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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. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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
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
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.
Patient who are unable to tolerate exercise stress testing.

2. What is the treatment for myocardial infarction?
NO because it isn't sterile so keep out.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

3. What should you tell someone about taking nitroglycerin tablets (SE)?
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
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.

4. Where is the tricuspid valve landmark on the chest?
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!
Lower left sternal border
NO because it isn't sterile so keep out.
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.

5. What are examples of calcium channel blockers?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
0.5-2.0 ng/ml
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

6. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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.

7. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

8. What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
(S1 - S2) Third left intercostal space

9. What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

10. Where should you place your stethescope to find the tricuspid valve?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
4th left intercostal space lower sternal border
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.

11. What are the nursing interventions for a pt. with ventricular tachycardia?
Cannot
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

12. During an Allen's test don't compress one artery _____ the other.
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.
Before
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

13. What do calcium channel blockers do?
Vitamin K (aqua myphiton)
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
Open up blood vessels

14. 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.
Lowers BP and makes heart beat stronger. SE: flushed face.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

15. What should you teach someone about iodine?
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Feeling warm (fire) or tin can taste is expected and will pass.

16. 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.
Open up blood vessels
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

17. What should you do immediately for someone experiencing anticoagulant induced epistaxis?
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Vascular - artery disease causing fluid to back up into the lungs.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

18. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
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.
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.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

19. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
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.
Feeling warm (fire) or tin can taste is expected and will pass.

20. What is Deep Vein Thrombosis (DVT)?
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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

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

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22. Who would most likely have peripheral venous disease?
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
Nitrates - Beta blockers - and Calcium channel blockers
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.
Old truck driver or someone on bed rest or with pelvic trauma.

23. What should you teach your patient about an electrocardiogram (ECG)?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
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.
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

24. What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
An inflammation of the pericardium. It may result in MI.
Air embolism
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

25. When should bleeding precautions be implemented?
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.)
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Second left intercostal space
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.

26. What are coumadin and heparin used for?
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
To inhibit thrombus and clot formation.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.

27. What should you do if the PT value is 45 sec?
Maintain BED REST
D/C the med and call the doctor.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

28. What landmarks should you be looking for on someone's chest?
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
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Before
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.

29. What are signs and symptoms of an MI?
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
NO NSAIDS or ASA.
Vitamin K (aqua myphiton)

30. What drugs are most commonly used for angina?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
An inflammation of the pericardium. It may result in MI.
Nitrates - Beta blockers - and Calcium channel blockers
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.

31. What is an acute peripheral arterial occlusion?
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).
Idiopathic
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

32. What are the S&S of superior vena cava syndrome?
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.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
Chronic arteriosclerotic disease.

33. What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
D/C the med and call the doctor.

34. What is impedance cardiography?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
(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.

35. What should you teach your patient about angiography (arteriography)?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Lowers BP and makes heart beat stronger. SE: flushed face.
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
Second left intercostal space

36. What is the treatment for someone in ventricular fibrillation?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Second Left intercostal space

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

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

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39. When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Left sternal border
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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.

40. What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
The internal jugular veins (external are less reliable).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
4th left intercostal space lower sternal border

41. How does the blood flow through the heart? (valves?)
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Right sided heart failure
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!
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)

42. What could happen without immediate intervention for a hematoma?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
The patient may suffer significant blood loss or femoral nerve compression.
D/C the med and call the doctor.

43. Where is the right ventricle landmark on the chest?
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
Left sternal border
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

44. What SE should you look for with calcium channel blocker use?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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.

45. What should be taught upon discharge for someone going home on coumadin as a result of a PE?
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.
Only for a few hours
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.
Second Right intercostal space.

46. What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
In the first 72 hours!!!!!
Air embolism
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.

47. What would make someone more at risk for digoxin toxicity?
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.
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.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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

48. What things should you do to assess cardiovascular status?
Protamine Sulfate
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Air embolism
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

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

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50. What are the treatments/ S&S of peripheral venous disease?
Patient who are unable to tolerate exercise stress testing.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).