Test your basic knowledge |

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 should you teach your patient about a cardiac catheterization?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
Lower HOB - place patient supine - assess LOC - open airway - assess breathing - get ambu bag - put on gloves - connect tubing from O2 source - adjust flow to 10 to 15 liters. First RESCUER: PLACE APEX of MASK OVER BRIDGE of NOSE And BASE BETWEEN LOW
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

2. 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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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

3. What are the steps for adult/child 1 rescuer CPR?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Air answers (open junctions)

4. What is a major complication of central line placement?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

5. What is Raynauds disease? Tx?
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
Include rest periods prior to any activity.

6. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
NO because it isn't sterile so keep out.

7. What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Patient who are unable to tolerate exercise stress testing.
Cannot
Second Right intercostal space.

8. Where should you place your stethescope to find the aortic valve?
Second Right intercostal space.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
An inflammation of the pericardium. It may result in MI.

9. For which heart sounds should the bell be used?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Maintain BED REST
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Lung disease

10. Which type of patient shouldn't take nitrates?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
0.5-2.0 ng/ml

11. What are signs and symptoms of an MI?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
BP is elevated or decreased depending on activity.

12. What is a nursing diagnosis for arterial occlusion? Tx
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

13. 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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Only for a few hours

14. What will a leg with arterial insufficiency look like?
Steroid treatment or a pregnant woman who is retaining water.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Only for a few hours
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

15. What body systems are affected by digoxin toxicity? S&S?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Include rest periods prior to any activity.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
NO NSAIDS or ASA.

16. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Lower left sternal border
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Nitrates - Beta blockers - and Calcium channel blockers

17. What is labile hypertension?
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.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
BP is elevated or decreased depending on activity.

18. How is the Allen's test done?
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
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
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

19. What is cardioversion?

20. Where do the internal jugular veins lie?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.

21. How do you prepare a patient for Impedance cardiography monitoring?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Old truck driver or someone on bed rest or with pelvic trauma.

22. What is a good diagnosis for someone with right sided HF?
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
Activity intolerance
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
No radial artery punctures if negative

23. Where should you place your stethescope to find the tricuspid valve?
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
An inflammation of the pericardium. It may result in MI.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
4th left intercostal space lower sternal border

24. How is angina treated?

25. What SE should you look for with calcium channel blocker 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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.

26. What can result from left sided heart failure if left untreated?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Pulmonary edema

27. When should you be concerned about premature ventricular contraction?
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 all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Lower HOB - place patient supine - assess LOC - open airway - assess breathing - get ambu bag - put on gloves - connect tubing from O2 source - adjust flow to 10 to 15 liters. First RESCUER: PLACE APEX of MASK OVER BRIDGE of NOSE And BASE BETWEEN LOW

28. What usually triggers angina pain?
Left sternal border
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

29. What is the nursing care associated with chemical stress tests (persantine stress test)?
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
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.
Lung disease
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

30. What should you teach your patient about MRI?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

31. Who would most likely have peripheral venous disease?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

32. What is cardiac tamponade? Common causes?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
Second Left intercostal space
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.

33. What is epistaxis?
A nosebleed
Iodine
To inhibit thrombus and clot formation.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

34. What is the treatment for premature ventricular contractions?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

35. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
A complication from a venous access device or port. It is a blockage of the superior vena cava preventing superior blood flow from reaching the heart.

36. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
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.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

37. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

38. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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
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.
Fifth left intercostal space medial to the midclavicular line.

39. What disease can cause right sided heart failure?
Chronic arteriosclerotic disease.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Old truck driver or someone on bed rest or with pelvic trauma.
Lung disease

40. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
Fat - Air - DVT - or Amniotic
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

41. What do calcium channel blockers do?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
D/C the med and call the doctor.
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.
Open up blood vessels

42. Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
0.5-2.0 ng/ml
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Lowers BP and makes heart beat stronger. SE: flushed face.

43. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
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
Second left intercostal space
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

44. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

45. What would make someone more at risk for digoxin toxicity?
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.

46. What needs to be held during the placement of a femoral artery compression device?
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
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).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

47. What is important to remember when taking care of patients with compression devices?
Cannot
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
One at a time to assess the pulse amplitude and contour.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

48. What are the steps for adult 2 rescuer CPR?
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

49. How should you palpate the apical pulse?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Patient who are unable to tolerate exercise stress testing.
In fatty areas or over major muscles - large breasts - or bony prominences.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.

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