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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 a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
If feel more than 3 shocks in a row or develop signs of infection at the site.

2. What drugs are most commonly used for angina?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Nitrates - Beta blockers - and Calcium channel blockers
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

3. What is pericarditis?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
An inflammation of the pericardium. It may result in MI.
Direct current cardioversion and digoxin/propranolol (inderal).
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.

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

5. What is a major complication of central line placement?
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).
Patient who are unable to tolerate exercise stress testing.
Pneumothorax and will end up with chest tube to help reinflate lung.

6. Which type of patient shouldn't take nitrates?
Don't interfere!
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

7. What are the S&S of aortic dissection?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Keep clean and dry for 72 hours - DON'T LIFT The ELBOW OR ARM ON The INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES) - DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS - take pulse and wt each day - CAll CARD
(S1 - S2) Third left intercostal space

8. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
In fatty areas or over major muscles - large breasts - or bony prominences.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
A monitor with four dual electrodes that are applied to the patients neck and thorax.
D/C the med and call the doctor.

9. What is important to remember when removing a CVC from a patient?
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
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
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Right sided heart failure

10. What is an air embolism?
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).

11. What should you teach someone with arterial insufficiency?

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

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

14. What type of EKG change indicates MI?
ST segment elevation (STEMI)
Fat - Air - DVT - or Amniotic
Chronic arteriosclerotic disease.
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

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

16. 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!
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.

17. What do calcium channel blockers do?
Open up blood vessels
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
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

18. What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
BP is elevated or decreased depending on activity.
Second left intercostal space
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

19. 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).
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
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Right sided heart failure

20. What should be done immediately if a pulmonary embolism is suspected?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.)
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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

21. Where should you place your stethescope to find the ERB's Point?
(S1 - S2) Third left intercostal space
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
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.
If feel more than 3 shocks in a row or develop signs of infection at the site.

22. What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
4th left intercostal space lower sternal border

23. Where is the pulmonic valve landmark on the chest?
A nosebleed
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Second left intercostal space

24. What should you teach your patient about an exercise ECG (stress test)?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
In the first 72 hours!!!!!
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-

25. What are the S&S associated with right sided heart failure?
Right sided heart failure
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

26. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
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
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

27. Where should you place your stethescope to find the mitral (apex) valve?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
No radial artery punctures if negative
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Fifth left intercostal space medial to the midclavicular line.

28. What places someone at risk for an aortic dissection?
Poorly controlled hypertension
A nosebleed
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
One at a time to assess the pulse amplitude and contour.

29. What is the treatments for hypertension?
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.
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.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
Cannot

30. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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 embolism
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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.

31. What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
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.
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
Maintain BED REST

32. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Patient who are unable to tolerate exercise stress testing.
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Second left intercostal space

33. What should be done immediately for someone with PE?
Iodine
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

34. Where is the apex/mitral valve landmark on the chest?
Feeling of fullness in head - tightness around shirt collar - or rings/jewelry that suddenly seem tight - swelling in face - hands - arms - and swollen/cyanotic lips - dyspnea - coughing - hoarseness - chest pain - hemotysis - visable collateral ches
Fourth or fifth intercostal space at or medial to the midclavicular line.
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.
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.

35. What are the steps for adult 2 rescuer CPR?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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
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.
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

36. 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?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
Lower left sternal border
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.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

37. What should you teach your patient about a cardiac catheterization?
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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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

38. What are the steps for infant 1&2 rescuer CPR?
BP is elevated or decreased depending on activity.
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
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
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

39. What causes essential/primary hypertension?
Right sided heart failure
Idiopathic
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).
Lowers BP and makes heart beat stronger. SE: flushed face.

40. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
An inflammation of the pericardium. It may result in MI.
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
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

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

42. What are common risk factors for an MI?
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.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Second left intercostal space
BIRTH CONTROL PILL (LEADING CAUSE of HTN In YOUNG WOMEN-45=STILL YOUNG) - BLACK Male (then white male - than black female - then white female) - obesity - smoking - stress - high Na diet - lack of exercise - age - sex - race - or noncompliance.

43. What should be checked in a patient on a beta blocker?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Must be flushed 1x/month with heparin and between treatments.
Pulse before and after giving.
Fourth or fifth intercostal space at or medial to the midclavicular line.

44. What is the treatment for a patient in complete heart block?
ST segment elevation (STEMI)
Whether the patients ulnar and radial arteries are patent.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.

45. During an Allen's test don't compress one artery _____ the other.
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Before
Nitrates - Beta blockers - and Calcium channel blockers

46. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Lowers BP and makes heart beat stronger. SE: flushed face.

47. 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.
Iodine
A nosebleed
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

48. 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.
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.
No radial artery punctures if negative
Activity intolerance

49. In what locations should you not place electrodes?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
One large emboli (smaller=better)
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).
In fatty areas or over major muscles - large breasts - or bony prominences.

50. What is the treatment for someone in ventricular fibrillation?
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
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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.
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