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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 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.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular 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

2. Where is the right ventricle landmark on the chest?
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.
Left sternal border
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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.

3. Where is the aortic valve landmark on the chest?
Second right intercostal space
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.

4. What is pericarditis?
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-
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
(S1 - S2) Third left intercostal space
An inflammation of the pericardium. It may result in MI.

5. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Air embolism
Second Right intercostal space.
Before
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

6. What are examples of calcium channel blockers?
If feel more than 3 shocks in a row or develop signs of infection at the site.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Maintain BED REST

7. What are the nursing interventions for a patient in atrial fibrillation?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Must be flushed 1x/month with heparin and between treatments.
Whether the patients ulnar and radial arteries are patent.

8. What is the antidote for heparin?
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
Activity intolerance
Protamine Sulfate

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

10. What usually triggers angina pain?
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking - avoid stress & cold - use a vasodilator (calcium channel blocker). No skiing or butcher for career.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Cannot
ST segment elevation (STEMI)

11. Where should you place your stethescope to find the tricuspid valve?
Fifth left intercostal space medial to the midclavicular line.
4th left intercostal space lower sternal border
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Feeling warm (fire) or tin can taste is expected and will pass.

12. What is the treatment for a pt. with ventricular tachycardia?
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.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.

13. What are the four types of pulmonary emboli?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Fat - Air - DVT - or Amniotic
One at a time to assess the pulse amplitude and contour.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

14. What are the treatments/ S&S of peripheral venous disease?
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.
Cannot
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

15. 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.
Don't interfere!
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Left sternal border

16. What should you teach your patient about a cardiac catheterization?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
Left sternal border
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

17. What is labile hypertension?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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!
BP is elevated or decreased depending on activity.

18. What is cardioversion?

19. How is angina treated?

20. What should a patient do if they feel chest pain or discomfort?
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table
0.5-2.0 ng/ml
An enlarged space indicates fluid accumulation in the pericardial sac.
Nitrates - Beta blockers - and Calcium channel blockers

21. What is pulsus paradoxus?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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

22. For which heart sounds should the bell be used?
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

23. What is the treatment for atrial fibrillation?
NO NSAIDS or ASA.
Direct current cardioversion and digoxin/propranolol (inderal).
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

24. What are the steps for infant 1&2 rescuer CPR?
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
NO NSAIDS or ASA.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.

25. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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

26. 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?
Protamine Sulfate
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

27. What is a chemical stress test (persantine stress test)?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Patient who are unable to tolerate exercise stress testing.
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

28. Who would most likely have peripheral venous disease?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
Old truck driver or someone on bed rest or with pelvic trauma.
D/C the med and call the doctor.

29. What is superior vena cava syndrome?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
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.
Air answers (open junctions)
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.

30. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Second Left intercostal space
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
An enlarged space indicates fluid accumulation in the pericardial sac.

31. How long is contrast media in the body?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Only for a few hours

32. How is the Allen's test done?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

33. What are the two common complications of pericarditis?
Don't interfere!
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
The internal jugular veins (external are less reliable).

34. What should you go when applying nitroglycerin ointment for angina?
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

35. Where is the apex/mitral valve landmark on the chest?
An enlarged space indicates fluid accumulation in the pericardial sac.
Fourth or fifth intercostal space at or medial to the midclavicular line.
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
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.

36. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
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
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
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.

37. 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.
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
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Patient who are unable to tolerate exercise stress testing.

38. What should you always assume with a patient who has a central line placed and is experiencing SOB?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
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.
Air embolism

39. What landmarks should you be looking for on someone's chest?
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.
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.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

40. What should you teach a patient regarding discharge after a DVT?

41. For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Second Left intercostal space
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

42. What is epistaxis?
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.)
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).
A nosebleed

43. What are the nursing interventions for a pt. with ventricular tachycardia?
Second Left intercostal space
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
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

44. What is the treatment for someone with right sided HF? How do you know working?
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.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
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.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

45. What are the 2 types of pacemakers?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

46. During an Allen's test don't compress one artery _____ the other.
0.5-2.0 ng/ml
Activity intolerance
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Before

47. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
0.5-2.0 ng/ml
Lower left sternal border
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

48. What should you do to treat pulmonary edema?
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
Stop What they are doing - sit down and rest - if prescribed nitroglycerin tablets place one under tongue - if it still remains take another tablet in 5 mins - and if still in pain take another after an additional 5 mins - if still pain after 3 table
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

49. What are the steps for adult/child 1 rescuer CPR?
Direct current cardioversion and digoxin/propranolol (inderal).
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

50. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
D/C the med and call the doctor.
The patient may suffer significant blood loss or femoral nerve compression.