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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 is the treatment for atrial fibrillation?
Cannot
Vascular - artery disease causing fluid to back up into the lungs.
Direct current cardioversion and digoxin/propranolol (inderal).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

2. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Maintain BED REST
Lowers BP and makes heart beat stronger. SE: flushed face.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.

3. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

4. What signals an elevated venous pressure based on the internal jugular veins?
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

5. What are the steps to perform the heimlich maneuver?
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.
Second left intercostal space
NO because it isn't sterile so keep out.
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.

6. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
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.
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.
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.

7. What should you teach your patient about an electrocardiogram (ECG)?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
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
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

8. What is cardiac tamponade? Common causes?
Before
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.
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
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

9. What should you observe for in someone on bleeding precautions?
One large emboli (smaller=better)
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).
A monitor with four dual electrodes that are applied to the patients neck and thorax.
An inflammation of the pericardium. It may result in MI.

10. What is the treatment for myocardial infarction?
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.
Direct current cardioversion and digoxin/propranolol (inderal).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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

11. What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

12. What is the goal of treatment for an MI? Treatment?
Before
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

13. For what disease should you do the Allen's test?

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14. What should be done immediately if a pulmonary embolism is suspected?
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
Chronic arteriosclerotic disease.
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

15. How should you palpate the apical pulse?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Before

16. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
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!

17. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
The internal jugular veins (external are less reliable).
Feeling warm (fire) or tin can taste is expected and will pass.

18. What is the nursing care associated with chemical stress tests (persantine stress test)?
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
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.
NO NSAIDS or ASA.
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

19. What are the steps for infant 1&2 rescuer CPR?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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
Idiopathic
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

20. What is a transthoracic echocardiograph (TTE)?
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.
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

21. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
D/C the med and call the doctor.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

22. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
Lower left sternal border
Maintain BED REST
NO because it isn't sterile so keep out.
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!

23. What is CVP? Normal?
Iodine
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Lung disease

24. What things should you do to assess cardiovascular status?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
4th left intercostal space lower sternal border
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

25. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Second left intercostal space
Right sided heart failure
Second right intercostal space
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

26. Where is the right ventricle landmark on the chest?
Left sternal border
Vitamin K (aqua myphiton)
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Lower HOB - place patient supine - assess LOC - open airway - assess breathing - get ambu bag - put on gloves - connect tubing from O2 source - adjust flow to 10 to 15 liters. First RESCUER: PLACE APEX of MASK OVER BRIDGE of NOSE And BASE BETWEEN LOW

27. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
D/C the med and call the doctor.
An enlarged space indicates fluid accumulation in the pericardial sac.

28. What should you do to treat pulmonary edema?
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
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.
Feeling warm (fire) or tin can taste is expected and will pass.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

29. What SE should you look for with calcium channel blocker use?
Must be flushed 1x/month with heparin and between treatments.
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).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

30. What is the treatment for someone in ventricular fibrillation?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.

31. What are the four types of pulmonary emboli?
In fatty areas or over major muscles - large breasts - or bony prominences.
Fat - Air - DVT - or Amniotic
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

32. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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33. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Fifth left intercostal space medial to the midclavicular line.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

34. What type of EKG change indicates MI?
Right sided heart failure
ST segment elevation (STEMI)
NO because it isn't sterile so keep out.
Clip hair if necessary - abrade the skin (use abrader pads or fine sandpaper and lightly rub skin using 2 or 3 brisk strokes - improves tracings) - dry skin if necessary - and attach the lead wires to the electrodes before you apply them to the patie

35. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.

36. What should be checked in a patient on a beta blocker?
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
To inhibit thrombus and clot formation.
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.)
Pulse before and after giving.

37. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Include rest periods prior to any activity.
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.

38. Test ending in Gram=?
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.
Iodine
Fourth or fifth intercostal space at or medial to the midclavicular line.
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

39. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Include rest periods prior to any activity.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

40. Where should you place your stethescope to find the ERB's Point?
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.
(S1 - S2) Third left intercostal space
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

41. What causes essential/primary hypertension?
Second right intercostal space
The patient may suffer significant blood loss or femoral nerve compression.
Activity intolerance
Idiopathic

42. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

43. How long is contrast media in the body?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.
Activity intolerance
Only for a few hours

44. What is the hallmark clinical finding associated with pericarditis?
BP is elevated or decreased depending on activity.
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
Activity intolerance

45. How is angina treated?

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46. What is pericarditis?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
An inflammation of the pericardium. It may result in MI.
A nosebleed

47. What is angina? Stable vs. unstable?

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48. What is a major complication of central line placement?
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Pulmonary edema

49. Where is the apex/mitral valve landmark on the chest?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Fourth or fifth intercostal space at or medial to the midclavicular line.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

50. What are the proper steps to changing a central venous catheter dressing?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
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