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

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2. How does the blood flow through the heart? (valves?)
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Activity intolerance
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
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!

3. Who would most likely have peripheral venous disease?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Old truck driver or someone on bed rest or with pelvic trauma.
Iodine
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.

4. What condition can cause left sided heart failure?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
Vascular - artery disease causing fluid to back up into the lungs.
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
Lower HOB - place patient supine - assess LOC - open airway - assess breathing - get ambu bag - put on gloves - connect tubing from O2 source - adjust flow to 10 to 15 liters. First RESCUER: PLACE APEX of MASK OVER BRIDGE of NOSE And BASE BETWEEN LOW

5. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
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!

6. What is cardioversion?

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7. What are examples of calcium channel blockers?
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
Lung disease
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).

8. What is more harmful a lot of little emboli or one large emboli?
No radial artery punctures if negative
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Lung disease
One large emboli (smaller=better)

9. What is Deep Vein Thrombosis (DVT)?
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).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
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

10. What drugs are most commonly used for angina?
The internal jugular veins (external are less reliable).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Right sided heart failure
Nitrates - Beta blockers - and Calcium channel blockers

11. What type of EKG change indicates MI?
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
An enlarged space indicates fluid accumulation in the pericardial sac.
Fifth left intercostal space medial to the midclavicular line.
ST segment elevation (STEMI)

12. 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+
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
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
NO because it isn't sterile so keep out.

13. How should you palpate the carotid arteries?
One large emboli (smaller=better)
Pulse before and after giving.
One at a time to assess the pulse amplitude and contour.
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.

14. What are the nursing interventions for a pt. with ventricular tachycardia?
In the first 72 hours!!!!!
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
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.
Patient who are unable to tolerate exercise stress testing.

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

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16. What type of surgery is done for an aortic dissection?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
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
Lung disease
The damaged portion of the aorta is removed and is repaired with a synthetic graft.

17. What signals an elevated venous pressure based on the internal jugular veins?
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
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.
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

18. What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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
Ask patient to make a tight fist - using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand - ask pt to relax hand (hand and palm should appear blanched bc flow stopped) - release pressure on ulna

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.
Pulse before and after giving.
One large emboli (smaller=better)
An inflammation of the pericardium. It may result in MI.

20. Where should you place your stethescope to find the ERB's Point?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
Nitrates - Beta blockers - and Calcium channel blockers
(S1 - S2) Third left intercostal space

21. Where should you place your stethescope to find the aortic valve?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Second Right intercostal space.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

22. What are coumadin and heparin used for?
4th left intercostal space lower sternal border
To inhibit thrombus and clot formation.
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.

23. What does the device for impedance cardiography consist of?
D/C the med and call the doctor.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.

24. What should a patient do if they feel chest pain or discomfort?
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
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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

25. What is a good diagnosis for someone with right sided HF?
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
Activity intolerance
NO NSAIDS or ASA.
Left sternal border

26. What should you observe for in someone on bleeding precautions?
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.
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
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).
An enlarged space indicates fluid accumulation in the pericardial sac.

27. What are the nursing interventions for a patient with premature ventricular contractions?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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.
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

28. What are the four types of pulmonary emboli?
Include rest periods prior to any activity.
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
Second Left intercostal space
Fat - Air - DVT - or Amniotic

29. What is the treatments for hypertension?
Old truck driver or someone on bed rest or with pelvic trauma.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.

30. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
A nosebleed
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
If feel more than 3 shocks in a row or develop signs of infection at the site.

31. What are the signs and symptoms of left sided HF?
Stand behind the victim - wrap arms around waist (IF PREGNANT WRAP ABOVE The BABy) - make a fist with one had and place thumb against abdomen midline - grasp fist with other hand - press into victims abdomen with quick upward thrusts.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
Vitamin K (aqua myphiton)

32. What is labile hypertension?
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
Chronic arteriosclerotic disease.
BP is elevated or decreased depending on activity.

33. What is characteristic of atrial fibrillation?
Open up blood vessels
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Patient who are unable to tolerate exercise stress testing.

34. What is a therapeutic digoxin level?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Left sternal border
Lowers BP and makes heart beat stronger. SE: flushed face.
0.5-2.0 ng/ml

35. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
Before
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
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 internal jugular veins (external are less reliable).

36. What should you teach someone about iodine?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Feeling warm (fire) or tin can taste is expected and will pass.
Fourth or fifth intercostal space at or medial to the midclavicular line.
One at a time to assess the pulse amplitude and contour.

37. Where is the apex/mitral valve landmark on the chest?
Patient who are unable to tolerate exercise stress testing.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

38. What is a major complication of central line placement?
Feeling warm (fire) or tin can taste is expected and will pass.
Pneumothorax and will end up with chest tube to help reinflate lung.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.)

39. 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.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Direct current cardioversion and digoxin/propranolol (inderal).
D/C the med and call the doctor.

40. What is the nursing care associated with chemical stress tests (persantine stress test)?
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.
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 nosebleed
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.

41. What should you do to treat pulmonary edema?
Direct current cardioversion and digoxin/propranolol (inderal).
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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
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

42. What makes the symptoms of superior vena cava syndrome better? Worse?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
NO NSAIDS or ASA.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

43. When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
4th left intercostal space lower sternal border
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.

44. What is defibrillation?
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.
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 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.
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

45. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Don't interfere!
An enlarged space indicates fluid accumulation in the pericardial sac.
Second 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).

46. What does plan of care include?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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.
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
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

47. Test ending in Gram=?
Lung disease
Iodine
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Direct current cardioversion and digoxin/propranolol (inderal).

48. When should you be concerned about premature ventricular contraction?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
Air embolism
Fat - Air - DVT - or Amniotic

49. When would a nurse use an external femoral artery compression device?
One at a time to assess the pulse amplitude and contour.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Don't interfere!

50. What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Second Right intercostal space.