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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. Where is the aortic valve landmark on the chest?
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the
Second right intercostal space
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
MONA=Magnesium sulfate - O2 - Nitroglycerin - Aspirin (mona has a heart so EKG also if select all that apply).

2. What is the maintenance for venous access port that isn't being regularly used?
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
Steroid treatment or a pregnant woman who is retaining water.
Must be flushed 1x/month with heparin and between treatments.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!

3. What are the S&S of aortic dissection?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
Old truck driver or someone on bed rest or with pelvic trauma.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

4. What activity should a patient with pericarditis - who is undergoing treatment - be allowed?
BP is elevated or decreased depending on activity.
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.
Chronic arteriosclerotic disease.
Maintain BED REST

5. What should you teach your patient about angiography (arteriography)?
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unu
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
A nosebleed
Direct current cardioversion and digoxin/propranolol (inderal).

6. What is more harmful a lot of little emboli or one large emboli?
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
One large emboli (smaller=better)
Pneumothorax and will end up with chest tube to help reinflate lung.
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

7. What is an air embolism?
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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.

8. In what locations should you not place electrodes?
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
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
Include rest periods prior to any activity.

9. What is Raynauds disease? Tx?
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.
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.

10. What is a chemical stress test (persantine stress test)?
Cannot
One at a time to assess the pulse amplitude and contour.
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

11. What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
(S1 - S2) Third left intercostal space

12. What will a leg with arterial insufficiency look like?
Pulmonary edema
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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
An enlarged space indicates fluid accumulation in the pericardial sac.

13. If a victim is choking but can cough - speak - or breath what should you do?

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14. What should you teach your patient about an exercise ECG (stress test)?
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
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-
No radial artery punctures if negative

15. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Vitamin K (aqua myphiton)
Right sided heart failure
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

16. What is important to remember when removing a CVC from a patient?
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.
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall - veins - and nerves where they become blocked. It is associated with smoking/tobacco use.
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

17. What does a swan ganz measure?
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-
Feeling warm (fire) or tin can taste is expected and will pass.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
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.

18. What is intermittent claudication?
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.
Arterial pulse: 60-90 - Amplitude: 4+=strong and bounding - Edema: 0=none - Reflex 2+
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Lung disease

19. What type of EKG change indicates MI?
Steroid treatment or a pregnant woman who is retaining water.
In the first 72 hours!!!!!
ST segment elevation (STEMI)
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

20. How should you palpate the apical pulse?
Second left intercostal space
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm

21. What are all the S&S of pericarditis?
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

22. What is cardiac tamponade? Common causes?
0.5-2.0 ng/ml
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
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Posterior nasal packing to stop the blood flow. The LPN CAN DO THIS!

23. What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
BP is elevated or decreased depending on activity.

24. How does the blood flow through the heart? (valves?)
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.
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!
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.

25. What should you observe for in someone on bleeding precautions?
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
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).
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.
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.

26. What usually triggers angina pain?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Pericardial friction rub - chest pain (sharp and aggravated with breathing) - abnormal EKG findings - possible fever and tachycardia.

27. What causes essential/primary hypertension?
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
Idiopathic
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Poorly controlled hypertension

28. When would a nurse use an external femoral artery compression device?
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
If you feel lightheaded - dizzy - or heart palpitations but feel no shock from the ICD.
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Second Left intercostal space

29. What is the goal of treatment for an MI? Treatment?
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
One large emboli (smaller=better)
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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

30. What does plan of care include?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

31. What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
NO NSAIDS or ASA.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.

32. Which type of patient shouldn't take nitrates?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Second left intercostal space

33. What is the correct way to insert an oropharyngeal airway?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
An enlarged space indicates fluid accumulation in the pericardial sac.
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

34. What causes secondary hypertension?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Steroid treatment or a pregnant woman who is retaining water.
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.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).

35. Who would most likely have peripheral venous disease?
Pneumothorax and will end up with chest tube to help reinflate lung.
NO NSAIDS or ASA.
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.
Old truck driver or someone on bed rest or with pelvic trauma.

36. During an Allen's test don't compress one artery _____ the other.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Before
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
No clearly defined or measurable P waves and an irregular - irregular ventricular response.

37. What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).
Steroid treatment or a pregnant woman who is retaining water.
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
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

38. What should you teach someone after they have had a pacemaker placed?

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39. Test ending in Gram=?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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
Cannot
Iodine

40. What are the treatments/ S&S of peripheral venous disease?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
The patient may suffer significant blood loss or femoral nerve compression.
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

41. What are the four types of pulmonary emboli?
Fat - Air - DVT - or Amniotic
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
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.
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

42. 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).
0.5-2.0 ng/ml
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.

43. How is angina treated?

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44. What is important to remember when taking care of patients with compression devices?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
4th left intercostal space lower sternal border
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).

45. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
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
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

46. What is an acute peripheral arterial occlusion?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
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.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.

47. What is characteristic of complete heart block?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
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.
Lowers BP and makes heart beat stronger. SE: flushed face.

48. What is CVP? Normal?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
Chronic arteriosclerotic disease.

49. What should you tell someone about taking nitroglycerin tablets (SE)?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Fifth left intercostal space medial to the midclavicular line.
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.
Pulse before and after giving.

50. What factors place you at risk for HTN?
Nitrates - Beta blockers - and Calcium channel blockers
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

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NCLEX Cardiac

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