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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 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?
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.
Second 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.

2. Where is the apex/mitral valve landmark on the chest?
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.
NO because it isn't sterile so keep out.
Fourth or fifth intercostal space at or medial to the midclavicular line.
One large emboli (smaller=better)

3. What can result from left sided heart failure if left untreated?
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.
Pulmonary edema
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
To inhibit thrombus and clot formation.

4. What should you teach your patient about an exercise ECG (stress test)?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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-
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
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

5. Where is the tricuspid valve landmark on the chest?
One large emboli (smaller=better)
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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
Lower left sternal border

6. What are the indications for a chemical stress test (persantine stress test)?
Second Left intercostal space
Patient who are unable to tolerate exercise stress testing.
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.
Direct current cardioversion and digoxin/propranolol (inderal).

7. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Second Right intercostal space.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
An enlarged space indicates fluid accumulation in the pericardial sac.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

8. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Maintain BED REST
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

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

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10. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
Second left intercostal space
Maintain BED REST
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.
Fat - Air - DVT - or Amniotic

11. What should you do immediately if you suspect someone of developing a hematoma?
Fifth left intercostal space medial to the midclavicular line.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
In fatty areas or over major muscles - large breasts - or bony prominences.
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.

12. What is an aortic dissection?

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13. What should be checked in a patient on a beta blocker?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Pulse before and after giving.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+

14. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Second left intercostal space
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Air answers (open junctions)
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.

15. What are the four types of pulmonary emboli?
Air answers (open junctions)
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
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.
Fat - Air - DVT - or Amniotic

16. Where should you place your stethescope to find the pulmonic valve?
(S1 - S2) Third left intercostal space
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!
Second Left intercostal space
D/C the med and call the doctor.

17. What is pulsus paradoxus?
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
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Chronic arteriosclerotic disease.

18. What are common risk factors for an MI?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

19. What is epistaxis?
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
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
A nosebleed

20. What is the antidote for heparin?
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.
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.
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
Protamine Sulfate

21. What are the treatments/ S&S of peripheral venous disease?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Whether the patients ulnar and radial arteries are patent.

22. What is the correct way to insert an oropharyngeal airway?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
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

23. What should be done immediately if a pulmonary embolism is suspected?
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
In fatty areas or over major muscles - large breasts - or bony prominences.
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
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

24. What does vasotec (Enalapril Maleate) do/SE?
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.
Feeling warm (fire) or tin can taste is expected and will pass.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.

25. What is the nursing care associated with chemical stress tests (persantine stress test)?
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
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Only for a few hours
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

26. What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Stand behind the victim - wrap arms around waist (IF PREGNANT WRAP ABOVE The BABy) - make a fist with one had and place thumb against abdomen midline - grasp fist with other hand - press into victims abdomen with quick upward thrusts.
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.
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.

27. What are the steps for infant 1&2 rescuer CPR?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
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
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.
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.

28. What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

29. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
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

30. How should you palpate the apical pulse?
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Lowers BP and makes heart beat stronger. SE: flushed face.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
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.

31. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Right sided heart failure
(S1 - S2) Third left intercostal space

32. What is the treatment for premature ventricular contractions?
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
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

33. What should you teach your patient about a holter monitor?

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34. What is Deep Vein Thrombosis (DVT)?
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
Maintain BED REST
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 disease in which thrombi trap blood in the deep veins of the pelvis and legs.

35. What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
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
Include rest periods prior to any activity.
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

36. When would a nurse use an external femoral artery compression device?
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.
Poorly controlled hypertension
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

37. What type of EKG change indicates MI?
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
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
ST segment elevation (STEMI)
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

38. What should you watch for with PICC lines that have been in place for 6 months?
Patient who are unable to tolerate exercise stress testing.
Air answers (open junctions)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.

39. What is the treatment for a pt. with ventricular tachycardia?
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.
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
D/C the med and call the doctor.
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.

40. What is superior vena cava syndrome?
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
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.
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
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.

41. What usually triggers angina pain?
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.
Second left intercostal space
Poorly controlled hypertension
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

42. What is characteristic of premature ventricular contractions?
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Lung disease
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.

43. What should you do if the PTT value is 80 for someone on heparin?
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.
D/C the med and call the doctor.

44. What is intermittent claudication?
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.
NO NSAIDS or ASA.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

45. Where should you place your stethescope to find the ERB's Point?
D/C the med and call the doctor.
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
(S1 - S2) Third left intercostal space
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.

46. What landmarks should you be looking for on someone's chest?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.

47. What are the S&S associated with right sided heart failure?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
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.)
Must be flushed 1x/month with heparin and between treatments.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

48. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
Lower left sternal border
Lowers BP and makes heart beat stronger. SE: flushed face.
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.

49. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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50. What should happen if someone converts to asystole/flatline?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Feeling warm (fire) or tin can taste is expected and will pass.
Lower HOB - place patient supine - assess LOC - open airway - assess breathing - get ambu bag - put on gloves - connect tubing from O2 source - adjust flow to 10 to 15 liters. First RESCUER: PLACE APEX of MASK OVER BRIDGE of NOSE And BASE BETWEEN LOW

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NCLEX Cardiac

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