NSG223/ NSG 223 Med Surg II Exam 1 (Latest 2026/2027 Update) | Complete Q&A with Verified Answers and Detailed Rationales | Atropine, Heparin, Warfarin, Digoxin, Antiarrhythmics | A+ Graded | Herzing University

INSTANT PDF DOWNLOAD — This comprehensive EXAM resource for NSG 223 Medical-Surgical Nursing II Exam 1 at Herzing University covers essential cardiac medications for the 2026/2027 academic year: Atropine, Heparin, Warfarin, Digoxin, and Antiarrhythmics. It features exam-style questions with verified answers and detailed rationales aligned with the NSG 223 Med-Surg II curriculum. ATROPINE Indication: Symptomatic bradycardia (sinus bradycardia, heart block), reversal of muscarinic effects, organophosphate poisoning, premedication for intubation to prevent bradycardia. Increases heart rate by blocking vagal tone on the SA node . Nursing Considerations: Use cautiously in coronary artery disease—total dose should be restricted to 2-3 mg (or 0.03-0.04 mg/kg) to avoid detrimental effects of tachycardia on myocardial oxygen demand . Monitor for paradoxical bradycardia with slow IV push; most effective for sinus and AV nodal bradycardia . Contains benzyl alcohol preservative which may be toxic to neonates; use undiluted for IM/IV/ET administration (ET dose may be doubled and diluted with 10 mL sterile water or NS) . Adverse Effects: Tachycardia (most common), dry mouth, blurred vision, photophobia, urinary retention, constipation, anhidrosis (heat intolerance). May precipitate acute glaucoma, pyloric obstruction, or complete urinary retention in BPH patients. CNS stimulation (restlessness, delirium, hallucinations) may occur with large doses . Contraindications: Avoid in myasthenia gravis, paralytic ileus, toxic megacolon, angle-closure glaucoma, benign prostatic hypertrophy, chronic lung disease (inspissation of bronchial secretions). No absolute contraindications in emergency life‑threatening situations . Monitoring: Heart rate, blood pressure, ECG, signs of anticholinergic toxicity; watch for fall risk especially in elderly patients. In severe overdose: dilated pupils, warm dry skin, tachycardia, tremor, ataxia, delirium, coma . Reversal Agent: Physostigmine (severe overdose, paradoxical CNS reactions) . HEPARIN (Unfractionated Heparin – UFH) Indication: Prevention and treatment of DVT, PE, and thromboembolic disorders; acute coronary syndromes, management of atrial fibrillation, DIC. Does NOT dissolve existing clots but prevents further clot formation. High‑alert medication per ISMP requiring special safeguards . Route & Onset: IV (immediate) or Subcutaneous (20-30 min onset). Continuous IV infusion is standard for acute anticoagulation; subcutaneous available for prevention. Nursing Considerations: Monitor aPTT (activated partial thromboplastin time) every 6 hours post-dose change until two consecutive values are within target (typically 1.5–2.5 times control). Use heparin nomograms to guide titration. Baseline labs: aPTT, PT, CBC with platelets. Monitor for HIT (Heparin‑Induced Thrombocytopenia): 50% drop in platelets from baseline 5‑10 days after exposure. If HIT suspected, STOP all heparin products (including flushes). Assess for bleeding: epistaxis, gingival bleeding, hematuria, melena, petechiae, ecchymoses. For weight-based dosing, document weight daily. Educate patients to avoid NSAIDs, alcohol, and activities that increase bleeding risk. High risk of medication errors; carefully confirm correct heparin concentration and product selection . Adverse Effects: Bleeding (most common), heparin-induced thrombocytopenia, HITT