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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 are examples of calcium channel blockers?
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.

2. What should a patient do if they feel chest pain or discomfort?
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

3. What should you teach your patient about an abdominal ultrasonography?
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
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.
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.
Include rest periods prior to any activity.

4. What type of EKG change indicates MI?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
ST segment elevation (STEMI)
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

5. How do you prepare a patient for Impedance cardiography monitoring?
Poorly controlled hypertension
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Left sternal border
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

6. What should be done for someone on bleeding precautions?
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer - hurts more - etc.)
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.
One large emboli (smaller=better)
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

7. What is the antidote for coumadin?
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
Vitamin K (aqua myphiton)

8. What is the treatment for someone with right sided HF? How do you know working?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
BP is elevated or decreased depending on activity.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

9. Where is the right ventricle landmark on the chest?
Direct current cardioversion and digoxin/propranolol (inderal).
Left sternal border
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

10. What things should you do to assess cardiovascular status?
Vitamin K (aqua myphiton)
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

11. What places someone at risk for an aortic dissection?
An inflammation of the pericardium. It may result in MI.
Poorly controlled hypertension
Patient who are unable to tolerate exercise stress testing.
Old truck driver or someone on bed rest or with pelvic trauma.

12. Where is the pulmonic valve landmark on the chest?
0.5-2.0 ng/ml
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
Second left intercostal space
Fifth left intercostal space medial to the midclavicular line.

13. What will a leg with arterial insufficiency look like?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
One large emboli (smaller=better)
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

14. What are the steps to perform the heimlich maneuver?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
Only for a few hours
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

15. What are the S&S of cardiac tamponade?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Protamine Sulfate

16. What is important to remember when removing a CVC from a patient?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
4th left intercostal space lower sternal border
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.

17. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
One large emboli (smaller=better)
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.
Whether the patients ulnar and radial arteries are patent.

18. What are the treatments/ S&S of peripheral venous disease?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD

19. Where is the aortic valve landmark on the chest?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Second right intercostal space
An enlarged space indicates fluid accumulation in the pericardial sac.

20. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
In the first 72 hours!!!!!
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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

21. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
Vitamin K (aqua myphiton)
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.

22. What should you not allow if a patient has a negative Allen's test?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
No radial artery punctures if negative
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

23. What are the five areas for listening to the heart?

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24. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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

25. When would a nurse use an external femoral artery compression device?
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
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

26. What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Cannot

27. What should be done immediately if a pulmonary embolism is suspected?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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
Maintain BED REST
Idiopathic

28. What should you tell someone about taking nitroglycerin tablets (SE)?
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
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.
In fatty areas or over major muscles - large breasts - or bony prominences.
Pulmonary edema

29. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Chronic arteriosclerotic disease.
Left sternal border
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

30. What is the correct way to insert an oropharyngeal airway?
Right sided heart failure
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
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
Old truck driver or someone on bed rest or with pelvic trauma.

31. What will be the treatment for an acute episode of life threatening tamponade?
Second left intercostal space
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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 clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

32. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Right sided heart failure
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.
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

33. What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
One large emboli (smaller=better)
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

34. What are the S&S of air embolism?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Pulmonary edema
Only for a few hours

35. A femoral artery compression device ______be assigned to an NA?
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.
Direct current cardioversion and digoxin/propranolol (inderal).
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

36. What disease can cause right sided heart failure?
Lung disease
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
ST segment elevation (STEMI)
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

37. What type of surgery is done for an aortic dissection?
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
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.
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-
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

38. What makes the symptoms of superior vena cava syndrome better? Worse?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

39. What should you watch for with PICC lines that have been in place for 6 months?
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.
In the first 72 hours!!!!!
Lower left sternal border
Air answers (open junctions)

40. How should you palpate the apical pulse?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.

41. What is epistaxis?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
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
A nosebleed

42. What is Raynauds disease? Tx?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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.

43. What should you do if the PTT value is 80 for someone on heparin?
Pneumothorax and will end up with chest tube to help reinflate lung.
D/C the med and call the doctor.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Activity intolerance

44. What is a chemical stress test (persantine stress test)?
Feeling warm (fire) or tin can taste is expected and will pass.
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

45. Where should you place your stethescope to find the aortic valve?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Fat - Air - DVT - or Amniotic
Second Right intercostal space.

46. What should you teach someone with arterial insufficiency?

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47. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
Whether the patients ulnar and radial arteries are patent.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

48. What is an aortic dissection?

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49. What is Deep Vein Thrombosis (DVT)?
Must be flushed 1x/month with heparin and between treatments.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

50. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
The internal jugular veins (external are less reliable).
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

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NCLEX Cardiac

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