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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 do to treat pulmonary edema?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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
Maintain BED REST
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

2. How should you palpate the carotid arteries?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
One at a time to assess the pulse amplitude and contour.
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
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

3. What is the treatment for a pt. with ventricular tachycardia?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
If feel more than 3 shocks in a row or develop signs of infection at the site.
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.
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

4. What should be done immediately for someone with PE?
Iodine
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Vitamin K (aqua myphiton)

5. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
Second Left intercostal space

6. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
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
Pneumothorax and will end up with chest tube to help reinflate lung.
Maintain BED REST
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

7. During an Allen's test don't compress one artery _____ the other.
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.
Chronic arteriosclerotic disease.
Before
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

8. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
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
Lower left sternal border
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

9. 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
In the first 72 hours!!!!!
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

10. In what locations should you not place electrodes?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Patient who are unable to tolerate exercise stress testing.
Old truck driver or someone on bed rest or with pelvic trauma.
In fatty areas or over major muscles - large breasts - or bony prominences.

11. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
No radial artery punctures if negative

12. What should you go when applying nitroglycerin ointment for angina?
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
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
Lower left sternal border

13. Where should you place your stethescope to find the tricuspid valve?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
4th left intercostal space lower sternal border

14. What is pericarditis?
Pneumothorax and will end up with chest tube to help reinflate lung.
To inhibit thrombus and clot formation.
An inflammation of the pericardium. It may result in MI.
Fat - Air - DVT - or Amniotic

15. What are the four types of pulmonary emboli?
Air embolism
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Fat - Air - DVT - or Amniotic
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

16. Where is the apex/mitral valve landmark on the chest?
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

17. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

18. When should you be concerned about premature ventricular contraction?
The internal jugular veins (external are less reliable).
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.
Lower left sternal border
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

19. What is the treatment for someone in ventricular fibrillation?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Cannot
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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

20. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
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!
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

21. What is the treatment for premature ventricular contractions?
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.
Don't interfere!
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

22. What are examples of calcium channel blockers?
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.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

23. For what disease should you do the Allen's test?

24. What should a patient do if they feel chest pain or discomfort?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
To inhibit thrombus and clot formation.
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

25. What is an air embolism?
D/C the med and call the doctor.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
One large emboli (smaller=better)

26. Who would most likely have peripheral venous disease?
Iodine
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.
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

27. What is a chemical stress test (persantine stress test)?
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.
Fifth left intercostal space medial to the midclavicular line.
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.
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

28. What should you do if the PT value is 45 sec?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
D/C the med and call the doctor.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

29. What are coumadin and heparin used for?
ST segment elevation (STEMI)
To inhibit thrombus and clot formation.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Second left intercostal space

30. What is Raynauds disease? Tx?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
In the first 72 hours!!!!!
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.

31. What should you teach your patient about MRI?
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.
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).
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

32. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Put on gloves - remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose - squeeze the prescribed ointment in a thin layer onto a clean ruled application paper - choose an unused site on the ches
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
4th left intercostal space lower sternal border

33. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
D/C the med and call the doctor.
Maintain BED REST
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

34. What is cardioversion?

35. What makes the symptoms of superior vena cava syndrome better? Worse?
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.
No radial artery punctures if negative
One large emboli (smaller=better)
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

36. Where do the internal jugular veins lie?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

37. What condition can cause left sided heart failure?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Vascular - artery disease causing fluid to back up into the lungs.
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.
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.

38. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
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.
Pulmonary edema
One large emboli (smaller=better)
Poorly controlled hypertension

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

40. What is characteristic of premature ventricular contractions?
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.
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Protamine Sulfate

41. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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
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.
Air embolism
Direct current cardioversion and digoxin/propranolol (inderal).

42. What landmarks should you be looking for on someone's chest?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Second right 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.
Include rest periods prior to any activity.

43. What should you observe for in someone on bleeding precautions?
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).
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
Vascular - artery disease causing fluid to back up into the lungs.
Only for a few hours

44. What does the device for impedance cardiography consist of?
ST segment elevation (STEMI)
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A monitor with four dual electrodes that are applied to the patients neck and thorax.

45. What disease can cause right sided heart failure?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Pulse before and after giving.
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.
Lung disease

46. What is impedance cardiography?
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.
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

47. 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.
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
0.5-2.0 ng/ml

48. What is the hallmark clinical finding associated with pericarditis?
Second Right 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.
Must be flushed 1x/month with heparin and between treatments.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

49. What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

50. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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
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.