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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. Test ending in Gram=?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Air embolism
Iodine
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

2. What will be the treatment for an acute episode of life threatening tamponade?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Pulmonary edema
4th left intercostal space lower sternal border
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

3. What is the treatments for hypertension?
Direct current cardioversion and digoxin/propranolol (inderal).
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.
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

4. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Pulmonary edema
Whether the patients ulnar and radial arteries are patent.
Air embolism

5. 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
NO because it isn't sterile so keep out.
Chronic arteriosclerotic disease.

6. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
Left 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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

7. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Must be flushed 1x/month with heparin and between treatments.
Pulse before and after giving.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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

8. What things should you do to assess cardiovascular status?
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.
D/C the med and call the doctor.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

9. What are signs and symptoms of an MI?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Pulmonary edema

10. What do calcium channel blockers do?
Open up blood vessels
Maintain BED REST
Only for a few hours
Include rest periods prior to any activity.

11. What should you teach your patient about angiography (arteriography)?
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.
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
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
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.

12. Without prompt surgery for an aortic dissection What is someone at risk for developing?
One large emboli (smaller=better)
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

13. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
4th left intercostal space lower sternal border

14. What is the treatment for a pt. with ventricular tachycardia?
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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
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.

15. What is labile hypertension?
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
BP is elevated or decreased depending on activity.

16. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
BP is elevated or decreased depending on activity.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

17. What should you not allow if a patient has a negative Allen's test?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
No radial artery punctures if negative
One at a time to assess the pulse amplitude and contour.
Protamine Sulfate

18. What places someone at risk for an aortic dissection?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Poorly controlled hypertension
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

19. What should you do if the PT value is 45 sec?
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.
D/C the med and call the doctor.
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
Idiopathic

20. What is intermittent claudication?
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.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Lung disease
If feel more than 3 shocks in a row or develop signs of infection at the site.

21. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Lung disease
Lower left sternal border
Right sided heart failure

22. 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
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.
Activity intolerance
Fifth left intercostal space medial to the midclavicular line.

23. What signals an elevated venous pressure based on the internal jugular veins?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.

24. What are the indications for a chemical stress test (persantine stress test)?
Protamine Sulfate
Don't interfere!
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Patient who are unable to tolerate exercise stress testing.

25. 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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

26. How long is contrast media in the body?
Only for a few hours
The patient may suffer significant blood loss or femoral nerve compression.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

27. What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Steroid treatment or a pregnant woman who is retaining water.
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
Include rest periods prior to any activity.

28. 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).
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
Whether the patients ulnar and radial arteries are patent.
This noninvasive test takes 24 hours and causes no discomfort. Electrodes are applied to your body - you need to log your activities for a 24 hour period (walking - sleeping - urinating - physical symptoms - and medications). Don't tamper with the mo

29. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Vascular - artery disease causing fluid to back up into the lungs.
Iodine
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

30. What are the nursing interventions for a pt. with ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

31. What should you teach your patient about an electrocardiogram (ECG)?
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
Idiopathic
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
Lowers BP and makes heart beat stronger. SE: flushed face.

32. What disease can cause right sided heart failure?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Lung disease
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Open up blood vessels

33. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
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
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!
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

34. What does a swan ganz measure?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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
(S1 - S2) Third left intercostal space
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

35. What is the most common cause of arterial insufficiency?
NO because it isn't sterile so keep out.
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
Chronic arteriosclerotic disease.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

36. 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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.

37. What is a good diagnosis for someone with right sided HF?
Activity intolerance
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!
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

38. What is defibrillation?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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 drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

39. What should be checked in a patient on a beta blocker?
Before
Pulse before and after giving.
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 S&S of decreased cardiac output and Notify physician (2nd).

40. Should the tubing for a venous access port be included under the dressing site?

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41. What is impedance cardiography?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.

42. What is a assessment finding with DVT?

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43. What should you tell someone about taking nitroglycerin tablets (SE)?
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.
Only for a few hours
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.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

44. What are the S&S of cardiac tamponade?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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).

45. What can result from left sided heart failure if left untreated?
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.
Pulmonary edema

46. What are the steps for adult/child 1 rescuer CPR?
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 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.
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
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

47. What is pulsus paradoxus?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
D/C the med and call the doctor.

48. What is the treatment for someone with right sided HF? How do you know working?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
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.)

49. What are the S&S of air embolism?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

50. How is angina treated?

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