Test your basic knowledge |

NCLEX Cardiac

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. During an Allen's test don't compress one artery _____ the other.
Before
If feel more than 3 shocks in a row or develop signs of infection at the site.
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!
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

2. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

3. What is defibrillation?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Fat - Air - DVT - or Amniotic
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
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.

4. What is the treatment for atrial fibrillation?
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
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
Don't interfere!
Direct current cardioversion and digoxin/propranolol (inderal).

5. What should be done immediately if a pulmonary embolism is suspected?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and 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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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

6. What are the treatments/ S&S of peripheral venous disease?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

7. What things should you do to assess cardiovascular status?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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. Where is the tricuspid valve landmark on the chest?
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
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.
Left sternal border
Lower left sternal border

9. What should you do if the PT value is 45 sec?
Only for a few hours
Lower left sternal border
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
D/C the med and call the doctor.

10. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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-
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

11. What are the nursing interventions for a pt. with ventricular tachycardia?
Poorly controlled hypertension
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Don't interfere!
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

12. What are the nursing interventions for a patient in atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
0.5-2.0 ng/ml
Whether the patients ulnar and radial arteries are patent.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

13. What are the steps for adult/child 1 rescuer CPR?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

14. What condition can cause left sided heart failure?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Vascular - artery disease causing fluid to back up into the lungs.
Must be flushed 1x/month with heparin and between treatments.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

15. Where should you place your stethescope to find the mitral (apex) valve?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Fifth left intercostal space medial to the midclavicular line.
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

16. Who would most likely have peripheral venous disease?
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Old truck driver or someone on bed rest or with pelvic trauma.
Open up blood vessels

17. What is the correct way to insert an oropharyngeal airway?
4th left intercostal space lower sternal border
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
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

18. What signals an elevated venous pressure based on the internal jugular veins?
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.
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

19. How do you prepare a patient for Impedance cardiography monitoring?
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).
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

20. What is the antidote for coumadin?
No radial artery punctures if negative
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Vitamin K (aqua myphiton)
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

21. For which heart sounds should the diaphragm be used?
Only for a few hours
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.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

22. What drugs are most commonly used for angina?
Nitrates - Beta blockers - and Calcium channel blockers
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
No radial artery punctures if negative

23. What does an Allen's test determine?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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
In the first 72 hours!!!!!
Whether the patients ulnar and radial arteries are patent.

24. What should you observe for in someone on bleeding precautions?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Direct current cardioversion and digoxin/propranolol (inderal).
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).

25. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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
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.
Protamine Sulfate
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

26. What should you go when applying nitroglycerin ointment for angina?
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.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Maintain BED REST
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

27. How does the blood flow through the heart? (valves?)
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.
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
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.
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!

28. What is the hallmark clinical finding associated with pericarditis?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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.
Don't interfere!
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.

29. In What time period is the greatest risk of sudden death from an MI?
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
In the first 72 hours!!!!!
D/C the med and call the doctor.
The internal jugular veins (external are less reliable).

30. What is a nursing diagnosis for arterial occlusion? Tx
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
A nosebleed
Second Right intercostal space.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

31. Test ending in Gram=?
Iodine
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
Whether the patients ulnar and radial arteries are patent.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

32. Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
The internal jugular veins (external are less reliable).
Lower left sternal border
Fourth or fifth intercostal space at or medial to the midclavicular line.

33. What are the signs and symptoms of left sided HF?
Must be flushed 1x/month with heparin and between treatments.
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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

34. What is an aortic dissection?

35. If a victim is choking but can cough - speak - or breath what should you do?

36. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Include rest periods prior to any activity.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

37. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Open up blood vessels
Second left intercostal space
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.
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

38. What should you teach your patient about MRI?
Lung disease
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

39. What should you teach your patient about a cardiac catheterization?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Fifth left intercostal space medial to the midclavicular line.
Open up blood vessels
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

40. What are the S&S associated with right sided heart failure?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Old truck driver or someone on bed rest or with pelvic trauma.

41. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

42. Where is the right ventricle landmark on the chest?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
The patient may suffer significant blood loss or femoral nerve compression.
Left sternal border
One large emboli (smaller=better)

43. How should you palpate the carotid arteries?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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
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.
One at a time to assess the pulse amplitude and contour.

44. What is the antidote for heparin?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Air answers (open junctions)
Protamine Sulfate
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. What are the 2 types of pacemakers?
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.
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.
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!
The patient may suffer significant blood loss or femoral nerve compression.

46. What is a good diagnosis for someone with right sided HF?
Before
Activity intolerance
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

47. What is a therapeutic digoxin level?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
0.5-2.0 ng/ml
Idiopathic
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

48. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Whether the patients ulnar and radial arteries are patent.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.
Pneumothorax and will end up with chest tube to help reinflate lung.

49. What is the treatment for someone with right sided HF? How do you know working?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

50. What is cardiac tamponade? Common causes?
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!