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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 should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
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
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

2. Where is the right ventricle landmark on the chest?
Left sternal border
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
NO because it isn't sterile so keep out.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

3. What should be checked in a patient on a beta blocker?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Pulse before and after giving.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

4. For which heart sounds should the bell be used?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
4th left intercostal space lower sternal border

5. What causes essential/primary hypertension?
Feeling warm (fire) or tin can taste is expected and will pass.
Idiopathic
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
Second right intercostal space

6. What are coumadin and heparin used for?
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
Only for a few hours
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
To inhibit thrombus and clot formation.

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

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8. What is the antidote for coumadin?
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-
Vitamin K (aqua myphiton)
Cannot
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.

9. How is angina treated?

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10. What are the S&S of pulmonary embolism?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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
Before
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

11. What should you teach your patient about an abdominal ultrasonography?
Steroid treatment or a pregnant woman who is retaining water.
Air embolism
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
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

12. What should be immediately done for a patient experiencing digoxin toxicity?
An inflammation of the pericardium. It may result in MI.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

13. What is the purpose of compression devices?
BP is elevated or decreased depending on activity.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Don't interfere!

14. What landmarks should you be looking for on someone's chest?
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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 right intercostal space

15. What condition can cause left sided heart failure?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Fifth left intercostal space medial to the midclavicular line.
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
Vascular - artery disease causing fluid to back up into the lungs.

16. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Activity intolerance

17. What is a good diagnosis for someone with right sided HF?
Protamine Sulfate
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Activity intolerance
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.

18. What factors place you at risk for HTN?
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Must be flushed 1x/month with heparin and between treatments.
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.

19. What are the S&S of aortic dissection?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Open up blood vessels
Must be flushed 1x/month with heparin and between treatments.

20. What is characteristic of ventricular fibrillation?
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.
BP is elevated or decreased depending on activity.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Old truck driver or someone on bed rest or with pelvic trauma.

21. What are the steps for adult/child 1 rescuer CPR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Fat - Air - DVT - or Amniotic
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
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

22. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Second Left intercostal space
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

23. What are all the S&S of pericarditis?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Vitamin K (aqua myphiton)

24. What places someone at risk for an aortic dissection?
Open up blood vessels
Poorly controlled hypertension
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

25. If a victim is choking but can cough - speak - or breath what should you do?

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26. What are the S&S of cardiac tamponade?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
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
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

27. What should you not allow if a patient has a negative Allen's test?
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 radial artery punctures if negative
One at a time to assess the pulse amplitude and contour.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

28. What should you do if the PTT value is 80 for someone on heparin?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
D/C the med and call the doctor.
Steroid treatment or a pregnant woman who is retaining water.

29. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
Air embolism
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.
A nosebleed
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.

30. What would make someone more at risk for digoxin toxicity?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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
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.
Include rest periods prior to any activity.

31. What is the treatment for atrial fibrillation?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Direct current cardioversion and digoxin/propranolol (inderal).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

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

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33. When should bleeding precautions be implemented?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
One at a time to assess the pulse amplitude and contour.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.

34. What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

35. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Maintain BED REST
Vascular - artery disease causing fluid to back up into the lungs.
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.

36. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

37. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
Pneumothorax and will end up with chest tube to help reinflate lung.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.

38. What do calcium channel blockers do?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Air answers (open junctions)
No radial artery punctures if negative
Open up blood vessels

39. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Iodine
Include rest periods prior to any activity.
Second right intercostal space
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

40. For which heart sounds should the diaphragm be used?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Steroid treatment or a pregnant woman who is retaining water.

41. What are the nursing interventions for a pt. with ventricular tachycardia?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Fifth left intercostal space medial to the midclavicular line.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

42. When would a nurse use an external femoral artery compression device?
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.
Iodine
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

43. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
Cannot
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

44. What is Raynauds disease? Tx?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Iodine
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.

45. What should you teach your patient about a cardiac catheterization?
Iodine
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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

46. What is the treatment for myocardial infarction?
Feeling warm (fire) or tin can taste is expected and will pass.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

47. What should you observe for in someone on bleeding precautions?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Pneumothorax and will end up with chest tube to help reinflate lung.
D/C the med and call the doctor.
Hematuria (tea or coca cola colored) - nosebleeds - gingival bleeding (no medicated mouth wash - flossing - or lemon glycerin swabs) - and bruising (assess for abuse w/o caregiver).

48. What are the steps to perform the heimlich maneuver?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
Air answers (open junctions)
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

49. What is defibrillation?
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.
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
Lung disease
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.

50. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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.
Hematuria (tea or coca cola colored) - nosebleeds - gingival bleeding (no medicated mouth wash - flossing - or lemon glycerin swabs) - and bruising (assess for abuse w/o caregiver).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
The internal jugular veins (external are less reliable).