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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 should you do when applying a femoral artery compression device?
All People Enjoy Time Magazine= Aortic - Pulmonic - ERB's point - Tricuspid - and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
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.
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
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.)

2. How is the Allen's test done?
No clearly defined or measurable P waves and an irregular - irregular ventricular response.
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.
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.
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

3. What is more harmful a lot of little emboli or one large emboli?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
One large emboli (smaller=better)
Administer 100% O2 - left trendelenburg position - heparin administered - and oral warfarin started (give heparin and warfarin together for at least 5 days).
No radial artery punctures if negative

4. What are the S&S of cardiac tamponade?
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.
An enlarged space indicates fluid accumulation in the pericardial sac.
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.
Don't interfere!

5. How should you palpate the apical pulse?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
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

6. What should be done immediately if a pulmonary embolism is suspected?
Nitrates - Beta blockers - and Calcium channel blockers
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
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!
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

7. What should you not allow if a patient has a negative Allen's test?
Protamine Sulfate
Second right intercostal space
No radial artery punctures if negative
4th left intercostal space lower sternal border

8. What are examples of calcium channel blockers?
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
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
Verapamil (calan) - diltiazem (cardizem) - nifedipine (procardia) - amlodipine (norvasc).
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.

9. Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
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.
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.
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.

10. What should you do to treat pulmonary edema?
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
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
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
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

11. When should you be concerned about premature ventricular contraction?
(S1 - S2) Third left intercostal space
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
To inhibit thrombus and clot formation.

12. What are the 2 types of pacemakers?
Air embolism
Lowers BP and makes heart beat stronger. SE: flushed face.
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.
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.

13. What is epistaxis?
GI - neuro - and cardiac. S&S= yellow/green vision - N&V - bradycardia - and anorexia.
A nosebleed
In the first 72 hours!!!!!
Pulse before and after giving.

14. What should you do if you are going to ventilate someone with an ambu bag?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
Stroke - renal or heart failure - paraplegia secondary to compromised blood flow - or death from aortic rupture.
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

15. What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

16. What should you tell someone about taking nitroglycerin tablets (SE)?
Open up blood vessels
In fatty areas or over major muscles - large breasts - or bony prominences.
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.
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.

17. What is the most common cause of arterial insufficiency?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Chronic arteriosclerotic disease.

18. Where do the internal jugular veins lie?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
Anxiousness - restlessness - tachycardia - tachypneic - 90% SP02 - dyspnea - substernal pain - coughing - hemoptysis - and fever.
When not visable - place the patient in the left lateral position - ask them to exhale fully and stop breathing for a few seconds.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.

19. What should be checked in a patient on a beta blocker?
Pulse before and after giving.
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
Stop the medication - address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.

20. What are signs and symptoms of an MI?
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
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
RAndI= Razor - electric - Aspirin - NO - Needles - small gauge - Decrease - needle sticks - and Injury- protect from. No percodan or NSAIDS - no open toed shoes.
Cannot

21. What is a good diagnosis for someone with right sided HF?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
Activity intolerance
One large emboli (smaller=better)
Direct current shock (defibrillation) and IV anti - arrhythmic drugs (lidocaine - Procainamide - and Bretylium).

22. What are the steps for infant 1&2 rescuer CPR?
In fatty areas or over major muscles - large breasts - or bony prominences.
No radial artery punctures if negative
Check for response - activate ERS - open airway head tilt chin lift - check breathing (5-10 sec) - give 2 breaths (1 sec) with visible chest rise - checks brachial pulse (5-10 sec) - locates CPR finger position - deliver 1st cycle of compressions (30
Right sided heart failure

23. What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
For the first month post op - do not lift more than 10 or 15 lbs. And avoid excessive pushing - pulling - or twisting.
The right and left ventricular pressures - cardiac output - arterial venous O2 difference - and pulmonary artery pressure.
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.

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

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25. What could happen without immediate intervention for a hematoma?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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
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.
The patient may suffer significant blood loss or femoral nerve compression.

26. What should you observe for in someone on bleeding precautions?
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!
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
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).

27. Where should you place your stethescope to find the aortic valve?
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.
Second Right intercostal space.
Include rest periods prior to any activity.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

28. 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.
Before
Protamine Sulfate
SOB - dyspnea - anxiousness - diaphoresis - cool/clammy skin - distended neck veins - mental status changes - narrowed pulse pressure - hypotension - and faint or muffled heart sounds.

29. What are the S&S of air embolism?
Iodine
Difficulty breathing - pain in midchest and shoulder - pale - nausea - and light headedness.
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.

30. What is pulsus paradoxus?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck - shoulders - or jaw - diaphoresis - nausea - and SOB.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
Direct current cardioversion and digoxin/propranolol (inderal).
Don't interfere!

31. What should you watch for with PICC lines that have been in place for 6 months?
ST segment elevation (STEMI)
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!
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
Air answers (open junctions)

32. What should you teach your patient about an electrocardiogram (ECG)?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
Direct current cardioversion and digoxin/propranolol (inderal).
Check all junctions frequently to make sure secure - especially before patient gets out of bed - and always use tubing with twist lock connections.
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

33. What is the treatment for premature ventricular contractions?
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
Temporary or permanent transvenous PACEMAKER INSERTION - and if the client is symptomatic and showing S&S of decreased cardiac output - GIVE ATROPINE.
Pallor - diaphoresis - tachypnea - severe tearing chest pain radiating to back - PULSES In ARMS Are STRONG BUT LEG PULSES Are WEAK - low SP02.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

34. What is important to remember when removing a CVC from a patient?
The arteries have narrowed - decreased O2 to tissues= hypoxia to cells.
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.
NO NSAIDS or ASA.
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).

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

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36. What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
An enlarged space indicates fluid accumulation in the pericardial sac.
Second Left intercostal space
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.
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.

37. What should you teach your patient about an exercise ECG (stress test)?
Elevated legs - anticoagulation therapy (aggressive: generally IV heparin) - Be alert for signs of PE.
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
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-
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.

38. What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
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.
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (The PT. Is DYING) And NotIFY PHYSICIAN (2ND).
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).

39. What is the hallmark clinical finding associated with pericarditis?
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.
Lung disease
One at a time to assess the pulse amplitude and contour.
Varicose veins - elevate legs - weight reduction - brawny in color - ted hose - topical steroids - ulcers - and skin color changes.

40. When would a nurse use an external femoral artery compression device?
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
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
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.)
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.

41. What is labile hypertension?
BP is elevated or decreased depending on activity.
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
ST segment elevation (STEMI)
Pulmonary edema

42. What causes secondary hypertension?
Nitrates - Beta blockers - and Calcium channel blockers
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
Steroid treatment or a pregnant woman who is retaining water.
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.

43. What signals an elevated venous pressure based on the internal jugular veins?
Direct current cardioversion and digoxin/propranolol (inderal).
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.
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.
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.

44. Where is the aortic valve landmark on the chest?
Second right intercostal space
Totally disorganized - chaotic pattern - and no discernible waves or complexes.
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
Smoking - elevated cholesterol - diabetes - hypertension - old age - and family hx of coronary artery disease.

45. What is the treatment for a pt. with ventricular tachycardia?
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.
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
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.

46. What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Aortic valve - Pulmonic valve - right ventricle - tricuspid valve - and apex or mitral valve.
Deep in the sternomastoid muscle - so look for pulsations in the soft tissue surrounding that area.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).

47. What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC - (2nd) if unconscious= begin CPR - and (3rd) Notify physician.
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
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

48. What should you do if the PT value is 45 sec?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
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
D/C the med and call the doctor.

49. What are the nursing interventions for a patient in complete heart block?
Second left intercostal space
Direct current cardioversion and digoxin/propranolol (inderal).
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) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).

50. What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing - swelling around site - palpable 2 inch fullness - and a bruit is present?
To inhibit thrombus and clot formation.
You need to maintain use of those devices continually except when the patient is ambulating - bathing - or during physical therapy or skin assessment.
Second left intercostal space
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.