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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 are the indications for a chemical stress test (persantine stress test)?
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
Patient who are unable to tolerate exercise stress testing.
Fifth left intercostal space medial to the midclavicular line.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

2. What is characteristic of atrial fibrillation?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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!
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

3. In What time period is the greatest risk of sudden death from an MI?
4th left intercostal space lower sternal border
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!
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
In the first 72 hours!!!!!

4. What usually triggers angina pain?
Air answers (open junctions)
Iodine
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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

5. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
A nosebleed
ST segment elevation (STEMI)
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.
Nitrates - Beta blockers - and Calcium channel blockers

6. What is Deep Vein Thrombosis (DVT)?
Pulmonary edema
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
The patient may suffer significant blood loss or femoral nerve compression.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

7. How should you palpate the apical pulse?
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.
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
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.

8. What will be the treatment for an acute episode of life threatening tamponade?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Patient who are unable to tolerate exercise stress testing.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

9. What should you teach your patient about an electrocardiogram (ECG)?
Vascular - artery disease causing fluid to back up into the lungs.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

10. What should you observe for in someone on bleeding precautions?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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).
In the first 72 hours!!!!!
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

11. What should you do if the PT value is 45 sec?
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).
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
D/C the med and call the doctor.

12. What is important to remember when removing a CVC from a patient?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
Cannot
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.

13. Where should you place your stethescope to find the tricuspid valve?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
4th left intercostal space lower sternal border
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

14. What is pericarditis?
An inflammation of the pericardium. It may result in MI.
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.
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).
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 should you go when applying nitroglycerin ointment for angina?
Air embolism
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
Second left intercostal space
Fourth or fifth intercostal space at or medial to the midclavicular line.

16. What are the S&S of cardiac tamponade?
Before
Lowers BP and makes heart beat stronger. SE: flushed face.
Nitrates - Beta blockers - and Calcium channel blockers
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

17. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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

18. What are signs and symptoms of an MI?
An inflammation of the pericardium. It may result in MI.
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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-

19. How is the Allen's test done?
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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

20. What are the S&S of aortic dissection?
(S1 - S2) Third left intercostal space
The internal jugular veins (external are less reliable).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Don't interfere!

21. In what locations should you not place electrodes?
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
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.
Lowers BP and makes heart beat stronger. SE: flushed face.
In fatty areas or over major muscles - large breasts - or bony prominences.

22. What is angina? Stable vs. unstable?

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

24. What places someone at risk for an aortic dissection?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Poorly controlled hypertension
If feel more than 3 shocks in a row or develop signs of infection at the site.

25. Where is the right ventricle landmark on the chest?
Left sternal border
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Fourth or fifth intercostal space at or medial to the midclavicular line.

26. For which heart sounds should the bell be used?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

27. What SE should you look for with calcium channel blocker use?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Lower left sternal border
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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

28. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
4th left intercostal space lower sternal border
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
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.

29. What should you tell someone about taking nitroglycerin tablets (SE)?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.

30. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
Lower left sternal border
Feeling warm (fire) or tin can taste is expected and will pass.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

31. What is intermittent claudication?
Exercise and use graduated compression devices as directed - don't stand for long period of time - to avoid dislodging blood clots don't rub or massage your legs.
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.
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).
Fifth left intercostal space medial to the midclavicular line.

32. Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
4th left intercostal space lower sternal border
An enlarged space indicates fluid accumulation in the pericardial sac.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

33. What is the hallmark clinical finding associated with pericarditis?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits - leans forward - and breaths out.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Feeling warm (fire) or tin can taste is expected and will pass.

34. What are the S&S of air embolism?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Before
Don't interfere!
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

35. What should you teach someone with arterial insufficiency?

36. 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.
Include rest periods prior to any activity.
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.
Air embolism

37. Where do the internal jugular veins lie?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

38. What is characteristic of ventricular tachycardia?
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Include rest periods prior to any activity.
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.

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

40. 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.
In fatty areas or over major muscles - large breasts - or bony prominences.
Left sternal border
Include rest periods prior to any activity.

41. What is the maintenance for venous access port that isn't being regularly used?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Fat - Air - DVT - or Amniotic
Must be flushed 1x/month with heparin and between treatments.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

42. How is angina treated?

43. What is labile hypertension?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
BP is elevated or decreased depending on activity.

44. What is the most common cause of arterial insufficiency?
Patient who are unable to tolerate exercise stress testing.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
One at a time to assess the pulse amplitude and contour.
Chronic arteriosclerotic disease.

45. What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
Lower left sternal border
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

46. What is a major complication of central line placement?
Nitrates - Beta blockers - and Calcium channel blockers
Pneumothorax and will end up with chest tube to help reinflate lung.
Fifth left intercostal space 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.

47. For which heart sounds should the diaphragm be used?
Fat - Air - DVT - or Amniotic
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Chronic arteriosclerotic disease.

48. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
No radial artery punctures if negative
Pneumothorax and will end up with chest tube to help reinflate lung.

49. Which type of patient shouldn't take nitrates?
(S1 - S2) Third left intercostal space
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
A nosebleed

50. What should you not allow if a patient has a negative Allen's test?
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
4th left intercostal space lower sternal border
The patient may suffer significant blood loss or femoral nerve compression.
No radial artery punctures if negative