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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 you remember while taking care of someone with a peripheral arterial occlusion?
One at a time to assess the pulse amplitude and contour.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
Only for a few hours

2. What is the most common cause of arterial insufficiency?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Chronic arteriosclerotic disease.

3. What does plan of care include?
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.
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

4. What is important to remember when removing a CVC from a patient?
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Protamine Sulfate
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

5. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Cannot
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

6. What are the nursing interventions for a patient in atrial fibrillation?
Left sternal border
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

7. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
No radial artery punctures if negative
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
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

8. What are the proper steps to changing a central venous catheter dressing?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
Fifth left intercostal space medial to the midclavicular line.
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.

9. Where should you place your stethescope to find the pulmonic valve?
The patient may suffer significant blood loss or femoral nerve compression.
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.
Second Left intercostal space
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.

10. What should you teach someone with arterial insufficiency?

11. 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).
Pulmonary edema
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

12. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Right sided heart failure

13. What is an acute peripheral arterial occlusion?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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

14. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular 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.

15. What are the S&S associated with right sided heart failure?
Include rest periods prior to any 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.
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

16. What should you teach someone about iodine?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Feeling warm (fire) or tin can taste is expected and will pass.

17. What can result from left sided heart failure if left untreated?
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.
Pulmonary edema
Lower left sternal border
NO NSAIDS or ASA.

18. What are the indications for a chemical stress test (persantine stress test)?
Vascular - artery disease causing fluid to back up into the lungs.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
D/C the med and call the doctor.
Patient who are unable to tolerate exercise stress testing.

19. What should be done immediately for someone with PE?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Second Left intercostal space
An enlarged space indicates fluid accumulation in the pericardial sac.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

20. What are common risk factors for an MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Activity intolerance
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
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

21. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
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.
Lung disease

22. What should you do when applying a femoral artery compression device?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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

23. What are the four types of pulmonary emboli?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Fat - Air - DVT - or Amniotic
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

24. What should you teach your patient about an exercise ECG (stress test)?
If feel more than 3 shocks in a row or develop signs of infection at the site.
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 patient may suffer significant blood loss or femoral nerve compression.
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-

25. What are the steps for adult 2 rescuer CPR?
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
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.
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
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

26. What is characteristic of ventricular tachycardia?
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

27. What is superior vena cava syndrome?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Whether the patients ulnar and radial arteries are patent.
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

28. For which heart sounds should the diaphragm be used?
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.
Idiopathic
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

29. What are the signs and symptoms of left sided HF?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Whether the patients ulnar and radial arteries are patent.
NO because it isn't sterile so keep out.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

30. What should you tell someone about taking nitroglycerin tablets (SE)?
Only for a few hours
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.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Don't interfere!

31. What are the S&S of aortic dissection?
ST segment elevation (STEMI)
The patient may suffer significant blood loss or femoral nerve compression.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

32. What is the goal of treatment for an MI? Treatment?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Fat - Air - DVT - or Amniotic
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

33. What are the S&S of air embolism?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

34. What is characteristic of atrial fibrillation?
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
To inhibit thrombus and clot formation.
(S1 - S2) Third left intercostal space
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

35. What is the correct way to insert an oropharyngeal airway?
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
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
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
D/C the med and call the doctor.

36. What is the antidote for heparin?
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.
Cannot
Protamine Sulfate
Second right intercostal space

37. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
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
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.
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.

38. What type of surgery is done for an aortic dissection?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Second Right intercostal space.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
4th left intercostal space lower sternal border

39. What is the treatment for a pt. with ventricular tachycardia?
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

40. How is the Allen's test done?
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.
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!
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
Left sternal border

41. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Steroid treatment or a pregnant woman who is retaining water.
The patient may suffer significant blood loss or femoral nerve compression.
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

42. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.
Pulmonary edema

43. What makes the symptoms of superior vena cava syndrome better? Worse?
Activity intolerance
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

44. Where is the pulmonic valve landmark on the chest?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Second right intercostal space
Second left intercostal space

45. Should the tubing for a venous access port be included under the dressing site?

46. Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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.
ST segment elevation (STEMI)

47. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Iodine
D/C the med and call the doctor.

48. How should you palpate the apical pulse?
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
ST segment elevation (STEMI)

49. How is angina treated?

50. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.