricuspid valve landmark on the chest?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Lower left sternal border