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NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

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

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

1. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
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.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Fifth left intercostal space medial to the midclavicular line.

2. What is labile hypertension?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Vascular - artery disease causing fluid to back up into the lungs.
BP is elevated or decreased depending on activity.

3. What is the treatment for myocardial infarction?
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
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

4. What body systems are affected by digoxin toxicity? S&S?
Open up blood vessels
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Second right intercostal space
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

5. What should you teach your patient about angiography (arteriography)?
NO because it isn't sterile so keep out.
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.

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

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7. What are the steps to perform the heimlich maneuver?
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
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.

8. Where should you place your stethescope to find the aortic valve?
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumat
Second Right 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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

9. How should you palpate the carotid arteries?
An inflammation of the pericardium. It may result in MI.
Open up blood vessels
One at a time to assess the pulse amplitude and contour.
Fat - Air - DVT - or Amniotic

10. How long is contrast media in the body?
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
Only for a few hours
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
Before

11. What is angina? Stable vs. unstable?

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12. What should you always assume with a patient who has a central line placed and is experiencing SOB?
ST segment elevation (STEMI)
Patient who are unable to tolerate exercise stress testing.
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
Air embolism

13. Where should you place your stethescope to find the ERB's Point?
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.)
(S1 - S2) Third left intercostal space
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
D/C the med and call the doctor.

14. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
Open up blood vessels
Maintain BED REST
Vascular - artery disease causing fluid to back up into the lungs.

15. What is cardiac tamponade? Common causes?
Whether the patients ulnar and radial arteries are patent.
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.
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

16. What should you do when applying a femoral artery compression device?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Only for a few hours
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
Vitamin K (aqua myphiton)

17. What are the 2 types of pacemakers?
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

18. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
Second Right 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.

19. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Left sternal border
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

20. What is a major complication of central line placement?
Activity intolerance
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Pneumothorax and will end up with chest tube to help reinflate lung.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

21. What are the two common complications of pericarditis?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

22. What are examples of calcium channel blockers?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Whether the patients ulnar and radial arteries are patent.
NO NSAIDS or ASA.
Air answers (open junctions)

23. What is a chemical stress test (persantine stress test)?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

24. What is a therapeutic digoxin level?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Steroid treatment or a pregnant woman who is retaining water.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
0.5-2.0 ng/ml

25. How should you palpate the apical pulse?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.

26. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Patient who are unable to tolerate exercise stress testing.
An enlarged space indicates fluid accumulation in the pericardial sac.
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 inflammation of the pericardium. It may result in MI.

27. What are common risk factors for an MI?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Idiopathic

28. What should you not allow if a patient has a negative Allen's test?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
No radial artery punctures if negative
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.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

29. What is the treatments for hypertension?
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.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
ST segment elevation (STEMI)

30. What should happen if someone converts to asystole/flatline?
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
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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!
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

31. What causes essential/primary hypertension?
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.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Idiopathic

32. What does vasotec (Enalapril Maleate) do/SE?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
In the first 72 hours!!!!!
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.
Lowers BP and makes heart beat stronger. SE: flushed face.

33. What should you go when applying nitroglycerin ointment for angina?
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Second Right intercostal space.
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

34. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
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
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 nursing interventions for a pt. with ventricular tachycardia?
NO NSAIDS or ASA.
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.
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

36. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Fat - Air - DVT - or Amniotic
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.

37. When should you be concerned about premature ventricular contraction?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
In the first 72 hours!!!!!

38. What should you teach someone with arterial insufficiency?

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39. Where is the aortic valve landmark on the chest?
Nitrates - Beta blockers - and Calcium channel blockers
Second right intercostal space
4th left intercostal space lower sternal border
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

40. What are the steps for adult 2 rescuer CPR?
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.
Include rest periods prior to any activity.
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
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.

41. What signals an elevated venous pressure based on the internal jugular veins?
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
4th left intercostal space lower sternal border
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.
No radial artery punctures if negative

42. What is Raynauds disease? Tx?
Second Left intercostal space
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
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.

43. What does plan of care include?
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
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
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.

44. What are the indications for a chemical stress test (persantine stress test)?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Patient who are unable to tolerate exercise stress testing.
D/C the med and call the doctor.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

45. What condition can cause left sided heart failure?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Vascular - artery disease causing fluid to back up into the lungs.
An enlarged space indicates fluid accumulation in the pericardial sac.

46. What is characteristic of ventricular tachycardia?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
To inhibit thrombus and clot formation.

47. What is superior vena cava syndrome?
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.
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.
Before
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

48. 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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Left sternal border
Second left intercostal space

49. What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Fat - Air - DVT - or Amniotic
Cannot
Second Left intercostal space

50. Where is the right ventricle landmark on the chest?
Second Left intercostal space
Nitrates - Beta blockers - and Calcium channel blockers
Left sternal border
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

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NCLEX Cardiac

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