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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 does a swan ganz measure?
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.
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
Fat - Air - DVT - or Amniotic

2. What are the S&S of aortic dissection?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Explain procedure - stress importance of reporting symptoms. INSTRUCT The PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE The TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH The TEST!!! (No va
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

3. What are the nursing interventions for a patient with premature ventricular contractions?
Iodine
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Direct current cardioversion and digoxin/propranolol (inderal).

4. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
Pulmonary edema
One at a time to assess the pulse amplitude and contour.
Activity intolerance

5. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
To inhibit thrombus and clot formation.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

6. What is an aortic dissection?

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

8. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
If feel more than 3 shocks in a row or develop signs of infection at the site.

9. For which heart sounds should the bell be used?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

10. What should you do immediately if you suspect someone of developing a hematoma?
Don't interfere!
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

11. What is important to remember when taking care of patients with compression devices?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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

12. What are the 2 types of pacemakers?
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
Lower left sternal border
Vitamin K (aqua myphiton)
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.

13. For what disease should you do the Allen's test?

14. What is defibrillation?
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.
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.
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).
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

15. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
No radial artery punctures if negative
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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

16. A femoral artery compression device ______be assigned to an NA?
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Before
Cannot

17. What does vasotec (Enalapril Maleate) do/SE?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Vascular - artery disease causing fluid to back up into the lungs.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Lowers BP and makes heart beat stronger. SE: flushed face.

18. What is INR?
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
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.

19. What should you do if the PT value is 45 sec?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
D/C the med and call the doctor.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
A monitor with four dual electrodes that are applied to the patients neck and thorax.

20. 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
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Idiopathic

21. What are the nursing interventions for a patient in atrial fibrillation?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

22. What would make someone more at risk for digoxin toxicity?
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.
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
Fat - Air - DVT - or Amniotic
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.

23. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.
0.5-2.0 ng/ml

24. What is the treatment for a pt. with ventricular tachycardia?
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.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna
Direct current cardioversion and digoxin/propranolol (inderal).

25. What is a good diagnosis for someone with right sided HF?
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
Activity intolerance
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

26. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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

27. What is the maintenance for venous access port that isn't being regularly used?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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.
In the first 72 hours!!!!!
Must be flushed 1x/month with heparin and between treatments.

28. Where do the internal jugular veins lie?
Fat - Air - DVT - or Amniotic
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
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.

29. What should be checked in a patient on a beta blocker?
Second Right intercostal space.
Pulse before and after giving.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

30. What should you teach your patient about an abdominal ultrasonography?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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 a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

31. What are the indications for a chemical stress test (persantine stress test)?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Patient who are unable to tolerate exercise stress testing.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

32. What are coumadin and heparin used for?
ST segment elevation (STEMI)
To inhibit thrombus and clot formation.
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
Feeling warm (fire) or tin can taste is expected and will pass.

33. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Fat - Air - DVT - or Amniotic
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
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.

34. What landmarks should you be looking for on someone's chest?
Lower left sternal border
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
ST segment elevation (STEMI)
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

35. What should you not allow if a patient has a negative Allen's test?
Activity intolerance
No radial artery punctures if negative
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

36. What is the treatment for myocardial infarction?
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!
BP is elevated or decreased depending on activity.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

37. What is cardiac tamponade? Common causes?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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
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.

38. What SE should you look for with calcium channel blocker use?
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
D/C the med and call the doctor.

39. What are the signs and symptoms of left sided HF?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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

40. What should be done for someone on bleeding precautions?
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.
D/C the med and call the doctor.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.

41. In what locations should you not place electrodes?
In fatty areas or over major muscles - large breasts - or bony prominences.
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

42. What are the five areas for listening to the heart?

43. What is the antidote for coumadin?
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
Vitamin K (aqua myphiton)
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

44. What is the hallmark clinical finding associated with pericarditis?
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.
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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

45. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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
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
ST segment elevation (STEMI)
An enlarged space indicates fluid accumulation in the pericardial sac.

46. What is epistaxis?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Patient who are unable to tolerate exercise stress testing.
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.
A nosebleed

47. What do calcium channel blockers do?
Open up blood vessels
No radial artery punctures if negative
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

48. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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
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.

49. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
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.

50. Where is the apex/mitral valve landmark on the chest?
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
Fifth left intercostal space medial to the midclavicular line.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.