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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 labile hypertension?
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 central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
BP is elevated or decreased depending on activity.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

2. What is a transthoracic echocardiograph (TTE)?
Second left intercostal space
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
ST segment elevation (STEMI)
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

3. How is the Allen's test done?
Include rest periods prior to any activity.
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
No radial artery punctures if negative
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

4. What disease can cause right sided heart failure?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Lung disease
ST segment elevation (STEMI)

5. What are the steps for infant 1&2 rescuer CPR?
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.

6. 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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
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

7. What causes essential/primary hypertension?
Right sided heart failure
Idiopathic
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
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

8. What is an aortic dissection?

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9. What is the maintenance for venous access port that isn't being regularly used?
Lung disease
Must be flushed 1x/month with heparin and between treatments.
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.
Poorly controlled hypertension

10. What is the treatment for atrial fibrillation?
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
Direct current cardioversion and digoxin/propranolol (inderal).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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

11. Where should you place your stethescope to find the ERB's Point?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
The internal jugular veins (external are less reliable).
(S1 - S2) Third left intercostal space

12. When should bleeding precautions be implemented?
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.
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.
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
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

13. What is a major complication of central line placement?
Fourth or fifth intercostal space at or medial to the midclavicular line.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Protamine Sulfate
Pneumothorax and will end up with chest tube to help reinflate lung.

14. Where is the apex/mitral valve landmark on the chest?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Lower left sternal border
4th left intercostal space lower sternal border

15. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

16. Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
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.
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.

17. Where should you place your stethescope to find the tricuspid valve?
Poorly controlled hypertension
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
4th left intercostal space lower sternal border
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

18. What does vasotec (Enalapril Maleate) do/SE?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Lowers BP and makes heart beat stronger. SE: flushed face.
NO NSAIDS or ASA.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

19. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Lung disease
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

20. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
An enlarged space indicates fluid accumulation in the pericardial sac.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Include rest periods prior to any activity.

21. What usually triggers angina pain?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
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.

22. What does an Allen's test determine?
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
Whether the patients ulnar and radial arteries are patent.

23. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
An inflammation of the pericardium. It may result in MI.

24. What should you teach your patient about an abdominal ultrasonography?
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.
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

25. What should a patient do if they feel chest pain or discomfort?
Lowers BP and makes heart beat stronger. SE: flushed face.
Nitrates - Beta blockers - and Calcium channel blockers
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

26. What is INR?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

27. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Chronic arteriosclerotic disease.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

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

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29. What should you do immediately if you suspect someone of developing a hematoma?
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.
Must be flushed 1x/month with heparin and between treatments.
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
Cannot

30. What is pulsus paradoxus?
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Protamine Sulfate

31. Without prompt surgery for an aortic dissection What is someone at risk for developing?
0.5-2.0 ng/ml
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Pulse before and after giving.

32. What is the treatments for hypertension?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
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
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.

33. What things should you do to assess cardiovascular status?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

34. Who would most likely have peripheral venous disease?
Fifth left intercostal space medial to the midclavicular line.
Nitrates - Beta blockers - and Calcium channel blockers
Before
Old truck driver or someone on bed rest or with pelvic trauma.

35. What would make someone more at risk for digoxin toxicity?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.

36. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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 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.
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

37. What are examples of calcium channel blockers?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Air embolism
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

38. Which type of patient shouldn't take nitrates?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Whether the patients ulnar and radial arteries are patent.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

39. What drugs are most commonly used for angina?
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-
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Nitrates - Beta blockers - and Calcium channel blockers

40. What is the treatment for someone with right sided HF? How do you know working?
Must be flushed 1x/month with heparin and between treatments.
An inflammation of the pericardium. It may result in MI.
Second left intercostal space
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

41. How should you palpate the carotid arteries?
A nosebleed
One at a time to assess the pulse amplitude and contour.
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

42. What is cardiac tamponade? Common causes?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Must be flushed 1x/month with heparin and between treatments.
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

43. What are the steps to perform the heimlich maneuver?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

44. What are the nursing interventions for a patient in atrial fibrillation?
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.
Second Right intercostal space.
Poorly controlled hypertension
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

45. What are the nursing interventions for a patient with premature ventricular contractions?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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!
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

46. What is defibrillation?
Maintain BED REST
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
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 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.

47. What should be done immediately if a pulmonary embolism is suspected?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
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.

48. What should you teach your patient about angiography (arteriography)?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.
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
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.

49. How is angina treated?

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50. Where should you place your stethescope to find the mitral (apex) valve?
Cannot
Old truck driver or someone on bed rest or with pelvic trauma.
Fifth left intercostal space medial to the midclavicular line.
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.