NSG 223 Exam 1: (Latest 2026/2027 Update) Valvular Heart Disease, CAD,
ACS, Pharmacology & Cardiomyopathy | Q&A | Grade A | 100% Correct
(Verified Answers)
Subject: Medical-Surgical Nursing / Cardiovascular Disorders
Source: NSG 223 Exam 1 – Comprehensive Review
Format: Q&A Guide with Clinical Rationale
1: Antidote for Digoxin Toxicity?
Correct Answer: Digoxin Immune Fab (Digibind, DigiFab).
1. Indicated for life-threatening digoxin toxicity (dysrhythmias, hyperkalemia).
2. Binds directly to digoxin molecules.
3. Monitor for hypokalemia after administration (rebound effect).
2: What does Thrombolytics do?
Correct Answer: Dissolve thrombi and reestablish blood flow as quickly as possible, prevent or limit
tissue damage, and maximize functional improvement.
1. Alteplase (tPA) lyses fibrin blood clots ("clot buster").
2. For STEMI: decreases ST elevations.
3. First-line therapy for ischemic stroke (return to baseline).
3: Nitroglycerin administration information
Correct Answer: Relaxes blood vessels, increases blood/O2 supply to heart while reducing workload.
Oral: tablet not chewed/crushed/swallowed. Buccal works fastest (under tongue or between
cheek/gum). 3 tablets at 5-minute intervals. Most common AE: headache. Withhold if systolic BP <90
or HR >100 bpm. Spray half-life 2-3 years. Ointment: apply to non-hairy area, avoid contact with
hands, do not massage.
1. Sublingual onset 1-3 minutes.
2. Store in original dark glass bottle (light-sensitive).
3. Replace every 6 months.
4: Atrial Fibrillation
Correct Answer: Heart's upper chambers beat chaotically and irregularly. Atrial rate 300-600 bpm;
ventricular rate 120-200 bpm. "Snakes in the grass" ECG pattern. Occasional (paroxysmal): symptoms
come and go minutes to hours. Persistent: does not go back to normal on own;
cardioversion/medications needed. Long-standing: >12 months.
1. Increased risk of thromboembolic stroke.
2. Rate control vs rhythm control strategy.
3. Anticoagulation based on CHA₂DS₂-VASc score.
,5: Heparin Action
Correct Answer: Combines with antithrombin III to inactivate clotting factors to prevent thrombus
formation. The goal of heparin therapy in DIC is to prevent blood coagulation long enough for clotting
factors to be replenished and thus control hemorrhage.
1. Prevents DVT, PE, and further thrombus formation.
2. Used in AFib.
3. aPTT goal 1.5-2.5x baseline (45-70 sec).
6: Prinzmetal's angina (Variant angina) causes
Correct Answer: Exposure to cold weather, stress, medicines that vasoconstrict, smoking, cocaine use.
Usually happens between midnight and morning while asleep or resting.
1. Caused by coronary artery vasospasm, not atherosclerosis.
2. Treat with calcium channel blockers, nitrates.
3. Avoid beta-blockers (may worsen vasospasm).
7: Atropine Overdose S/S
Correct Answer: Decreased secretions, increased HR, decreased GI and GU tone.
1. Anticholinergic toxidrome: "hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a
hatter."
2. Physostigmine antidote (IV slow 1 mg/min).
3. Monitor for seizures, arrhythmias.
8: What are symptoms of Digoxin Toxicity?
Correct Answer: Vision changes with yellow-green halos and blurred vision, N/V, loss of appetite,
abdominal pain, hyperkalemia, hypercalcemia.
1. Bradycardia, heart block, ventricular arrhythmias.
2. Hypokalemia, hypomagnesemia increase toxicity risk.
3. Hold digoxin if apical pulse <60 bpm.
9: Ezetimibe (Zetia) Action
Correct Answer: Acts in small intestine to inhibit absorption of cholesterol and decrease delivery of
intestinal cholesterol to the liver.
1. Peak effect 4-12 hours.
2. Take at same time each day (night if with statin).
3. Separate from bile acid sequestrants by 2 hours before or 4 hours after.
10: Aortic Regurgitation: Pathophysiology
Correct Answer: Blood from the aorta returns to the left ventricle during diastole.
1. Chronic volume overload causes LV dilation and hypertrophy.
2. Leads to wide pulse pressure (bounding pulses).
3. ECHO every 6 months.
, 11: Mitral Valve Prolapse: Pathophysiology
Correct Answer: A portion of one or both mitral valve leaflets balloons back into the atrium during
systole.
1. Most common valvular abnormality.
2. Often benign, may cause chest pain, palpitations.
3. Increased risk of infective endocarditis.
12: Mitral Valve Prolapse: Assessment and Diagnostic Findings
Correct Answer: Extra heart sound referred to as a mitral click (mid-systolic click).
1. Late systolic murmur may follow the click.
2. ECHO confirms diagnosis.
3. Often asymptomatic, found incidentally.
13: Mitral valve regurgitation: Pathophysiology
Correct Answer: With each beat of the left ventricle, some blood is forced back into the left atrium,
adding to blood flowing in from the lungs. Lungs become congested. The volume overload causes
ventricular hypertrophy.
1. Chronic MR leads to left atrial enlargement.
2. Increased risk of atrial fibrillation.
3. Pulmonary hypertension may develop.
14: Mitral valve regurgitation: Assessment and Diagnostic Findings
Correct Answer: A high-pitched systolic murmur, blowing sound at the apex that may radiate to the
left axilla.
1. Holosystolic murmur best heard at apex.
2. S3 may be present with severe MR.
3. TTE or TEE for diagnosis.
15: Mitral valve stenosis: Pathophysiology
Correct Answer: Obstruction to blood flowing from the left atrium into the left ventricle. Mitral valve
narrows and progressively obstructs blood flow into the ventricle.
1. Decreased cardiac output.
2. Pulmonary hypertension develops.
3. Left atrial enlargement → AFib.
16: Mitral valve stenosis Cause
Correct Answer: Rheumatic endocarditis, which thickens mitral valve leaflets and chordae tendineae.
HR increases, diastole is shortened and more blood backs up into pulmonary veins.
1. Most common cause worldwide.
2. Congenital stenosis rare.
3. Calcium deposition in elderly.
ACS, Pharmacology & Cardiomyopathy | Q&A | Grade A | 100% Correct
(Verified Answers)
Subject: Medical-Surgical Nursing / Cardiovascular Disorders
Source: NSG 223 Exam 1 – Comprehensive Review
Format: Q&A Guide with Clinical Rationale
1: Antidote for Digoxin Toxicity?
Correct Answer: Digoxin Immune Fab (Digibind, DigiFab).
1. Indicated for life-threatening digoxin toxicity (dysrhythmias, hyperkalemia).
2. Binds directly to digoxin molecules.
3. Monitor for hypokalemia after administration (rebound effect).
2: What does Thrombolytics do?
Correct Answer: Dissolve thrombi and reestablish blood flow as quickly as possible, prevent or limit
tissue damage, and maximize functional improvement.
1. Alteplase (tPA) lyses fibrin blood clots ("clot buster").
2. For STEMI: decreases ST elevations.
3. First-line therapy for ischemic stroke (return to baseline).
3: Nitroglycerin administration information
Correct Answer: Relaxes blood vessels, increases blood/O2 supply to heart while reducing workload.
Oral: tablet not chewed/crushed/swallowed. Buccal works fastest (under tongue or between
cheek/gum). 3 tablets at 5-minute intervals. Most common AE: headache. Withhold if systolic BP <90
or HR >100 bpm. Spray half-life 2-3 years. Ointment: apply to non-hairy area, avoid contact with
hands, do not massage.
1. Sublingual onset 1-3 minutes.
2. Store in original dark glass bottle (light-sensitive).
3. Replace every 6 months.
4: Atrial Fibrillation
Correct Answer: Heart's upper chambers beat chaotically and irregularly. Atrial rate 300-600 bpm;
ventricular rate 120-200 bpm. "Snakes in the grass" ECG pattern. Occasional (paroxysmal): symptoms
come and go minutes to hours. Persistent: does not go back to normal on own;
cardioversion/medications needed. Long-standing: >12 months.
1. Increased risk of thromboembolic stroke.
2. Rate control vs rhythm control strategy.
3. Anticoagulation based on CHA₂DS₂-VASc score.
,5: Heparin Action
Correct Answer: Combines with antithrombin III to inactivate clotting factors to prevent thrombus
formation. The goal of heparin therapy in DIC is to prevent blood coagulation long enough for clotting
factors to be replenished and thus control hemorrhage.
1. Prevents DVT, PE, and further thrombus formation.
2. Used in AFib.
3. aPTT goal 1.5-2.5x baseline (45-70 sec).
6: Prinzmetal's angina (Variant angina) causes
Correct Answer: Exposure to cold weather, stress, medicines that vasoconstrict, smoking, cocaine use.
Usually happens between midnight and morning while asleep or resting.
1. Caused by coronary artery vasospasm, not atherosclerosis.
2. Treat with calcium channel blockers, nitrates.
3. Avoid beta-blockers (may worsen vasospasm).
7: Atropine Overdose S/S
Correct Answer: Decreased secretions, increased HR, decreased GI and GU tone.
1. Anticholinergic toxidrome: "hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a
hatter."
2. Physostigmine antidote (IV slow 1 mg/min).
3. Monitor for seizures, arrhythmias.
8: What are symptoms of Digoxin Toxicity?
Correct Answer: Vision changes with yellow-green halos and blurred vision, N/V, loss of appetite,
abdominal pain, hyperkalemia, hypercalcemia.
1. Bradycardia, heart block, ventricular arrhythmias.
2. Hypokalemia, hypomagnesemia increase toxicity risk.
3. Hold digoxin if apical pulse <60 bpm.
9: Ezetimibe (Zetia) Action
Correct Answer: Acts in small intestine to inhibit absorption of cholesterol and decrease delivery of
intestinal cholesterol to the liver.
1. Peak effect 4-12 hours.
2. Take at same time each day (night if with statin).
3. Separate from bile acid sequestrants by 2 hours before or 4 hours after.
10: Aortic Regurgitation: Pathophysiology
Correct Answer: Blood from the aorta returns to the left ventricle during diastole.
1. Chronic volume overload causes LV dilation and hypertrophy.
2. Leads to wide pulse pressure (bounding pulses).
3. ECHO every 6 months.
, 11: Mitral Valve Prolapse: Pathophysiology
Correct Answer: A portion of one or both mitral valve leaflets balloons back into the atrium during
systole.
1. Most common valvular abnormality.
2. Often benign, may cause chest pain, palpitations.
3. Increased risk of infective endocarditis.
12: Mitral Valve Prolapse: Assessment and Diagnostic Findings
Correct Answer: Extra heart sound referred to as a mitral click (mid-systolic click).
1. Late systolic murmur may follow the click.
2. ECHO confirms diagnosis.
3. Often asymptomatic, found incidentally.
13: Mitral valve regurgitation: Pathophysiology
Correct Answer: With each beat of the left ventricle, some blood is forced back into the left atrium,
adding to blood flowing in from the lungs. Lungs become congested. The volume overload causes
ventricular hypertrophy.
1. Chronic MR leads to left atrial enlargement.
2. Increased risk of atrial fibrillation.
3. Pulmonary hypertension may develop.
14: Mitral valve regurgitation: Assessment and Diagnostic Findings
Correct Answer: A high-pitched systolic murmur, blowing sound at the apex that may radiate to the
left axilla.
1. Holosystolic murmur best heard at apex.
2. S3 may be present with severe MR.
3. TTE or TEE for diagnosis.
15: Mitral valve stenosis: Pathophysiology
Correct Answer: Obstruction to blood flowing from the left atrium into the left ventricle. Mitral valve
narrows and progressively obstructs blood flow into the ventricle.
1. Decreased cardiac output.
2. Pulmonary hypertension develops.
3. Left atrial enlargement → AFib.
16: Mitral valve stenosis Cause
Correct Answer: Rheumatic endocarditis, which thickens mitral valve leaflets and chordae tendineae.
HR increases, diastole is shortened and more blood backs up into pulmonary veins.
1. Most common cause worldwide.
2. Congenital stenosis rare.
3. Calcium deposition in elderly.
