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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 cardiac tamponade? Common causes?
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
In the first 72 hours!!!!!
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

2. In What time period is the greatest risk of sudden death from an MI?
Fourth or fifth intercostal space at or medial to the midclavicular line.
In the first 72 hours!!!!!
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Lower left sternal border

3. Where is the tricuspid valve landmark on the chest?
The internal jugular veins (external are less reliable).
Lower left sternal border
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

4. What is a nursing diagnosis for arterial occlusion? Tx
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Fat - Air - DVT - or Amniotic
Chronic arteriosclerotic disease.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

5. What are the S&S of cardiac tamponade?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

6. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
Iodine
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
One at a time to assess the pulse amplitude and contour.

7. What is impedance cardiography?
Whether the patients ulnar and radial arteries are patent.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

8. What should you teach your patient about MRI?
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
NO NSAIDS or ASA.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

9. Where should you place your stethescope to find the aortic valve?
Chronic arteriosclerotic disease.
Pulse before and after giving.
Second Right intercostal space.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

10. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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
Air answers (open junctions)
Don't interfere!

11. What is a chemical stress test (persantine stress test)?
Lower left sternal border
An enlarged space indicates fluid accumulation in the pericardial sac.
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
Must be flushed 1x/month with heparin and between treatments.

12. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Iodine
An enlarged space indicates fluid accumulation in the pericardial sac.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

13. What are all the S&S of pericarditis?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.

14. What is the treatment for premature ventricular contractions?
Pulmonary edema
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

15. What is defibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
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.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

16. What should you not allow if a patient has a negative Allen's test?
Pneumothorax and will end up with chest tube to help reinflate lung.
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
No radial artery punctures if negative
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

17. What should you teach a patient regarding discharge after a DVT?

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18. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
The internal jugular veins (external are less reliable).
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.
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.
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.

19. What is the treatment for a pt. with ventricular tachycardia?
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.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

20. What should you do if the PTT value is 80 for someone on heparin?
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
D/C the med and call the doctor.
Left sternal border
Must be flushed 1x/month with heparin and between treatments.

21. What is the most common cause of arterial insufficiency?
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
Chronic arteriosclerotic disease.
Direct current cardioversion and digoxin/propranolol (inderal).
Nitrates - Beta blockers - and Calcium channel blockers

22. What should you teach your patient about an electrocardiogram (ECG)?
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
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

23. What type of EKG change indicates MI?
Lowers BP and makes heart beat stronger. SE: flushed face.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
ST segment elevation (STEMI)
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

24. What should happen if someone converts to asystole/flatline?
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

25. What is important to remember when removing a CVC from a patient?
Before
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.

26. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

27. What should you go when applying nitroglycerin ointment for angina?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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

28. What is a assessment finding with DVT?

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29. What factors place you at risk for HTN?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Second Right intercostal space.

30. For which heart sounds should the diaphragm be used?
0.5-2.0 ng/ml
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Must be flushed 1x/month with heparin and between treatments.
Don't interfere!

31. What should be done for someone on bleeding precautions?
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.
Vitamin K (aqua myphiton)
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.)
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

32. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
NO NSAIDS or ASA.
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.

33. What is epistaxis?
Before
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
A nosebleed
BP is elevated or decreased depending on activity.

34. What is labile hypertension?
Pulse before and after giving.
BP is elevated or decreased depending on activity.
Old truck driver or someone on bed rest or with pelvic trauma.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

35. What are the S&S of superior vena cava syndrome?
Left sternal border
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Cannot

36. What are examples of calcium channel blockers?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
NO NSAIDS or ASA.

37. What lab value is used to evaluate a patient on coumadin? What is the normal value?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Pneumothorax and will end up with chest tube to help reinflate lung.
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 inhibit thrombus and clot formation.

38. When should you be concerned about premature ventricular contraction?
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

39. What should a patient do if they feel chest pain or discomfort?
Include rest periods prior to any activity.
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
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

40. What is superior vena cava syndrome?
Poorly controlled hypertension
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
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

41. What is Deep Vein Thrombosis (DVT)?
Vascular - artery disease causing fluid to back up into the lungs.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

42. What is characteristic of ventricular fibrillation?
NO because it isn't sterile so keep out.
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Vascular - artery disease causing fluid to back up into the lungs.

43. Test ending in Gram=?
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.
Chronic arteriosclerotic disease.
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
Iodine

44. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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-
Pulmonary edema

45. What type of surgery is done for an aortic dissection?
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

46. What should you do to treat pulmonary edema?
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.
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
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.
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

47. What is the antidote for heparin?
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
Don't interfere!
Protamine Sulfate
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

48. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

49. What is the purpose of compression devices?
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
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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

50. What are coumadin and heparin used for?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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
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
To inhibit thrombus and clot formation.