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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. Where is the pulmonic valve landmark on the chest?
Second left intercostal space
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.
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.

2. What should you watch for with PICC lines that have been in place for 6 months?
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
Air answers (open junctions)
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.
One large emboli (smaller=better)

3. What is CVP? Normal?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Vascular - artery disease causing fluid to back up into the lungs.
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.

4. Test ending in Gram=?
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
Iodine
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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.

5. In what locations should you not place electrodes?
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
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
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.

6. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
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

7. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
D/C the med and call the doctor.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

8. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
4th left intercostal space lower sternal border
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Direct current cardioversion and digoxin/propranolol (inderal).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

9. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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.
Right sided heart failure
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.
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

10. What is the treatment for a pt. with ventricular tachycardia?
Open up blood vessels
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

11. What is the nursing care associated with chemical stress tests (persantine stress test)?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

12. What should a patient do if they feel chest pain or discomfort?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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

13. How is angina treated?

14. What is cardiac tamponade? Common causes?
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.
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
Pulse before and after giving.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

15. What does the device for impedance cardiography consist of?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Second left intercostal space
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

16. During an Allen's test don't compress one artery _____ the other.
The internal jugular veins (external are less reliable).
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.
Before
Pulmonary edema

17. What is the treatment for someone with right sided HF? How do you know working?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

18. How should you palpate the carotid arteries?
Pulmonary edema
One at a time to assess the pulse amplitude and contour.
Lower left sternal border
Steroid treatment or a pregnant woman who is retaining water.

19. What should you teach your patient about a cardiac catheterization?
Second Right intercostal space.
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

20. What is labile hypertension?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
BP is elevated or decreased depending on activity.
To inhibit thrombus and clot formation.
Lower left sternal border

21. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Second Left intercostal space
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
The internal jugular veins (external are less reliable).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

22. When should you be concerned about premature ventricular contraction?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Don't interfere!
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Fourth or fifth intercostal space at or medial to the midclavicular line.

23. What should happen if someone converts to asystole/flatline?
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
D/C the med and call the doctor.
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.)
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

24. What are the four types of pulmonary emboli?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
4th left intercostal space lower sternal border
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.
Fat - Air - DVT - or Amniotic

25. What is intermittent claudication?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
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.
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.

26. Where should you place your stethescope to find the tricuspid valve?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.
4th left intercostal space lower sternal border
In fatty areas or over major muscles - large breasts - or bony prominences.

27. What are signs and symptoms of an MI?
Must be flushed 1x/month with heparin and between treatments.
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
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

28. What should you remember while taking care of someone with a peripheral arterial occlusion?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Feeling warm (fire) or tin can taste is expected and will pass.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Maintain BED REST

29. What disease can cause right sided heart failure?
Lung disease
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
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

30. Where should you place your stethescope to find the aortic valve?
One large emboli (smaller=better)
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Direct current cardioversion and digoxin/propranolol (inderal).
Second Right intercostal space.

31. What does vasotec (Enalapril Maleate) do/SE?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
Lowers BP and makes heart beat stronger. SE: flushed face.
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.

32. What are common risk factors for an MI?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.

33. What will be the treatment for an acute episode of life threatening tamponade?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

34. What is the correct way to insert an oropharyngeal airway?
Maintain BED REST
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

35. What is an acute peripheral arterial occlusion?
Pulse before and after giving.
Lung disease
BP is elevated or decreased depending on activity.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

36. What should you do to treat pulmonary edema?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Vascular - artery disease causing fluid to back up into the lungs.
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
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.

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

38. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Need for follow up blood tests - Need to take oral warfarin for at least 3 months - and to reduce current risk encourage weight loss - smoking cessation - and regular exercise.
Don't interfere!
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

39. What does an Allen's test determine?
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
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Whether the patients ulnar and radial arteries are patent.

40. What is a chemical stress test (persantine stress test)?
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
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

41. What are the steps to perform the heimlich maneuver?
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
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Second Left intercostal space

42. What is a major complication of central line placement?
The patient may suffer significant blood loss or femoral nerve compression.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Pneumothorax and will end up with chest tube to help reinflate lung.
Maintain BED REST

43. What is characteristic of premature ventricular contractions?
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.
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
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.
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.

44. What type of EKG change indicates MI?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The patient may suffer significant blood loss or femoral nerve compression.
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
ST segment elevation (STEMI)

45. What causes essential/primary hypertension?
D/C the med and call the doctor.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Idiopathic

46. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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
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.
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 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

47. What is the treatment for myocardial infarction?
Lung disease
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.

48. What needs to be held during the placement of a femoral artery compression device?
Open up blood vessels
NO NSAIDS or ASA.
Pneumothorax and will end up with chest tube to help reinflate lung.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

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

50. What are the S&S of cardiac tamponade?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
The patient may suffer significant blood loss or femoral nerve compression.