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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 S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
NO NSAIDS or ASA.

2. 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?
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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!
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

3. What should you do if the PTT value is 80 for someone on heparin?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
D/C the med and call the doctor.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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

4. What should you teach someone with arterial insufficiency?

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5. During an Allen's test don't compress one artery _____ the other.
Pulse before and after giving.
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
Before
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

6. What should be done for someone on bleeding precautions?
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.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

7. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Poorly controlled hypertension
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
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

8. What are the nursing interventions for a patient with premature ventricular contractions?
Second right intercostal space
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Feeling warm (fire) or tin can taste is expected and will pass.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

9. What disease can cause right sided heart failure?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Lung disease

10. What is the treatment for atrial fibrillation?
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Direct current cardioversion and digoxin/propranolol (inderal).
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

11. What is an acute peripheral arterial occlusion?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

12. What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

13. Where should you place your stethescope to find the tricuspid valve?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Air answers (open junctions)
4th left intercostal space lower sternal border
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

14. What usually triggers angina pain?
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
One large emboli (smaller=better)
The internal jugular veins (external are less reliable).

15. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
An enlarged space indicates fluid accumulation in the pericardial sac.

16. Where is the right ventricle landmark on the chest?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Left sternal border
Fat - Air - DVT - or Amniotic
Pulse before and after giving.

17. Where do the internal jugular veins lie?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

18. What is Raynauds disease? Tx?
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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

19. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Second left intercostal space
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

20. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Pulse before and after giving.
Air answers (open junctions)

21. What should happen if someone converts to asystole/flatline?
Pulmonary edema
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.

22. What places someone at risk for an aortic dissection?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Patient who are unable to tolerate exercise stress testing.
Poorly controlled hypertension

23. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

24. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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

25. Where should you place your stethescope to find the pulmonic valve?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Second Left intercostal space
BP is elevated or decreased depending on activity.

26. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Whether the patients ulnar and radial arteries are patent.
Fat - Air - DVT - or Amniotic
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.

27. 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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Lowers BP and makes heart beat stronger. SE: flushed face.
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.

28. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
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
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Must be flushed 1x/month with heparin and between treatments.
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

29. 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.
No radial artery punctures if negative
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.
Old truck driver or someone on bed rest or with pelvic trauma.

30. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.

31. When should bleeding precautions be implemented?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
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.

32. What is an air embolism?
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
NO because it isn't sterile so keep out.

33. What is a good diagnosis for someone with right sided HF?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
D/C the med and call the doctor.
Activity intolerance
Second Left intercostal space

34. What are the 2 types of pacemakers?
Only for a few hours
Activity intolerance
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.
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.

35. What are the S&S of pulmonary embolism?
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

36. What should you teach your patient about angiography (arteriography)?
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unu
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
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.
(S1 - S2) Third left intercostal space

37. What is an aortic dissection?

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38. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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

39. What should you do immediately if you suspect someone of developing a hematoma?
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.
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

40. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Second Right intercostal space.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

41. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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
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
Cannot
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

42. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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
Right sided heart failure
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.

43. What is the treatment for premature ventricular contractions?
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.
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.)
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

44. What factors place you at risk for HTN?
Second Right intercostal space.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.

45. What is the treatment for someone with right sided HF? How do you know working?
Pulse before and after giving.
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.)
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

46. How is angina treated?

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47. What are the steps for infant 1&2 rescuer CPR?
(S1 - S2) Third left intercostal space
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

48. For which heart sounds should the diaphragm be used?
Pulmonary edema
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Fifth left intercostal space medial to the midclavicular line.

49. How does the blood flow through the heart? (valves?)
A monitor with four dual electrodes that are applied to the patients neck and thorax.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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!

50. Where should you place your stethescope to find the mitral (apex) valve?
Second left intercostal space
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.
Fifth left intercostal space medial to the midclavicular line.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

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NCLEX Cardiac

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