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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 condition can cause left sided heart failure?
(1st) Assess the client for signs of decreased cardiac output and Notify the 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
Vascular - artery disease causing fluid to back up into the lungs.
Poorly controlled hypertension

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

3. What are the steps for adult/child 1 rescuer CPR?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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!
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

4. What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Steroid treatment or a pregnant woman who is retaining water.
Protamine Sulfate

5. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
D/C the med and call the doctor.
An enlarged space indicates fluid accumulation in the pericardial sac.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

6. In What time period is the greatest risk of sudden death from an MI?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
In the first 72 hours!!!!!
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

7. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Cannot
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.
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

8. What are all the S&S of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
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.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

9. What should you do immediately if you suspect someone of developing a hematoma?
Include rest periods prior to any activity.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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
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.

10. What should you not allow if a patient has a negative Allen's test?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
An inflammation of the pericardium. It may result in MI.
No radial artery punctures if negative
Pneumothorax and will end up with chest tube to help reinflate lung.

11. Where should you place your stethescope to find the mitral (apex) valve?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A nosebleed
Fifth left intercostal space medial to the midclavicular line.
Whether the patients ulnar and radial arteries are patent.

12. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

13. What is defibrillation?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
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.

14. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

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

16. What is an air embolism?
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
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.
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 a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

17. How do you prepare a patient for Impedance cardiography monitoring?
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
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Air answers (open junctions)
Right sided heart failure

18. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
NO because it isn't sterile so keep out.
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.
One at a time to assess the pulse amplitude and contour.

19. What are the steps for adult 2 rescuer CPR?
Don't interfere!
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
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
Pulmonary edema

20. What is Raynauds disease? Tx?
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.
Iodine
Nitrates - Beta blockers - and Calcium channel blockers

21. When would a nurse use an external femoral artery compression device?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Patient who are unable to tolerate exercise stress testing.

22. 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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
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

23. A femoral artery compression device ______be assigned to an NA?
Pneumothorax and will end up with chest tube to help reinflate lung.
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!
Cannot
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.

24. What is the goal of treatment for an MI? Treatment?
0.5-2.0 ng/ml
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Idiopathic

25. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Air embolism
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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

26. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

27. What should you do to treat pulmonary edema?
Air embolism
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
Old truck driver or someone on bed rest or with pelvic trauma.

28. What is the maintenance for venous access port that isn't being regularly used?
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Must be flushed 1x/month with heparin and between treatments.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

29. Where should you place your stethescope to find the aortic valve?
Vitamin K (aqua myphiton)
Second Right intercostal space.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Feeling warm (fire) or tin can taste is expected and will pass.

30. When should bleeding precautions be implemented?
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.
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

31. What is cardioversion?

32. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Left sternal border

33. What is characteristic of atrial fibrillation?
Iodine
Don't interfere!
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.

34. What does the device for impedance cardiography consist of?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Air embolism
A monitor with four dual electrodes that are applied to the patients neck and thorax.

35. Where should you place your stethescope to find the ERB's Point?
Left sternal border
Don't interfere!
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.
(S1 - S2) Third left intercostal space

36. What should be done immediately for someone with PE?
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.

37. What could happen without immediate intervention for a hematoma?
Old truck driver or someone on bed rest or with pelvic trauma.
No radial artery punctures if negative
The patient may suffer significant blood loss or femoral nerve compression.
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

38. What is a major complication of central line placement?
Pneumothorax and will end up with chest tube to help reinflate lung.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

39. What is characteristic of complete heart block?
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Direct current cardioversion and digoxin/propranolol (inderal).

40. What type of surgery is done for an aortic dissection?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Nitrates - Beta blockers - and Calcium channel blockers
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

41. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Whether the patients ulnar and radial arteries are patent.
Lower left sternal border

42. What are the S&S of cardiac tamponade?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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.
ST segment elevation (STEMI)

43. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Pneumothorax and will end up with chest tube to help reinflate lung.
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-

44. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
The internal jugular veins (external are less reliable).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

45. What are the signs and symptoms of left sided HF?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Must be flushed 1x/month with heparin and between treatments.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

46. What SE should you look for with calcium channel blocker use?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
The patient may suffer significant blood loss or femoral nerve compression.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

47. What should you teach your patient about MRI?
D/C the med and call the doctor.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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
In fatty areas or over major muscles - large breasts - or bony prominences.

48. What disease can cause right sided heart failure?
Lung disease
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Old truck driver or someone on bed rest or with pelvic trauma.
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

49. What usually triggers angina pain?
Chronic arteriosclerotic disease.
If feel more than 3 shocks in a row or develop signs of infection at the site.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

50. What does vasotec (Enalapril Maleate) do/SE?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).