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 holter monitor?

2. Where should you place your stethescope to find the pulmonic valve?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Second Left intercostal space
A nosebleed

3. What should a patient do if they feel chest pain or discomfort?
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.
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
An inflammation of the pericardium. It may result in MI.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

4. What is characteristic of atrial fibrillation?
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
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).
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

5. Which type of patient shouldn't take nitrates?
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.

6. What are examples of calcium channel blockers?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Fifth left intercostal space medial to the midclavicular line.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Pulmonary edema

7. What are coumadin and heparin used for?
Second Right intercostal space.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Feeling warm (fire) or tin can taste is expected and will pass.
To inhibit thrombus and clot formation.

8. What is intermittent claudication?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

9. What is characteristic of ventricular tachycardia?
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Must be flushed 1x/month with heparin and between treatments.

10. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Before
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

11. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Iodine
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

12. 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
BP is elevated or decreased depending on activity.
Vitamin K (aqua myphiton)
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

13. In what locations should you not place electrodes?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
In fatty areas or over major muscles - large breasts - or bony prominences.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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

14. What are the S&S of pulmonary embolism?
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
An enlarged space indicates fluid accumulation in the pericardial sac.

15. What is important to remember when taking care of patients with compression devices?
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
Fat - Air - DVT - or Amniotic

16. What is a major complication of central line placement?
One large emboli (smaller=better)
Activity intolerance
Pneumothorax and will end up with chest tube to help reinflate lung.
Second Left intercostal space

17. What drugs are most commonly used for angina?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Nitrates - Beta blockers - and Calcium channel blockers
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
0.5-2.0 ng/ml

18. How should you palpate the carotid arteries?
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
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Include rest periods prior to any activity.
One at a time to assess the pulse amplitude and contour.

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

20. A femoral artery compression device ______be assigned to an NA?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Cannot
Only for a few hours
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

21. What will be the treatment for an acute episode of life threatening tamponade?
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).
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
NO because it isn't sterile so keep out.

22. Where should you place your stethescope to find the aortic valve?
Second Right intercostal space.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

23. Where is the aortic valve landmark on the chest?
Second right intercostal space
Chronic arteriosclerotic disease.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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

24. What SE should you look for with calcium channel blocker use?
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
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Patient who are unable to tolerate exercise stress testing.

25. What are common risk factors for an MI?
Idiopathic
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Steroid treatment or a pregnant woman who is retaining water.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

26. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
The patient may suffer significant blood loss or femoral nerve compression.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
If feel more than 3 shocks in a row or develop signs of infection at the site.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

27. What is characteristic of ventricular fibrillation?
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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
Activity intolerance

28. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
NO NSAIDS or ASA.

29. What is the antidote for coumadin?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Vitamin K (aqua myphiton)

30. What is the treatments for hypertension?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.)
Check for response - activate ERS - open airway head tilt chin lift - check breathing (5-10 sec) - give 2 breaths (1 sec) with visible chest rise - checks brachial pulse (5-10 sec) - locates CPR finger position - deliver 1st cycle of compressions (30
Decrease in weight - diuretics (watch K loss) - aldactone (k sparing but check renal fx) - inderal (do Not give to asthma patients or diabetic patients) - more exercise - no smoking - and decreased Na intake.

31. What should you teach someone with arterial insufficiency?

32. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Right sided heart failure
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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

33. What is the antidote for heparin?
Protamine Sulfate
Include rest periods prior to any activity.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

34. What is a assessment finding with DVT?

35. What disease can cause right sided heart failure?
4th left intercostal space lower sternal border
Lung disease
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
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.

36. What are the proper steps to changing a central venous catheter dressing?
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-
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
Air answers (open junctions)
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.)

37. What are the treatments/ S&S of peripheral venous disease?
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.
D/C the med and call the doctor.
In fatty areas or over major muscles - large breasts - or bony prominences.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

38. What is Raynauds disease? Tx?
NO NSAIDS or ASA.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
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.

39. What are the nursing interventions for a pt. with ventricular tachycardia?
Patient who are unable to tolerate exercise stress testing.
Maintain BED REST
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

40. What should you teach your patient about MRI?
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.
D/C the med and call the doctor.
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
One at a time to assess the pulse amplitude and contour.

41. What should you do immediately if you suspect someone of developing a hematoma?
NO NSAIDS or ASA.
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

42. What are the nursing interventions for a patient with premature ventricular contractions?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

43. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
A nosebleed
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.

44. What should be done for someone on bleeding precautions?
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
In fatty areas or over major muscles - large breasts - or bony prominences.

45. What is characteristic of premature ventricular contractions?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.

46. What is cardioversion?

47. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Pulmonary edema
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

48. What should you explain to the patient about an impedance cardiography test?
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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

49. What should you observe for in someone on bleeding precautions?
4th left intercostal space lower sternal border
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).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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

50. 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.
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
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.
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.