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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 the purpose of compression devices?
ST segment elevation (STEMI)
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

2. What should a patient do if they feel chest pain or discomfort?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Before

3. What are the S&S of cardiac tamponade?
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.
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

4. What are the 2 types of pacemakers?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
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
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

5. What is angina? Stable vs. unstable?

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6. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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
An enlarged space indicates fluid accumulation in the pericardial sac.
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.

7. What should be done immediately if a pulmonary embolism is suspected?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Open up blood vessels
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.
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

8. What is important to remember when taking care of patients with compression devices?
If feel more than 3 shocks in a row or develop signs of infection at the site.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

9. What drugs are most commonly used for angina?
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.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Nitrates - Beta blockers - and Calcium channel blockers

10. Where is the apex/mitral valve landmark on the chest?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Only for a few hours
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

11. What landmarks should you be looking for on someone's chest?
Pulmonary edema
D/C the med and call the doctor.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

12. What should be immediately done for a patient experiencing digoxin toxicity?
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.
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!
Fat - Air - DVT - or Amniotic

13. What are the steps for adult/child 1 rescuer CPR?
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
No radial artery punctures if negative
Second Left intercostal space
If feel more than 3 shocks in a row or develop signs of infection at the site.

14. What does a swan ganz measure?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Maintain BED REST
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

15. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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 central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

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

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17. What is the antidote for heparin?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
Protamine Sulfate
ST segment elevation (STEMI)
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.

18. What type of EKG change indicates MI?
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Patient who are unable to tolerate exercise stress testing.
ST segment elevation (STEMI)

19. What should you teach your patient about angiography (arteriography)?
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
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
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
ST segment elevation (STEMI)

20. What is the treatment for a pt. with ventricular tachycardia?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
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.

21. What should you teach someone with arterial insufficiency?

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22. What is cardiac tamponade? Common causes?
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
D/C the med and call the doctor.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
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

23. What could happen without immediate intervention for a hematoma?
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.
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.
The patient may suffer significant blood loss or femoral nerve compression.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

24. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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
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
The internal jugular veins (external are less reliable).
If feel more than 3 shocks in a row or develop signs of infection at the site.

25. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
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.

26. What are coumadin and heparin used for?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
To inhibit thrombus and clot formation.
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.
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.

27. What makes the symptoms of superior vena cava syndrome better? Worse?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
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

28. A femoral artery compression device ______be assigned to an NA?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Cannot
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Second right intercostal space

29. What is a good diagnosis for someone with right sided HF?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Activity intolerance
A nosebleed
An enlarged space indicates fluid accumulation in the pericardial sac.

30. How should you palpate the apical pulse?
Vitamin K (aqua myphiton)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Pneumothorax and will end up with chest tube to help reinflate lung.

31. What are the nursing interventions for a patient in complete heart block?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

32. What is superior vena cava syndrome?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
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.

33. What is the treatment for someone with right sided HF? How do you know working?
Poorly controlled hypertension
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
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
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

34. What should you remember while taking care of someone with a peripheral arterial occlusion?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Fifth left intercostal space medial to the midclavicular line.
Nitrates - Beta blockers - and Calcium channel blockers

35. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
Nitrates - Beta blockers - and Calcium channel blockers
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

36. What does an Allen's test determine?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Whether the patients ulnar and radial arteries are patent.

37. How should you palpate the carotid arteries?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
One at a time to assess the pulse amplitude and contour.

38. What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Pulmonary edema

39. What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
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
The patient may suffer significant blood loss or femoral nerve compression.
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.

40. What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
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

41. How long is contrast media in the body?
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.
Must be flushed 1x/month with heparin and between treatments.
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
Only for a few hours

42. Where is the pulmonic valve landmark on the chest?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Second left intercostal space

43. What is Deep Vein Thrombosis (DVT)?
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.
Air embolism
Idiopathic

44. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
The internal jugular veins (external are less reliable).
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.
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.

45. What should you not allow if a patient has a negative Allen's test?
D/C the med and call the doctor.
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).
Second left intercostal space
No radial artery punctures if negative

46. What would make someone more at risk for digoxin toxicity?
Second Left intercostal space
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
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 hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

47. What is important to remember when removing a CVC from a patient?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Cannot
Fat - Air - DVT - or Amniotic
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.

48. What should be done for someone on bleeding precautions?
0.5-2.0 ng/ml
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

49. Where is the tricuspid valve landmark on the chest?
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
Lower left sternal border
An inflammation of the pericardium. It may result in MI.
Nitrates - Beta blockers - and Calcium channel blockers

50. What is the correct way to insert an oropharyngeal airway?
Maintain BED REST
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
D/C the med and call the doctor.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.