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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 things should you do to assess cardiovascular status?
Second Left intercostal space
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

2. What is a chemical stress test (persantine stress test)?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

3. When would a nurse use an external 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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Air answers (open junctions)
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

4. What should you do if the PT value is 45 sec?
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.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
D/C the med and call the doctor.
Second right intercostal space

5. What SE should you look for with calcium channel blocker use?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

6. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Pulse before and after giving.
Right atrium - TRICUSPID VALVE (tissue) - right ventricle - PULMONIC VALVE (paper) - lungs - left atrium - MITRAL VALVE (My) - left ventricle - AORTIC VALVE (Assets). Tissue PAPER MY ASSETS!
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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

7. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Vitamin K (aqua myphiton)
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.
Clip hair if necessary - abrade the skin (use abrader pads or fine sandpaper and lightly rub skin using 2 or 3 brisk strokes - improves tracings) - dry skin if necessary - and attach the lead wires to the electrodes before you apply them to the patie

8. What should you explain to the patient about an impedance cardiography test?
The patient may suffer significant blood loss or femoral nerve compression.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
NO because it isn't sterile so keep out.
Before

9. What should be done immediately if a pulmonary embolism is suspected?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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.
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
Maintain BED REST

10. What are the 2 types of pacemakers?
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.
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.
Idiopathic
Lowers BP and makes heart beat stronger. SE: flushed face.

11. What should be done immediately for someone with PE?
Direct current cardioversion and digoxin/propranolol (inderal).
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.

12. What should you go when applying nitroglycerin ointment for angina?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.

13. What does the device for impedance cardiography consist of?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Second right intercostal space
A monitor with four dual electrodes that are applied to the patients neck and thorax.

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

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15. What is cardiac tamponade? Common causes?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Include rest periods prior to any activity.
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
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.

16. Where is the right ventricle landmark on the chest?
Left sternal border
Activity intolerance
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

17. What is the treatment for premature ventricular contractions?
In fatty areas or over major muscles - large breasts - or bony prominences.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

18. What is CVP? Normal?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Steroid treatment or a pregnant woman who is retaining water.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

19. What is superior vena cava syndrome?
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.
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.

20. Where should you place your stethescope to find the pulmonic valve?
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Second Left intercostal space
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.

21. How should you palpate the carotid arteries?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.
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-
One at a time to assess the pulse amplitude and contour.

22. What are the S&S of air embolism?
To inhibit thrombus and clot formation.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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.

23. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
Fat - Air - DVT - or Amniotic
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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

24. 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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.)
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.

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

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26. What is a assessment finding with DVT?

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27. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
An enlarged space indicates fluid accumulation in the pericardial sac.
Maintain BED REST
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.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

28. What are the indications for a chemical stress test (persantine stress test)?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Whether the patients ulnar and radial arteries are patent.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Patient who are unable to tolerate exercise stress testing.

29. What is epistaxis?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Second Right intercostal space.
A nosebleed
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

30. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
An enlarged space indicates fluid accumulation in the pericardial sac.

31. What needs to be held during the placement of a femoral artery compression device?
Fourth or fifth intercostal space at or medial to the midclavicular line.
NO because it isn't sterile so keep out.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
NO NSAIDS or ASA.

32. What should you teach your patient about angiography (arteriography)?
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.
Right sided heart failure
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.)
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

33. What are the steps for adult/child 1 rescuer CPR?
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
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).
BP is elevated or decreased depending on activity.

34. What is a good diagnosis for someone with right sided HF?
If feel more than 3 shocks in a row or develop signs of infection at the site.
(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.
Activity intolerance

35. What should be immediately done for a patient experiencing digoxin toxicity?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
The internal jugular veins (external are less reliable).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Iodine

36. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Protamine Sulfate

37. Which type of patient shouldn't take nitrates?
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.
No radial artery punctures if negative
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.

38. What is characteristic of atrial fibrillation?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

39. What is characteristic of ventricular tachycardia?
A nosebleed
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.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

40. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
The internal jugular veins (external are less reliable).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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.

41. What is a major complication of central line placement?
Pneumothorax and will end up with chest tube to help reinflate lung.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

42. What should you do to treat pulmonary edema?
Protamine Sulfate
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
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.
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

43. What is the treatment for someone in ventricular fibrillation?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

44. How does the blood flow through the heart? (valves?)
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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!
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.

45. What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated in
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

46. What factors place you at risk for HTN?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Lowers BP and makes heart beat stronger. SE: flushed face.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.

47. What are the nursing interventions for a patient in atrial fibrillation?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Second left intercostal space
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

48. Where is the pulmonic valve landmark on the chest?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Second left intercostal space
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.
Only for a few hours

49. What are the S&S associated with right sided heart failure?
Cannot
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

50. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Pneumothorax and will end up with chest tube to help reinflate lung.
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.

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NCLEX Cardiac

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