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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 teach your patient about a holter monitor?

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2. What landmarks should you be looking for on someone's chest?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Lowers BP and makes heart beat stronger. SE: flushed face.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

3. What causes essential/primary hypertension?
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-
Idiopathic
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

4. What SE should you look for with calcium channel blocker use?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

5. What is the purpose of compression devices?
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.
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

6. What are the steps to perform the heimlich maneuver?
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
Maintain BED REST
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

7. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
0.5-2.0 ng/ml
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

8. What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
Vascular - artery disease causing fluid to back up into the lungs.
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

9. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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.)
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

10. What are the indications for a chemical stress test (persantine stress test)?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Patient who are unable to tolerate exercise stress testing.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

11. What should a patient do if they feel chest pain or discomfort?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Iodine
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
In the first 72 hours!!!!!

12. 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.
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
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Left sternal border

13. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
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.
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

14. What is the goal of treatment for an MI? Treatment?
Nitrates - Beta blockers - and Calcium channel blockers
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
To inhibit thrombus and clot formation.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

15. How is angina treated?

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16. How should you palpate the apical pulse?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

17. What is the maintenance for venous access port that isn't being regularly used?
(S1 - S2) Third left intercostal space
Must be flushed 1x/month with heparin and between treatments.
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.
Right sided heart failure

18. What is the antidote for coumadin?
Vitamin K (aqua myphiton)
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

19. What is labile hypertension?
Pulmonary edema
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
D/C the med and call the doctor.
BP is elevated or decreased depending on activity.

20. What are the nursing interventions for a pt. with ventricular tachycardia?
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.
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
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

21. What will be the treatment for an acute episode of life threatening tamponade?
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.
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
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

22. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Maintain BED REST
Nitrates - Beta blockers - and Calcium channel blockers
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.

23. What should be immediately done for a patient experiencing digoxin toxicity?
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

24. Which type of patient shouldn't take nitrates?
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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

25. What disease can cause right sided heart failure?
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.
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
Old truck driver or someone on bed rest or with pelvic trauma.

26. What is an aortic dissection?

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27. What do calcium channel blockers do?
Open up blood vessels
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Must be flushed 1x/month with heparin and between treatments.

28. What is more harmful a lot of little emboli or one large emboli?
Vitamin K (aqua myphiton)
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
Air answers (open junctions)
One large emboli (smaller=better)

29. What are the S&S associated with right sided heart failure?
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.
Nitrates - Beta blockers - and Calcium channel blockers
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.

30. Who would most likely have peripheral venous disease?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Old truck driver or someone on bed rest or with pelvic trauma.
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

31. What are the nursing interventions for a patient in complete heart block?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
An enlarged space indicates fluid accumulation in the pericardial sac.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

32. What does a swan ganz measure?
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
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

33. Where should you place your stethescope to find the mitral (apex) valve?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Second Right intercostal space.
Fifth left intercostal space medial to the midclavicular line.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

34. What is important to remember when removing a CVC from a patient?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Fourth or fifth intercostal space at or medial to the midclavicular line.

35. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
In the first 72 hours!!!!!
NO because it isn't sterile so keep out.
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.
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.

36. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

37. 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.
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.
Feeling warm (fire) or tin can taste is expected and will pass.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

38. What is an air embolism?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Patient who are unable to tolerate exercise stress testing.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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 patient with premature ventricular contractions?
0.5-2.0 ng/ml
No radial artery punctures if negative
Clip hair if necessary - abrade the skin (use abrader pads or fine sandpaper and lightly rub skin using 2 or 3 brisk strokes - improves tracings) - dry skin if necessary - and attach the lead wires to the electrodes before you apply them to the patie
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

40. What is a chemical stress test (persantine stress test)?
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
The patient may suffer significant blood loss or femoral nerve compression.
One large emboli (smaller=better)
Second Left intercostal space

41. What is epistaxis?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
An enlarged space indicates fluid accumulation in the pericardial sac.
A nosebleed

42. What signals an elevated venous pressure based on the internal jugular veins?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

43. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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.
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

44. What are all the S&S of pericarditis?
Maintain BED REST
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.
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.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

45. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
An inflammation of the pericardium. It may result in MI.
NO because it isn't sterile so keep out.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

46. What is the correct way to insert an oropharyngeal airway?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

47. What are the S&S of superior vena cava syndrome?
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
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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
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.

48. What is CVP? Normal?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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.
Nitrates - Beta blockers - and Calcium channel blockers
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

49. What is a assessment finding with DVT?

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50. When would a nurse use an external femoral artery compression device?
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT In DIET (don't avoid all fat) - lose weight - exercise - limit salt intake - nitro - Angioplasty (stent insertion) or CABG.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!