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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 places someone at risk for an aortic dissection?
Nitrates - Beta blockers - and Calcium channel blockers
Poorly controlled hypertension
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
Iodine

2. What is a assessment finding with DVT?

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3. In what locations should you not place electrodes?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
In fatty areas or over major muscles - large breasts - or bony prominences.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

4. What would make someone more at risk for digoxin toxicity?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Nitrates - Beta blockers - and Calcium channel blockers
To inhibit thrombus and clot formation.

5. What should you do if the PTT value is 80 for someone on heparin?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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).
D/C the med and call the doctor.
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.

6. What landmarks should you be looking for on someone's chest?
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

7. 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.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

8. What should be done immediately if a pulmonary embolism is suspected?
Must be flushed 1x/month with heparin and between treatments.
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
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

9. What causes essential/primary hypertension?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
NO NSAIDS or ASA.
Idiopathic
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.

10. What should a patient do if they feel chest pain or discomfort?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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 a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

11. What is Deep Vein Thrombosis (DVT)?
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

12. Where is the right ventricle landmark on the chest?
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.
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.
Left sternal border
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

13. What is the antidote for coumadin?
No radial artery punctures if negative
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Vitamin K (aqua myphiton)
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

14. What type of surgery is done for an aortic dissection?
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
Iodine
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

15. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
Steroid treatment or a pregnant woman who is retaining water.
Idiopathic
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

16. When would a nurse use an external femoral artery compression device?
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.
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.
Only for a few hours
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

17. What is characteristic of premature ventricular contractions?
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.
Whether the patients ulnar and radial arteries are patent.
BP is elevated or decreased depending on activity.
NO because it isn't sterile so keep out.

18. What are the S&S of air embolism?
Iodine
Activity intolerance
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

19. Test ending in Gram=?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Lower left sternal border
Iodine
A monitor with four dual electrodes that are applied to the patients neck and thorax.

20. What is the treatment for someone with right sided HF? How do you know working?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Only for a few hours
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

21. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
BP is elevated or decreased depending on activity.
Maintain BED REST
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
D/C the med and call the doctor.

22. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Maintain BED REST
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.

23. What are the 2 types of pacemakers?
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.
D/C the med and call the doctor.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

24. What will a leg with arterial insufficiency look like?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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

25. What is the nursing care associated with chemical stress tests (persantine stress test)?
Vitamin K (aqua myphiton)
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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

26. What is angina? Stable vs. unstable?

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27. Where should you place your stethescope to find the tricuspid valve?
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.
4th left intercostal space lower sternal border
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

28. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Cannot
4th left intercostal space lower sternal border
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

29. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Protamine Sulfate
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

30. What does the device for impedance cardiography consist of?
Lung disease
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
D/C the med and call the doctor.

31. What are the signs and symptoms of left sided HF?
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.
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

32. What is the correct way to insert an oropharyngeal airway?
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.
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
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.
In the first 72 hours!!!!!

33. What is defibrillation?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.
NO NSAIDS or ASA.

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

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35. What needs to be held during the placement of a femoral artery compression device?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.)
NO NSAIDS or ASA.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

36. What is the treatment for myocardial infarction?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
In the first 72 hours!!!!!

37. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Pulmonary edema
Don't interfere!
The patient may suffer significant blood loss or femoral nerve compression.

38. What does an Allen's test determine?
In the first 72 hours!!!!!
Whether the patients ulnar and radial arteries are patent.
Lung disease
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

39. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Old truck driver or someone on bed rest or with pelvic trauma.
Air embolism
ST segment elevation (STEMI)
Second Right intercostal space.

40. Where should you place your stethescope to find the mitral (apex) valve?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
Fifth left intercostal space medial to the midclavicular line.
(S1 - S2) Third left intercostal space

41. What is superior vena cava syndrome?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.

42. During an Allen's test don't compress one artery _____ the other.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Before
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

43. What should you teach your patient about a holter monitor?

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44. What is labile hypertension?
BP is elevated or decreased depending on activity.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

45. What things should you do to assess cardiovascular status?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

46. What are the indications for a chemical stress test (persantine stress test)?
Left sternal border
Patient who are unable to tolerate exercise stress testing.
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

47. What is the treatment for a pt. with ventricular tachycardia?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.)
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.
No radial artery punctures if negative

48. What should you watch for with PICC lines that have been in place for 6 months?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Air answers (open junctions)
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

49. 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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Activity intolerance
Second Left intercostal space

50. What should be done for someone on bleeding precautions?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

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NCLEX Cardiac

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