NSG 223 MED SURG 2 Exam 1: Cardiac Stress Testing, Dysrhythmias,
Valvular Disorders, MI, Pharmacology | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: Medical-Surgical Nursing – Cardiac Stress Testing (Exercise & Pharmacological);
Echocardiography (TTE, TEE); Labs for MI (Troponin, CK-MB); Atrial Fibrillation & Atrial Flutter;
Cardiac Catheterization; Catheter Ablation; WATCHMAN Device; Electrical Conduction of the Heart;
ECG Waveforms (P, PR, QRS, ST, T, QT, U); Normal Sinus Rhythm; Angina Types (Stable, Unstable,
Variant); Endocarditis, Myocarditis, Pericarditis; Cardiomyopathy (Dilated, Hypertrophic); Valvular
Disorders (Mitral Stenosis, Regurgitation, Prolapse; Aortic Stenosis, Regurgitation); Valvuloplasty; Valve
Replacement; NSTEMI vs STEMI; MI vs Cardiac Arrest; CAD; Beta-Blockers; Amiodarone; tPA Time
Window; Heparin aPTT; Statins; Nitroglycerin Administration; Post-MI Discharge Instructions
Source: NSG 223 MED SURG 2 Exam 1 Bank – Latest 2026/2027 Curriculum
Format: Q&A Guide with Clinical Rationale
1. What is a cardiac stress test?
Correct Answer: The patient walks or runs on a treadmill (most common) or pedals a stationary
bicycle. The test is stopped when the target heart rate is achieved or if the patient experiences signs of
myocardial ischemia. Abnormal findings include chest pain, ventricular arrhythmia, ST-segment
depression, lack of heart rate or BP elevation with exercise.
1. Patient must be capable of walking on a treadmill or stationary bike.
2. NPO 3+ hours before; avoid stimulants like tobacco and caffeine.
3. After test, patient monitored for 10-15 minutes until return to normal.
2. What is a pharmacological stress test?
Correct Answer: Patients who are cognitively impaired, physically disabled, or deconditioned will not
be able to achieve target heart rate by exercising. Must avoid xanthine derivatives (theophylline,
aminophylline, caffeine) for 24-48 hours prior (they block effects of vasodilating agents). NPO 3 hours
before, abstain from all caffeine 24 hours prior, including chocolate and caffeine-free beverages (tea).
1. Medications used: vasodilating agents (dipyridamole, adenosine, regadenoson) or dobutamine.
2. Side effects: chest pain, headache, flushing, nausea, heart block, dyspnea.
3. Reversed with IV aminophylline. Adenosine has extremely short half-life (<10 seconds).
3. What are nursing interventions for TEE (Transesophageal Echocardiography)?
Correct Answer: Instruct patient not to eat or drink anything for 6 hours prior. Recovery period: patient
must maintain bed rest with HOB elevated to 45 degrees. Monitor for dyspnea, vital signs, SpO2, level
of consciousness, and gag reflex. Sore throat may be present for next 24 hours. Report persistent sore
throat, shortness of breath, or difficulty swallowing.
1. TEE involves threading small transducer through mouth into esophagus; topical anesthetic and sedation used.
2. Transthoracic echocardiography transmits sound waves through chest wall.
4. What labs are used to diagnose MI?
Correct Answer: Elevated troponin, elevated creatine kinase-MB (CK-MB).
1. Troponin is most specific and sensitive marker for myocardial necrosis.
2. CK-MB rises within 4-6 hours, peaks at 12-24 hours.
, 5. What would be appreciated for a patient with A-fib?
Correct Answer: Nurse should turn off irregular heart rate alarm.
1. Atrial fibrillation is irregularly irregular; constant alarms would be disruptive.
2. Monitor for rate control and anticoagulation.
6. What is atrial fibrillation?
Correct Answer: Atrial rate: 350-600 bpm; ventricular rate: 120-200 bpm. P wave not discernible with
irregular baseline. PR interval not measurable. QRS complex normal. Rhythm is irregular and usually
rapid unless controlled. Characterized by disorganized atrial electrical activity. No clear P waves;
irregularly irregular QRS spacing.
1. Hallmark signs: quivering (atrial fibrillation) vs saw tooth (atrial flutter).
2. Risk of thrombin formation and stroke.
7. What is one risk of uncontrolled A-fib?
Correct Answer: Thrombin (blood clot formation leading to stroke).
1. CHA₂DS₂-VASc score guides anticoagulation decisions.
2. Warfarin, DOACs used for stroke prevention.
8. What is the P wave?
Correct Answer: Atrial depolarization (contraction). First upward deflection. Represents atrial
depolarization. Usually followed by QRS.
1. Normal P wave duration <0.12 seconds.
2. Absent P waves in atrial fibrillation; saw-tooth in atrial flutter.
9. What is the PR interval?
Correct Answer: Time impulse takes to move through atria and AV node (time needed for atrial
depolarization/contraction). “The time between atrial depolarization and ventricular depolarization.”
From beginning of P wave to beginning of QRS complex. Length: 0.12 – 0.20 sec (3 to 5 small boxes).
1. Prolonged PR interval indicates first-degree AV block or AV node delay.
2. PR interval not measurable in atrial fibrillation.
10. What is the QRS complex?
Correct Answer: Composition of 3 waves. Represents ventricular depolarization (contraction). Length:
<0.12 sec (less than 3 small boxes). Q – first negative depolarization; R – first positive upward
deflection; S – first negative deflection following R wave.
1. Wide QRS (>0.12 sec) indicates ventricular origin or bundle branch block.
2. Narrow and wide QRS help differentiate supraventricular vs ventricular tachycardia.
11. What is the ST segment?
Correct Answer: Early repolarization of ventricles. Measured from J point to onset of T wave.
Elevation or depression may indicate abnormality (possible MI). Length nonspecific (we monitor where
it falls, not measure).
1. ST elevation: STEMI, pericarditis. ST depression: ischemia, electrolyte imbalance.
2. ST elevation myocardial infarction (STEMI) indicates complete coronary artery occlusion.
Valvular Disorders, MI, Pharmacology | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: Medical-Surgical Nursing – Cardiac Stress Testing (Exercise & Pharmacological);
Echocardiography (TTE, TEE); Labs for MI (Troponin, CK-MB); Atrial Fibrillation & Atrial Flutter;
Cardiac Catheterization; Catheter Ablation; WATCHMAN Device; Electrical Conduction of the Heart;
ECG Waveforms (P, PR, QRS, ST, T, QT, U); Normal Sinus Rhythm; Angina Types (Stable, Unstable,
Variant); Endocarditis, Myocarditis, Pericarditis; Cardiomyopathy (Dilated, Hypertrophic); Valvular
Disorders (Mitral Stenosis, Regurgitation, Prolapse; Aortic Stenosis, Regurgitation); Valvuloplasty; Valve
Replacement; NSTEMI vs STEMI; MI vs Cardiac Arrest; CAD; Beta-Blockers; Amiodarone; tPA Time
Window; Heparin aPTT; Statins; Nitroglycerin Administration; Post-MI Discharge Instructions
Source: NSG 223 MED SURG 2 Exam 1 Bank – Latest 2026/2027 Curriculum
Format: Q&A Guide with Clinical Rationale
1. What is a cardiac stress test?
Correct Answer: The patient walks or runs on a treadmill (most common) or pedals a stationary
bicycle. The test is stopped when the target heart rate is achieved or if the patient experiences signs of
myocardial ischemia. Abnormal findings include chest pain, ventricular arrhythmia, ST-segment
depression, lack of heart rate or BP elevation with exercise.
1. Patient must be capable of walking on a treadmill or stationary bike.
2. NPO 3+ hours before; avoid stimulants like tobacco and caffeine.
3. After test, patient monitored for 10-15 minutes until return to normal.
2. What is a pharmacological stress test?
Correct Answer: Patients who are cognitively impaired, physically disabled, or deconditioned will not
be able to achieve target heart rate by exercising. Must avoid xanthine derivatives (theophylline,
aminophylline, caffeine) for 24-48 hours prior (they block effects of vasodilating agents). NPO 3 hours
before, abstain from all caffeine 24 hours prior, including chocolate and caffeine-free beverages (tea).
1. Medications used: vasodilating agents (dipyridamole, adenosine, regadenoson) or dobutamine.
2. Side effects: chest pain, headache, flushing, nausea, heart block, dyspnea.
3. Reversed with IV aminophylline. Adenosine has extremely short half-life (<10 seconds).
3. What are nursing interventions for TEE (Transesophageal Echocardiography)?
Correct Answer: Instruct patient not to eat or drink anything for 6 hours prior. Recovery period: patient
must maintain bed rest with HOB elevated to 45 degrees. Monitor for dyspnea, vital signs, SpO2, level
of consciousness, and gag reflex. Sore throat may be present for next 24 hours. Report persistent sore
throat, shortness of breath, or difficulty swallowing.
1. TEE involves threading small transducer through mouth into esophagus; topical anesthetic and sedation used.
2. Transthoracic echocardiography transmits sound waves through chest wall.
4. What labs are used to diagnose MI?
Correct Answer: Elevated troponin, elevated creatine kinase-MB (CK-MB).
1. Troponin is most specific and sensitive marker for myocardial necrosis.
2. CK-MB rises within 4-6 hours, peaks at 12-24 hours.
, 5. What would be appreciated for a patient with A-fib?
Correct Answer: Nurse should turn off irregular heart rate alarm.
1. Atrial fibrillation is irregularly irregular; constant alarms would be disruptive.
2. Monitor for rate control and anticoagulation.
6. What is atrial fibrillation?
Correct Answer: Atrial rate: 350-600 bpm; ventricular rate: 120-200 bpm. P wave not discernible with
irregular baseline. PR interval not measurable. QRS complex normal. Rhythm is irregular and usually
rapid unless controlled. Characterized by disorganized atrial electrical activity. No clear P waves;
irregularly irregular QRS spacing.
1. Hallmark signs: quivering (atrial fibrillation) vs saw tooth (atrial flutter).
2. Risk of thrombin formation and stroke.
7. What is one risk of uncontrolled A-fib?
Correct Answer: Thrombin (blood clot formation leading to stroke).
1. CHA₂DS₂-VASc score guides anticoagulation decisions.
2. Warfarin, DOACs used for stroke prevention.
8. What is the P wave?
Correct Answer: Atrial depolarization (contraction). First upward deflection. Represents atrial
depolarization. Usually followed by QRS.
1. Normal P wave duration <0.12 seconds.
2. Absent P waves in atrial fibrillation; saw-tooth in atrial flutter.
9. What is the PR interval?
Correct Answer: Time impulse takes to move through atria and AV node (time needed for atrial
depolarization/contraction). “The time between atrial depolarization and ventricular depolarization.”
From beginning of P wave to beginning of QRS complex. Length: 0.12 – 0.20 sec (3 to 5 small boxes).
1. Prolonged PR interval indicates first-degree AV block or AV node delay.
2. PR interval not measurable in atrial fibrillation.
10. What is the QRS complex?
Correct Answer: Composition of 3 waves. Represents ventricular depolarization (contraction). Length:
<0.12 sec (less than 3 small boxes). Q – first negative depolarization; R – first positive upward
deflection; S – first negative deflection following R wave.
1. Wide QRS (>0.12 sec) indicates ventricular origin or bundle branch block.
2. Narrow and wide QRS help differentiate supraventricular vs ventricular tachycardia.
11. What is the ST segment?
Correct Answer: Early repolarization of ventricles. Measured from J point to onset of T wave.
Elevation or depression may indicate abnormality (possible MI). Length nonspecific (we monitor where
it falls, not measure).
1. ST elevation: STEMI, pericarditis. ST depression: ischemia, electrolyte imbalance.
2. ST elevation myocardial infarction (STEMI) indicates complete coronary artery occlusion.
