NSG 223 MED SURG 2 Exam 1: (Latest 2026/2027 Update) Cardiovascular
Diagnostics & ECG Interpretation | Q&A | Grade A | 100% Correct (Verified
Answers) – Nursing Program
Subject: NSG 223 – Medical-Surgical Nursing / Cardiovascular
Source: NSG 223 MED SURG 2 Exam 1 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the difference between NSTEMI and STEMI?
Correct Answer: STEMI = complete blockage of the heart artery with ST-segment elevation on ECG.
NSTEMI = partial blockage without ST-segment elevation, but cardiac enzymes are elevated (non-ST
elevation MI).
1. STEMI requires emergent reperfusion (PCI within 90 min or thrombolytics).
2. NSTEMI managed with medical therapy and risk stratification; urgent PCI may be indicated if
high risk.
3. Both require aspirin, heparin, anti-ischemic therapy.
2. What is the difference between MI and cardiac arrest?
Correct Answer: MI = pumping problem (myocardial necrosis). Cardiac arrest = electrical problem
(sudden loss of heart function, arrhythmia).
1. Cardiac arrest is often caused by VT/VF; requires defibrillation, CPR.
2. MI may lead to cardiac arrest but not always.
3. MI treated with revascularization; cardiac arrest treated with ACLS protocol.
3. What is a pharmacological stress test and what must the patient avoid beforehand?
Correct Answer: Pharmacological stress test uses IV medication (dipyridamole, adenosine,
regadenoson, dobutamine) for patients unable to exercise. Must avoid xanthine derivatives
(theophylline, aminophylline, caffeine) for 24-48 hours prior; NPO 3 hours; abstain from all caffeine
including chocolate and decaf tea for 24 hours.
1. Adenosine half-life <10 seconds; severe effects subside rapidly.
2. Aminophylline reverses vasodilating agents.
4. What is the 5-Lead ECG color placement/mnemonic?
Correct Answer: RA: White below right clavicle; LA: Black below left clavicle; LL: Red on left side
of abdomen; RL: Green on right side of abdomen; V1 (precordial): Brown at 4th ICS right of sternum.
Mnemonic: "White on right, smoke (black) over fire (red), green goes to ground, brown is central."
1. Proper placement reduces artifact and ensures accurate rhythm interpretation.
3. Avoid placing electrodes over bone or large muscles.
, 5. What is the 12-lead ECG placement for precordial (chest) leads?
Correct Answer: V1: 4th ICS right of sternum; V2: 4th ICS left of sternum; V3: midway between V2
and V4; V4: 5th ICS midclavicular line; V5: anterior axillary line horizontal to V4; V6: midaxillary line
horizontal to V4/V5.
1. Correct placement essential for accurate ST-segment interpretation, MI localization.
2. Improper placement leads to false ST changes, misdiagnosis.
3. Limb leads: RA (white), LA (black), LL (red), RL (green), precordial leads V1-V6.
6. What is the difference between a mechanical replacement valve and a bioprosthetic valve
regarding anticoagulation?
Correct Answer: Mechanical valves require lifelong anticoagulation (warfarin INR 2.5-3.5 for mitral,
1.8-2.2 for aortic). Bioprosthetic valves require short-term anticoagulation only (3-6 months) then
aspirin.
1. Mechanical valves are durable but thrombogenic; need warfarin.
2. Bioprosthetic valves degenerate faster but lower bleeding risk.
3. Patients with mechanical valve need antibiotic prophylaxis for dental procedures.
7. What is the electrical conduction pathway of the heart?
Correct Answer: 1. SA node (60-100 bpm) → P-wave; 2. Internodal pathways → AV node (40-60
bpm); 3. Bundle of His; 4. Right/left bundle branches; 5. Purkinje fibers (20-40 bpm).
1. SA node is primary pacemaker.
2. AV node delay allows ventricular filling.
3. Purkinje fibers are the fastest conduction velocity; lowest inherent rate.
8. What is the T wave and what does a peaked T wave indicate?
Correct Answer: T wave represents ventricular repolarization. Peaked (tented) T wave indicates
hyperkalemia. U wave (after T) indicates hypokalemia.
1. Hyperkalemia: tall, peaked T waves, widened QRS, sine wave, V-fib.
2. Hypokalemia: U waves, flat T waves, prolonged QT.
3. T wave inversion may indicate ischemia, ventricular hypertrophy, or normal variant.
9. What is mitral stenosis and its hallmark symptom?
Correct Answer: Obstruction of blood flow from left atrium to left ventricle. Hallmark symptom:
hemoptysis (bloody cough) from pulmonary congestion or bronchial vein rupture.
1. Most common cause: rheumatic fever. Other causes: congenital, cardiomyopathy.
2. Orthopnea, dyspnea on exertion, AFib common.
3. Diastolic murmur (opening snap, rumble).
Diagnostics & ECG Interpretation | Q&A | Grade A | 100% Correct (Verified
Answers) – Nursing Program
Subject: NSG 223 – Medical-Surgical Nursing / Cardiovascular
Source: NSG 223 MED SURG 2 Exam 1 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the difference between NSTEMI and STEMI?
Correct Answer: STEMI = complete blockage of the heart artery with ST-segment elevation on ECG.
NSTEMI = partial blockage without ST-segment elevation, but cardiac enzymes are elevated (non-ST
elevation MI).
1. STEMI requires emergent reperfusion (PCI within 90 min or thrombolytics).
2. NSTEMI managed with medical therapy and risk stratification; urgent PCI may be indicated if
high risk.
3. Both require aspirin, heparin, anti-ischemic therapy.
2. What is the difference between MI and cardiac arrest?
Correct Answer: MI = pumping problem (myocardial necrosis). Cardiac arrest = electrical problem
(sudden loss of heart function, arrhythmia).
1. Cardiac arrest is often caused by VT/VF; requires defibrillation, CPR.
2. MI may lead to cardiac arrest but not always.
3. MI treated with revascularization; cardiac arrest treated with ACLS protocol.
3. What is a pharmacological stress test and what must the patient avoid beforehand?
Correct Answer: Pharmacological stress test uses IV medication (dipyridamole, adenosine,
regadenoson, dobutamine) for patients unable to exercise. Must avoid xanthine derivatives
(theophylline, aminophylline, caffeine) for 24-48 hours prior; NPO 3 hours; abstain from all caffeine
including chocolate and decaf tea for 24 hours.
1. Adenosine half-life <10 seconds; severe effects subside rapidly.
2. Aminophylline reverses vasodilating agents.
4. What is the 5-Lead ECG color placement/mnemonic?
Correct Answer: RA: White below right clavicle; LA: Black below left clavicle; LL: Red on left side
of abdomen; RL: Green on right side of abdomen; V1 (precordial): Brown at 4th ICS right of sternum.
Mnemonic: "White on right, smoke (black) over fire (red), green goes to ground, brown is central."
1. Proper placement reduces artifact and ensures accurate rhythm interpretation.
3. Avoid placing electrodes over bone or large muscles.
, 5. What is the 12-lead ECG placement for precordial (chest) leads?
Correct Answer: V1: 4th ICS right of sternum; V2: 4th ICS left of sternum; V3: midway between V2
and V4; V4: 5th ICS midclavicular line; V5: anterior axillary line horizontal to V4; V6: midaxillary line
horizontal to V4/V5.
1. Correct placement essential for accurate ST-segment interpretation, MI localization.
2. Improper placement leads to false ST changes, misdiagnosis.
3. Limb leads: RA (white), LA (black), LL (red), RL (green), precordial leads V1-V6.
6. What is the difference between a mechanical replacement valve and a bioprosthetic valve
regarding anticoagulation?
Correct Answer: Mechanical valves require lifelong anticoagulation (warfarin INR 2.5-3.5 for mitral,
1.8-2.2 for aortic). Bioprosthetic valves require short-term anticoagulation only (3-6 months) then
aspirin.
1. Mechanical valves are durable but thrombogenic; need warfarin.
2. Bioprosthetic valves degenerate faster but lower bleeding risk.
3. Patients with mechanical valve need antibiotic prophylaxis for dental procedures.
7. What is the electrical conduction pathway of the heart?
Correct Answer: 1. SA node (60-100 bpm) → P-wave; 2. Internodal pathways → AV node (40-60
bpm); 3. Bundle of His; 4. Right/left bundle branches; 5. Purkinje fibers (20-40 bpm).
1. SA node is primary pacemaker.
2. AV node delay allows ventricular filling.
3. Purkinje fibers are the fastest conduction velocity; lowest inherent rate.
8. What is the T wave and what does a peaked T wave indicate?
Correct Answer: T wave represents ventricular repolarization. Peaked (tented) T wave indicates
hyperkalemia. U wave (after T) indicates hypokalemia.
1. Hyperkalemia: tall, peaked T waves, widened QRS, sine wave, V-fib.
2. Hypokalemia: U waves, flat T waves, prolonged QT.
3. T wave inversion may indicate ischemia, ventricular hypertrophy, or normal variant.
9. What is mitral stenosis and its hallmark symptom?
Correct Answer: Obstruction of blood flow from left atrium to left ventricle. Hallmark symptom:
hemoptysis (bloody cough) from pulmonary congestion or bronchial vein rupture.
1. Most common cause: rheumatic fever. Other causes: congenital, cardiomyopathy.
2. Orthopnea, dyspnea on exertion, AFib common.
3. Diastolic murmur (opening snap, rumble).
