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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 signals an elevated venous pressure based on the internal jugular veins?
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
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.
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.
Right sided heart failure

2. What is the treatment for someone with right sided HF? How do you know working?
Cannot
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
Don't interfere!

3. What could happen without immediate intervention for a hematoma?
Lower left sternal border
In fatty areas or over major muscles - large breasts - or bony prominences.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
The patient may suffer significant blood loss or femoral nerve compression.

4. What does vasotec (Enalapril Maleate) do/SE?
In the first 72 hours!!!!!
Lowers BP and makes heart beat stronger. SE: flushed face.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

5. What should be done immediately for someone with PE?
Protamine Sulfate
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.
Must be flushed 1x/month with heparin and between treatments.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

6. What is pericarditis?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
An inflammation of the pericardium. It may result in MI.
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.
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

7. What should you do if the PT value is 45 sec?
Second right intercostal space
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.
D/C the med and call the doctor.
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.

8. What does an Allen's test determine?
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
The patient may suffer significant blood loss or femoral nerve compression.
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
Whether the patients ulnar and radial arteries are patent.

9. What is the treatment for atrial fibrillation?
Before
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.
Fourth or fifth intercostal space at or medial to the midclavicular line.
Direct current cardioversion and digoxin/propranolol (inderal).

10. Which type of patient shouldn't take nitrates?
Cannot
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
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
(S1 - S2) Third left intercostal space

11. What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Only for a few hours
It is noninvasive. You must not eat - smoke - or drink alcohol for 3 hours before the test. WEAR COMFORTABLE SHOES And LOOSE LIGHTWEIGHT SHORTS OR SLACKS - YOU MAY GET AN INJECTION of THAllIUM - after your blood pressure and ECG are monitored for 10-
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

12. What is epistaxis?
D/C the med and call the doctor.
A nosebleed
Protamine Sulfate
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.

13. What is a good diagnosis for someone with right sided HF?
Activity intolerance
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Iodine
Fat - Air - DVT - or Amniotic

14. What should you do immediately if you suspect someone of developing a hematoma?
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.
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.
Fat - Air - DVT - or Amniotic
Activity intolerance

15. What are the two common complications of pericarditis?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

16. What is a major complication of central line placement?
Pulse before and after giving.
Pneumothorax and will end up with chest tube to help reinflate lung.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.

17. What should be immediately done for a patient experiencing digoxin toxicity?
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.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

18. If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.

19. What is a chemical stress test (persantine stress test)?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
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
Nitrates - Beta blockers - and Calcium channel blockers
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!

20. What should you teach your patient about a holter monitor?

21. Where do the internal jugular veins lie?
Right sided heart failure
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
Protamine Sulfate
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).

22. What is impedance cardiography?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
0.5-2.0 ng/ml
Second Left intercostal space

23. What is cardioversion?

24. How long is contrast media in the body?
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
Lower left sternal border
Only for a few hours
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

25. How should you palpate the carotid arteries?
D/C the med and call the doctor.
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.
One at a time to assess the pulse amplitude and contour.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

26. In what locations should you not place electrodes?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
In fatty areas or over major muscles - large breasts - or bony prominences.
NO because it isn't sterile so keep out.

27. When would a nurse use an external femoral artery compression device?
Patient who are unable to tolerate exercise stress testing.
4th left intercostal space lower sternal border
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

28. What should you do if you are going to ventilate someone with an ambu bag?
Poorly controlled hypertension
Second left intercostal space
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
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

29. What lab value is used to evaluate a patient on coumadin? What is the normal value?
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.
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
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).

30. Test ending in Gram=?
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
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.
Maintain BED REST
Iodine

31. What causes essential/primary hypertension?
Include rest periods prior to any activity.
Idiopathic
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.
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.

32. What body systems are affected by digoxin toxicity? S&S?
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
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.

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

34. What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
An enlarged space indicates fluid accumulation in the pericardial sac.
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
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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!

35. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
An enlarged space indicates fluid accumulation in the pericardial sac.
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Include rest periods prior to any activity.

36. What factors place you at risk for HTN?
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).
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.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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.

37. What disease can cause right sided heart failure?
Lung disease
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.)
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Protamine Sulfate

38. What is the treatment for someone in ventricular fibrillation?
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.
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
One at a time to assess the pulse amplitude and contour.
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

39. What should you watch for with PICC lines that have been in place for 6 months?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Iodine
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
Air answers (open junctions)

40. What is Deep Vein Thrombosis (DVT)?
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

41. What needs to be held during the placement of a femoral artery compression device?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
NO NSAIDS or ASA.
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
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 should you do when applying a femoral artery compression device?
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
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
It is an elective procedure - where the client is awake - it is synchronized with 'QRS' - the patient is sedated - a consent form must be signed prior to - they are placed on an EKG monitor - and they are shocked with 50-200 Joules.
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.

43. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
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
Steroid treatment or a pregnant woman who is retaining water.
Don't interfere!
The internal jugular veins (external are less reliable).

44. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
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
If feel more than 3 shocks in a row or develop signs of infection at the site.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Pulse before and after giving.

45. What are the indications for a chemical stress test (persantine stress test)?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
Patient who are unable to tolerate exercise stress testing.
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

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

47. What should you always assume with a patient who has a central line placed and is experiencing SOB?
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
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Air embolism

48. What drugs are most commonly used for angina?
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.
In the first 72 hours!!!!!
Nitrates - Beta blockers - and Calcium channel blockers
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

49. What is the antidote for heparin?
Protamine Sulfate
Pulmonary edema
Lower left sternal border
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

50. What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Lowers BP and makes heart beat stronger. SE: flushed face.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).