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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 do calcium channel blockers do?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
Open up blood vessels
Iodine

2. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Poorly controlled hypertension
Air answers (open junctions)

3. What should you always assume with a patient who has a central line placed and is experiencing SOB?
The patient may suffer significant blood loss or femoral nerve compression.
Air embolism
Air answers (open junctions)
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

4. What is characteristic of ventricular fibrillation?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
If feel more than 3 shocks in a row or develop signs of infection at the site.

5. What is the nursing care associated with chemical stress tests (persantine stress test)?
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-
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

6. What is more harmful a lot of little emboli or one large emboli?
(S1 - S2) Third left intercostal space
One large emboli (smaller=better)
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Pulse before and after giving.

7. What should happen if someone converts to asystole/flatline?
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!
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

8. What is the purpose of compression devices?
(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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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

9. What is a therapeutic digoxin level?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
0.5-2.0 ng/ml
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

10. Where should you place your stethescope to find the mitral (apex) valve?
Fifth left intercostal space medial to the midclavicular line.
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 monitor with four dual electrodes that are applied to the patients neck and thorax.
Activity intolerance

11. What are the nursing interventions for a patient in atrial fibrillation?
In fatty areas or over major muscles - large breasts - or bony prominences.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
In the first 72 hours!!!!!
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

12. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.

13. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
The patient may suffer significant blood loss or femoral nerve compression.
4th left intercostal space lower sternal border
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.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

14. Where should you place your stethescope to find the tricuspid valve?
Vitamin K (aqua myphiton)
4th left intercostal space lower sternal border
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

15. What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
0.5-2.0 ng/ml
A nosebleed
Must be flushed 1x/month with heparin and between treatments.

16. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Include rest periods prior to any activity.
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-
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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

17. What are the S&S of superior vena cava syndrome?
Open up blood vessels
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
Fat - Air - DVT - or Amniotic
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

18. What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

19. What should you teach your patient about an electrocardiogram (ECG)?
Lower left sternal border
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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.
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

20. What should be done immediately if a pulmonary embolism is suspected?
Whether the patients ulnar and radial arteries are patent.
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!
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.
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

21. What should be done for someone on bleeding precautions?
Maintain BED REST
The internal jugular veins (external are less reliable).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
In fatty areas or over major muscles - large breasts - or bony prominences.

22. What is cardioversion?

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23. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Steroid treatment or a pregnant woman who is retaining water.
An inflammation of the pericardium. It may result in MI.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

24. What is labile hypertension?
BP is elevated or decreased depending on activity.
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
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.
Open up blood vessels

25. What should you teach your patient about an exercise ECG (stress test)?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
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 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-

26. For which heart sounds should the bell be used?
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

27. What is the treatments for hypertension?
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
To inhibit thrombus and clot formation.
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.

28. What is an acute peripheral arterial occlusion?
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.
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Idiopathic

29. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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!
Maintain BED REST
Before
An enlarged space indicates fluid accumulation in the pericardial sac.

30. What is a nursing diagnosis for arterial occlusion? Tx
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
One at a time to assess the pulse amplitude and contour.

31. What are the steps for adult 2 rescuer CPR?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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

32. What will a leg with arterial insufficiency look like?
D/C the med and call the doctor.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

33. What should you watch for with PICC lines that have been in place for 6 months?
Activity intolerance
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.
Air answers (open junctions)
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

34. What is important to remember when taking care of patients with compression devices?
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
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

35. What is intermittent claudication?
Feeling warm (fire) or tin can taste is expected and will pass.
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.
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.
Maintain BED REST

36. What is defibrillation?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.

37. Where is the tricuspid valve landmark on the chest?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Lower left sternal border
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.
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

38. What does plan of care include?
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.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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

39. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Idiopathic
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

40. What is the hallmark clinical finding associated with pericarditis?
One at a time to assess the pulse amplitude and contour.
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Protamine Sulfate

41. What body systems are affected by digoxin toxicity? S&S?
NO because it isn't sterile so keep out.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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

42. How is angina treated?

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43. Where should you place your stethescope to find the aortic valve?
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
Second Right intercostal space.
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

44. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
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

45. In What time period is the greatest risk of sudden death from an MI?
Direct current cardioversion and digoxin/propranolol (inderal).
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
In the first 72 hours!!!!!
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

46. During an Allen's test don't compress one artery _____ the other.
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
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.
Before
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

47. What needs to be held during the placement of a femoral artery compression device?
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.
NO NSAIDS or ASA.
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

48. What does the device for impedance cardiography consist of?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
The patient may suffer significant blood loss or femoral nerve compression.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

49. What is a assessment finding with DVT?

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50. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Maintain BED REST
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Direct current cardioversion and digoxin/propranolol (inderal).
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.