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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 body systems are affected by digoxin toxicity? S&S?
Right sided heart failure
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

2. What should you teach your patient about MRI?
(S1 - S2) Third left intercostal space
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
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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

3. 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.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
D/C the med and call the doctor.
Only for a few hours

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

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5. Who would most likely have peripheral venous disease?
Steroid treatment or a pregnant woman who is retaining water.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Old truck driver or someone on bed rest or with pelvic trauma.

6. What is pericarditis?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
An inflammation of the pericardium. It may result in MI.
NO because it isn't sterile so keep out.

7. What are the nursing interventions for a patient in atrial fibrillation?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Patient who are unable to tolerate exercise stress testing.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

8. What is cardioversion?

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9. What are the steps for adult/child 1 rescuer CPR?
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
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
Pulmonary edema

10. What is the maintenance for venous access port that isn't being regularly used?
Give furosemide (lasix) 40-60 mg IV - O2 administration - morphine sulfate 3-5 mg IV - have patient sit up with feet lowered (decreases venous return to the heart) - nitroglycerin given sublingual or IV - and rotating tourniquets (can reduce intratho
Must be flushed 1x/month with heparin and between treatments.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
4th left intercostal space lower sternal border

11. What is the treatment for myocardial infarction?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.
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.
Fat - Air - DVT - or Amniotic

12. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Fifth left intercostal space medial to the midclavicular line.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.

13. In What time period is the greatest risk of sudden death from an MI?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
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
In the first 72 hours!!!!!

14. What should you teach someone about iodine?
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.
Feeling warm (fire) or tin can taste is expected and will pass.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.

15. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
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
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
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.

16. What is the correct way to insert an oropharyngeal airway?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
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
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

17. What should you teach your patient about an abdominal ultrasonography?
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
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
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.

18. What is angina? Stable vs. unstable?

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19. What factors place you at risk for HTN?
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
One at a time to assess the pulse amplitude and contour.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

20. What condition can cause left sided heart failure?
In the first 72 hours!!!!!
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.
Pneumothorax and will end up with chest tube to help reinflate lung.
Vascular - artery disease causing fluid to back up into the lungs.

21. What makes the symptoms of superior vena cava syndrome better? Worse?
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.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

22. Without prompt surgery for an aortic dissection What is someone at risk for developing?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

23. What is the treatment for premature ventricular contractions?
ST segment elevation (STEMI)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Air embolism

24. What is cardiac tamponade? Common causes?
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
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.
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

25. What is an acute peripheral arterial occlusion?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.

26. When would a nurse use an external femoral artery compression device?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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

27. What are common risk factors for an MI?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.

28. What is an aortic dissection?

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29. What is characteristic of atrial fibrillation?
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.
Maintain BED REST
Lower left sternal border
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

30. What should you do if the PTT value is 80 for someone on heparin?
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
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Patient who are unable to tolerate exercise stress testing.
D/C the med and call the doctor.

31. A femoral artery compression device ______be assigned to an NA?
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
Cannot
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.

32. What should you teach your patient about an exercise ECG (stress test)?
To inhibit thrombus and clot formation.
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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-
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

33. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

34. What are examples of 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.
To inhibit thrombus and clot formation.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

35. Where should you place your stethescope to find the mitral (apex) valve?
Fifth left intercostal space medial to the midclavicular line.
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
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.
ST segment elevation (STEMI)

36. What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
D/C the med and call the doctor.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
One at a time to assess the pulse amplitude and contour.

37. What is characteristic of complete heart block?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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.
The internal jugular veins (external are less reliable).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.

38. Where do the internal jugular veins lie?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

39. What should you observe for in someone on bleeding precautions?
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).
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

40. What could happen without immediate intervention for a hematoma?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
The patient may suffer significant blood loss or femoral nerve compression.
Air embolism

41. What should a patient do if they feel chest pain or discomfort?
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
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
To inhibit thrombus and clot formation.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

42. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
Pneumothorax and will end up with chest tube to help reinflate lung.
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

43. What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
To inhibit thrombus and clot formation.
0.5-2.0 ng/ml

44. What is characteristic of ventricular tachycardia?
Patient who are unable to tolerate exercise stress testing.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

45. 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).
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.
D/C the med and call the doctor.

46. What are the S&S of pulmonary embolism?
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
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
Chronic arteriosclerotic disease.
Fourth or fifth intercostal space at or medial to the midclavicular line.

47. What disease can cause right sided heart failure?
Lung disease
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
Lowers BP and makes heart beat stronger. SE: flushed face.

48. What are the signs and symptoms of left sided HF?
Lung disease
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

49. What is the treatment for someone in ventricular fibrillation?
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
Nitrates - Beta blockers - and Calcium channel blockers
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

50. When should bleeding precautions be implemented?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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.