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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. When should you be concerned about premature ventricular contraction?
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
Pulmonary edema
Must be flushed 1x/month with heparin and between treatments.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

2. What is a nursing diagnosis for arterial occlusion? Tx
Before
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.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

3. What are the two common complications of pericarditis?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.
0.5-2.0 ng/ml
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

4. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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
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

5. What signals an elevated venous pressure based on the internal jugular veins?
The patient may suffer significant blood loss or femoral nerve compression.
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
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.
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

6. What should be immediately done for a patient experiencing digoxin toxicity?
Second right intercostal space
One large emboli (smaller=better)
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Lowers BP and makes heart beat stronger. SE: flushed face.

7. What is a therapeutic digoxin level?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
The internal jugular veins (external are less reliable).
0.5-2.0 ng/ml

8. Where is the aortic valve landmark on the chest?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
In the first 72 hours!!!!!
Open up blood vessels
Second right intercostal space

9. What is intermittent claudication?
To report to her healthcare provider if she feels a large bump in her groin - if she has groin pain unrelieved by acetaminophen - or if she develops numbness - tingling - etc. in the affected leg.
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

10. What should you teach your patient about a cardiac catheterization?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
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
Fat - Air - DVT - or Amniotic
(S1 - S2) Third left intercostal space

11. What body systems are affected by digoxin toxicity? S&S?
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

12. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Second left intercostal space
The patient may suffer significant blood loss or femoral nerve compression.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.

13. What are the 2 types of pacemakers?
Chronic arteriosclerotic disease.
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.
Patient who are unable to tolerate exercise stress testing.
Vascular - artery disease causing fluid to back up into the lungs.

14. What should you teach your patient about MRI?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Right sided heart failure
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

15. 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?
In the first 72 hours!!!!!
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Open up blood vessels

16. What is characteristic of atrial fibrillation?
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Vascular - artery disease causing fluid to back up into the lungs.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

17. What would make someone more at risk for digoxin toxicity?
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.
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.
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.
Iodine

18. What is angina? Stable vs. unstable?

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19. What is the treatment for myocardial infarction?
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
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Idiopathic
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.

20. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
D/C the med and call the doctor.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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
Must be flushed 1x/month with heparin and between treatments.

21. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
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
Must be flushed 1x/month with heparin and between treatments.
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

22. What is characteristic of complete heart block?
Protamine Sulfate
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
NO because it isn't sterile so keep out.
Second left intercostal space

23. What should you remember while taking care of someone with a peripheral arterial occlusion?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Lowers BP and makes heart beat stronger. SE: flushed face.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

24. Where is the right ventricle landmark on the chest?
NO NSAIDS or ASA.
Chronic arteriosclerotic disease.
Left sternal border
If feel more than 3 shocks in a row or develop signs of infection at the site.

25. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
Steroid treatment or a pregnant woman who is retaining water.
The internal jugular veins (external are less reliable).
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.

26. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Air answers (open junctions)
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

27. What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

28. What is a major complication of central line placement?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Pneumothorax and will end up with chest tube to help reinflate lung.
Steroid treatment or a pregnant woman who is retaining water.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

29. What is epistaxis?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Don't interfere!
A nosebleed
Fat - Air - DVT - or Amniotic

30. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

31. Where is the tricuspid valve landmark on the chest?
One at a time to assess the pulse amplitude and contour.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Lower left sternal border

32. When would a nurse use an external femoral artery compression device?
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
Whether the patients ulnar and radial arteries are patent.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

33. What should you teach your patient about an electrocardiogram (ECG)?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
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

34. What should you teach someone about iodine?
Before
Fat - Air - DVT - or Amniotic
Feeling warm (fire) or tin can taste is expected and will pass.
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.

35. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
To report to her healthcare provider if she feels a large bump in her groin - if she has groin pain unrelieved by acetaminophen - or if she develops numbness - tingling - etc. in the affected leg.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Second left intercostal space
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.

36. What should be done immediately for someone with PE?
ST segment elevation (STEMI)
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
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

37. What is an aortic dissection?

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38. What do calcium channel blockers do?
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.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Open up blood vessels

39. Where should you place your stethescope to find the mitral (apex) valve?
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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
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.
Fifth left intercostal space medial to the midclavicular line.

40. What is CVP? Normal?
Before
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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. What is a transthoracic echocardiograph (TTE)?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Lowers BP and makes heart beat stronger. SE: flushed face.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.

42. What type of surgery is done for an aortic dissection?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
(S1 - S2) Third left intercostal space
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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

43. What is defibrillation?
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
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.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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

44. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

45. What should you teach your patient about angiography (arteriography)?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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
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.

46. What are the nursing interventions for a pt. with ventricular tachycardia?
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
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.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

47. What are the S&S associated with right sided heart failure?
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Steroid treatment or a pregnant woman who is retaining water.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

48. What is the correct way to insert an oropharyngeal airway?
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.
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

49. For which heart sounds should the diaphragm be used?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Iodine
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

50. What landmarks should you be looking for on someone's chest?
Chronic arteriosclerotic disease.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.