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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. If a victim is choking but can cough - speak - or breath what should you do?

2. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Don't interfere!
In the first 72 hours!!!!!
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

3. What could happen without immediate intervention for a hematoma?
Direct current cardioversion and digoxin/propranolol (inderal).
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.
The patient may suffer significant blood loss or femoral nerve compression.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

4. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
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
ST segment elevation (STEMI)
Before

5. Where should you place your stethescope to find the ERB's Point?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
The internal jugular veins (external are less reliable).
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.
(S1 - S2) Third left intercostal space

6. What is the nursing care associated with chemical stress tests (persantine stress test)?
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.
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
Whether the patients ulnar and radial arteries are patent.
It is noninvasive. You must not eat - smoke - or drink alcohol for 3 hours before the test. WEAR COMFORTABLE SHOES And LOOSE LIGHTWEIGHT SHORTS OR SLACKS - YOU MAY GET AN INJECTION of THAllIUM - after your blood pressure and ECG are monitored for 10-

7. What are the S&S of pulmonary embolism?
0.5-2.0 ng/ml
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Include rest periods prior to any activity.

8. A femoral artery compression device ______be assigned to an NA?
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Cannot
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

9. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Patient who are unable to tolerate exercise stress testing.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

10. What are the two common complications of pericarditis?
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.

11. What landmarks should you be looking for on someone's chest?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
0.5-2.0 ng/ml
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
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

12. What should be done for someone on bleeding precautions?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.

13. What should be done immediately for someone with PE?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

14. What are the steps to perform the heimlich maneuver?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.
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
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

15. What are the steps for adult/child 1 rescuer CPR?
Demand: Works PRN (when HR goes below predetermined rate) or Fixed: beats constantly at predetermined rate so no matter what heart does still beats at same rate.
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
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 clearly defined or measurable P waves and an irregular - irregular ventricular response.

16. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
D/C the med and call the doctor.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.

17. What are the S&S associated with right sided heart failure?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

18. What things should you do to assess cardiovascular status?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

19. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
The patient may suffer significant blood loss or femoral nerve compression.
Fifth left intercostal space medial to the midclavicular line.

20. What is a assessment finding with DVT?

21. 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?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(S1 - S2) Third left intercostal space
Maintain BED REST
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

22. What should you remember while taking care of someone with a peripheral arterial occlusion?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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

23. What will be the treatment for an acute episode of life threatening tamponade?
Pulmonary edema
(S1 - S2) Third left intercostal space
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

24. What should you teach your patient about MRI?
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

25. What is a transthoracic echocardiograph (TTE)?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

26. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Vascular - artery disease causing fluid to back up into the lungs.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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

27. What is characteristic of premature ventricular contractions?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

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

29. What is intermittent claudication?
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
4th left intercostal space lower sternal border
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
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.

30. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
D/C the med and call the doctor.

31. What should you do if the PT value is 45 sec?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
D/C the med and call the doctor.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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

32. What is characteristic of ventricular tachycardia?
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
Don't interfere!

33. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Fifth left intercostal space medial to the midclavicular line.
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
Second Right intercostal space.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

34. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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 should you do frequently for someone with a central line to help prevent pulmonary emboli?
4th left intercostal space lower sternal border
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Left sternal border
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

36. What should you teach someone with arterial insufficiency?

37. What is important to remember when taking care of patients with compression devices?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

38. What are examples of calcium channel blockers?
NO NSAIDS or ASA.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Right sided heart failure
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

39. Where should you place your stethescope to find the tricuspid valve?
Feeling warm (fire) or tin can taste is expected and will pass.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
4th left intercostal space lower sternal border
Open up blood vessels

40. How long is contrast media in the body?
Only for a few hours
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

41. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
No radial artery punctures if negative
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
Vascular - artery disease causing fluid to back up into the lungs.

42. What is cardiac tamponade? Common causes?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Patient who are unable to tolerate exercise stress testing.
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
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

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

44. What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Feeling warm (fire) or tin can taste is expected and will pass.
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
Maintain BED REST

45. What should you watch for with PICC lines that have been in place for 6 months?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Air answers (open junctions)

46. What are the nursing interventions for a patient with premature ventricular contractions?
It is noninvasive. You must not eat - smoke - or drink alcohol for 3 hours before the test. WEAR COMFORTABLE SHOES And LOOSE LIGHTWEIGHT SHORTS OR SLACKS - YOU MAY GET AN INJECTION of THAllIUM - after your blood pressure and ECG are monitored for 10-
It is 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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The internal jugular veins (external are less reliable).

47. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
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
NO NSAIDS or ASA.
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.

48. How should you palpate the carotid arteries?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
One at a time to assess the pulse amplitude and contour.

49. 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!
The internal jugular veins (external are less reliable).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Pulmonary edema

50. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Open up blood vessels
Maintain BED REST
Second Right intercostal space.