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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 are the two common complications of pericarditis?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
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.
Old truck driver or someone on bed rest or with pelvic trauma.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

2. What is a good diagnosis for someone with right sided HF?
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
The internal jugular veins (external are less reliable).
A nosebleed
Activity intolerance

3. 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
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
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).
ST segment elevation (STEMI)

4. Where should you place your stethescope to find the tricuspid valve?
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
To inhibit thrombus and clot formation.
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
4th left intercostal space lower sternal border

5. In what locations should you not place electrodes?
D/C the med and call the doctor.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
In fatty areas or over major muscles - large breasts - or bony prominences.

6. Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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.
One at a time to assess the pulse amplitude and contour.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

7. How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
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.)
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

8. What is the treatment for someone in ventricular fibrillation?
Left sternal border
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

9. When would a nurse use an external femoral artery compression device?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
BP is elevated or decreased depending on activity.
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).

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

11. What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
D/C the med and call the doctor.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Air answers (open junctions)

12. What type of EKG change indicates MI?
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
ST segment elevation (STEMI)
Feeling warm (fire) or tin can taste is expected and will pass.
NO NSAIDS or ASA.

13. What is cardioversion?

14. What should you teach your patient about MRI?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
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
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.

15. What is a assessment finding with DVT?

16. What is an air embolism?
Chronic arteriosclerotic disease.
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.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
NO NSAIDS or ASA.

17. What are the nursing interventions for a pt. with ventricular tachycardia?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.

18. What should you tell a patient who developed a hematoma in the hospital and is being discharged?
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.
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).
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.
Air answers (open junctions)

19. A femoral artery compression device ______be assigned to an NA?
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).
Cannot
The patient may suffer significant blood loss or femoral nerve compression.

20. What landmarks should you be looking for on someone's chest?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Cannot
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.

21. What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
An inflammation of the pericardium. It may result in MI.
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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.
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.

22. What should be done for someone on bleeding precautions?
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
4th left intercostal space lower sternal border
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.)
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

23. What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

24. What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
BP is elevated or decreased depending on activity.
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.
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

25. Where is the aortic valve landmark on the chest?
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
Second right intercostal space
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

26. How should you palpate the apical pulse?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
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.)
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.

27. When should you be concerned about premature ventricular contraction?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
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.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).

28. What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
Second Right intercostal space.
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
To inhibit thrombus and clot formation.

29. What is important to remember when taking care of patients with compression devices?
Direct current cardioversion and digoxin/propranolol (inderal).
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
Vascular - artery disease causing fluid to back up into the lungs.

30. What should you do to treat pulmonary edema?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
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!
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
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

31. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
Right sided heart failure
Lung disease
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.

32. During an Allen's test don't compress one artery _____ the other.
ST segment elevation (STEMI)
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Before

33. What condition can cause left sided heart failure?
Vascular - artery disease causing fluid to back up into the lungs.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.

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

35. When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
Air embolism
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

36. What factors place you at risk for HTN?
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.
Patient who are unable to tolerate exercise stress testing.
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.
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 is epistaxis?
(S1 - S2) Third left intercostal space
A nosebleed
In fatty areas or over major muscles - large breasts - or bony prominences.
Idiopathic

38. What is the purpose of compression devices?
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.
Pulse before and after giving.
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.

39. Without prompt surgery for an aortic dissection What is someone at risk for developing?
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
0.5-2.0 ng/ml

40. How is angina treated?

41. What is characteristic of ventricular fibrillation?
Whether the patients ulnar and radial arteries are patent.
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
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
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.

42. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
No magnets (cell phone 6 inches away from) - DO Not DRINK CAFFEINATED BEVERAGES - DO Not ENGAGE In ROUGH ACTIVITIES (FOOTBAll OR WRESTLING) - and no tight clothing over site.
Must be flushed 1x/month with heparin and between treatments.
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.

43. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
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
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
An enlarged space indicates fluid accumulation in the pericardial sac.
Old truck driver or someone on bed rest or with pelvic trauma.

44. What would make someone more at risk for digoxin toxicity?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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.
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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.

45. What are the indications for a chemical stress test (persantine stress test)?
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
An enlarged space indicates fluid accumulation in the pericardial sac.
Patient who are unable to tolerate exercise stress testing.
Must be flushed 1x/month with heparin and between treatments.

46. What type of surgery is done for an aortic dissection?
Pulmonary edema
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
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.

47. What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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).
Direct current cardioversion and digoxin/propranolol (inderal).

48. What usually triggers angina pain?
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
Fat - Air - DVT - or Amniotic
BP is elevated or decreased depending on activity.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

49. What is the treatments for hypertension?
D/C the med and call the doctor.
Second left intercostal space
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.
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

50. What lab value is used to evaluate a patient on coumadin? What is the normal value?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
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.
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
NO NSAIDS or ASA.