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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. In what locations should you not place electrodes?
ST segment elevation (STEMI)
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
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

2. What should you teach your patient about angiography (arteriography)?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
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
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.
Pulse before and after giving.

3. What should you teach your patient about an electrocardiogram (ECG)?
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
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
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 left sternal border

4. What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
Steroid treatment or a pregnant woman who is retaining water.
An enlarged space indicates fluid accumulation in the pericardial sac.
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
Right sided heart failure

5. What is epistaxis?
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.
A nosebleed
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
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.

6. What is CVP? Normal?
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.
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.
D/C the med and call the doctor.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

7. What lab value is used to evaluate a patient on coumadin? What is the normal value?
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.

8. What usually triggers angina pain?
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
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
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
It usually occurs when your heart is working harder (ex: exercising - eating large meal - or feeling stress. Also very hot or cold weather).

9. What should you observe for in someone on bleeding precautions?
Paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - BLOOD TINGED SPUTUM - cough - orthopnea - exertional dyspnea - cyanosis.
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).
Poorly controlled hypertension
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.

10. Where is the right ventricle landmark on the chest?
Second right intercostal space
Left sternal border
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.

11. 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+
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).
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure - hypertension - or dyspnea.
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.

12. What things should you do to assess cardiovascular status?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
Inspect pulses on chest - inspect the internal jugular veins - palpate the apical pulse - palpate the carotid arteries - and auscultate the heart sounds.
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

13. Where should you place your stethescope to find the mitral (apex) valve?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
D/C the med and call the doctor.
A patient on sildenafil (Viagra) - Cealis - or Levitra bc these drugs together can cause very low blood pressure and heart attack.
Fifth left intercostal space medial to the midclavicular line.

14. What SE should you look for with calcium channel blocker use?
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.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.

15. What are examples of calcium channel blockers?
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
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.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
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

16. What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
NO TED HOSE - NO SHEETS/BLANKETS - NO COMPRESSION DEVICES - (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
Old truck driver or someone on bed rest or with pelvic trauma.
Only for a few hours

17. What does an Allen's test determine?
BP is elevated or decreased depending on activity.
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.
Whether the patients ulnar and radial arteries are patent.
Second left intercostal space

18. What should you do if you are going to ventilate someone with an ambu bag?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
BP is elevated or decreased depending on activity.
In fatty areas or over major muscles - large breasts - or bony prominences.
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

19. Where should you place your stethescope to find the aortic valve?
It is a sterile procedure so both nurse and patient should wear a mask - arrange sterile field - remove dressing - assess the catheter insertion site for infection - put on sterile gloves - clean the site moving outwardly in a circular motion - apply
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Activity intolerance
Second Right intercostal space.

20. What should you do immediately if you suspect someone of developing a hematoma?
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.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
NO because it isn't sterile so keep out.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).

21. What are coumadin and heparin used for?
Idiopathic
To inhibit thrombus and clot formation.
D/C the med and call the doctor.
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.

22. What are common risk factors for an MI?
Open up blood vessels
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.
Before

23. What is the proper way to access and implanted venous access port (IVAP) (Mediport)?

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24. What should you not allow if a patient has a negative Allen's test?
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.
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).
No radial artery punctures if negative
Air embolism

25. What causes secondary hypertension?
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
Pulse before and after giving.
Steroid treatment or a pregnant woman who is retaining water.
A nosebleed

26. What is the treatment for a patient in complete heart block?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.

27. What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
A nosebleed
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.

28. Where should you place your stethescope to find the ERB's Point?
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.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
(S1 - S2) Third left intercostal space
Fourth or fifth intercostal space at or medial to the midclavicular line.

29. What is the correct way to insert an oropharyngeal airway?
Second left intercostal space
No radial artery punctures if negative
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
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

30. What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
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
Fourth or fifth intercostal space at or medial to the midclavicular line.
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

31. What is superior vena cava syndrome?
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.
A monitor with four dual electrodes that are applied to the patients neck and thorax.
If feel more than 3 shocks in a row or develop signs of infection at the site.
Direct current cardioversion and digoxin/propranolol (inderal).

32. What body systems are affected by digoxin toxicity? S&S?
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.
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
Poorly controlled hypertension
Idiopathic

33. What is characteristic of ventricular fibrillation?
Cannot
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Totally disorganized - chaotic pattern - and no discernible waves or complexes.

34. What is Deep Vein Thrombosis (DVT)?
Vascular - artery disease causing fluid to back up into the lungs.
The patient may suffer significant blood loss or femoral nerve compression.
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.

35. What is a major complication of central line placement?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
Pneumothorax and will end up with chest tube to help reinflate lung.

36. If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
BP is elevated or decreased depending on activity.
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
Right sided heart failure

37. What are the steps for infant 1&2 rescuer CPR?
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.
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
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L

38. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
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
Lung disease
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.

39. What are the nursing interventions for a patient in complete heart block?
Fatigue - JVD - Increased peripheral venous pressure - ascites - anorexia/complaints of GI distress - cyanosis - and dependent edema.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
In the first 72 hours!!!!!

40. What should you always assume with a patient who has a central line placed and is experiencing SOB?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Air embolism
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
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.

41. What is a therapeutic digoxin level?
0.5-2.0 ng/ml
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
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
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).

42. What disease can cause right sided heart failure?
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
Lung disease
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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.

43. What are the proper steps to changing a central venous catheter dressing?
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 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
Poorly controlled hypertension
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

44. What should you teach your patient about an abdominal ultrasonography?
Hair loss - muscle mass loss - pallor when elevated - dependent rubor - and prolonged cap refill time.
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 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
BP is elevated or decreased depending on activity.

45. What is more harmful a lot of little emboli or one large emboli?
NO NSAIDS or ASA.
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
One large emboli (smaller=better)
To reduce a patients risk of DVT and PE. They include graduated compression stockings - vena cava filters - and intermittent sequential external compression devices.

46. What should you explain to the patient about an impedance cardiography test?
BP is elevated or decreased depending on activity.
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
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

47. What landmarks should you be looking for on someone's chest?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
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.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
In the first 72 hours!!!!!

48. What should you teach someone with arterial insufficiency?

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

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50. What is the treatments for hypertension?
Fat - Air - DVT - or Amniotic
Vascular - artery disease causing fluid to back up into the lungs.
High pitched sounds like S1 and S2 (pericardial friction rubs - aortic/mitral regurgitation murmurs). DIAPH(high)ragm
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.