NSG 223 Exam 1: (Latest 2026/2027 Update) Cardiovascular Emergencies &
Diagnostics | Q&A | Grade A | 100% Correct (Verified Answers) – Nursing
Program
Subject: NSG 223 – Medical-Surgical Nursing / Cardiovascular
Source: NSG 223 Exam 1 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the priority care for a patient with myocardial infarction (MI)?
Correct Answer: Relieve chest pain (pain management reduces myocardial oxygen demand).
1. Pain increases sympathetic tone → increased HR, BP, myocardial O2 demand.
2. Morphine is first-line for pain relief (also reduces preload and anxiety).
3. Pain relief also reduces risk of cardiogenic shock.
2. What is a contraindication for an exercise stress test?
Correct Answer: 48 hours after MI (recent MI within 2-5 days is contraindication).
1. Risk of arrhythmias, reinfarction, or cardiac rupture.
2. Alternative: pharmacological stress test (dobutamine, adenosine, regadenoson).
3. Uncontrolled heart failure, severe aortic stenosis also contraindications.
3. What is variant angina?
Correct Answer: Occurs at night or rest (Prinzmetal angina — coronary artery vasospasm).
1. Not related to exertion; often occurs between midnight and early morning.
2. ST-segment elevation during pain (transient).
3. Treatment: calcium channel blockers, nitrates; avoid beta-blockers (may worsen vasospasm).
4. What is endocarditis?
Correct Answer: Inflammation of the inner layer of the heart (endocardium, typically heart valves).
1. Infective endocarditis: bacterial colonization of valves, vegetations.
2. Risk factors: prosthetic valves, IV drug use, structural heart disease.
3. Treatment: prolonged IV antibiotics (4-6 weeks).
5. What is a risk factor for atrial fibrillation (AFib)?
Correct Answer: High blood pressure, diabetes, congestive heart failure.
1. Hypertension is most common risk factor (LA enlargement, fibrosis).
2. Valvular disease (especially mitral stenosis), hyperthyroidism, obesity, sleep apnea, alcohol
use.
3. Advanced age (incidence increases with age).
, 6. What does the QRS wave represent and what is its normal duration?
Correct Answer: Ventricular depolarization (contraction); should be <0.12 seconds.
1. Narrow QRS (<0.12 sec) = supraventricular origin (sinus, atrial, junctional).
2. Wide QRS (≥0.12 sec) = ventricular origin or bundle branch block.
3. QRS amplitude varies by lead; low voltage may indicate pericardial effusion.
7. What is the treatment for mitral stenosis?
Correct Answer: Anticoagulants (for atrial fibrillation prevention of thromboembolism).
1. Mitral stenosis increases risk of AFib → anticoagulation (warfarin, DOAC) to prevent stroke.
2. Diuretics for pulmonary congestion; beta-blockers or CCB for rate control if AFib.
3. Definitive treatment: valvuloplasty or valve replacement.
8. Patient education for cardiac stress test?
Correct Answer: NPO 3+ hours before, avoid stimulants, no smoking before test, must be physically
able to exercise.
1. Fasting reduces risk of aspiration and nausea during exercise.
2. Avoid caffeine, beta-blockers (may alter results).
3. Wear comfortable shoes/clothes; report chest pain, dizziness, SOB during test.
9. What is a risk of uncontrolled atrial fibrillation (AFib)?
Correct Answer: Thrombi — lead to heart failure or stroke.
1. Atrial stasis → thrombus formation in left atrial appendage → embolization → stroke.
2. CHA₂DS₂-VASc score guides anticoagulation (warfarin, DOAC).
3. Rapid ventricular response can cause tachycardia-induced cardiomyopathy, HF.
10. What should the nurse do with telemetry if a patient has atrial fibrillation (AFib)?
Correct Answer: Turn off irregular HR alarm (prevents nuisance alarms).
1. AFib is characteristically irregularly irregular; alarm would trigger constantly.
2. Nurse still monitors rate and rhythm changes (e.g., sustained bradycardia or rapid rate).
3. Alarm parameters adjusted for patients with known chronic arrhythmias.
11. What lab value is used to diagnose myocardial infarction (MI)?
Correct Answer: Elevated creatine kinase-MB (CK-MB) and troponin (troponin is gold standard).
1. Troponin I or T is most specific (rises 4-6 hrs, peaks 12-24 hrs).
2. CK-MB rises 4-6 hrs, peaks 12-24 hrs, returns to normal in 48-72 hrs.
3. CK-MB helpful for reinfarction (troponin remains elevated longer).
Diagnostics | Q&A | Grade A | 100% Correct (Verified Answers) – Nursing
Program
Subject: NSG 223 – Medical-Surgical Nursing / Cardiovascular
Source: NSG 223 Exam 1 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the priority care for a patient with myocardial infarction (MI)?
Correct Answer: Relieve chest pain (pain management reduces myocardial oxygen demand).
1. Pain increases sympathetic tone → increased HR, BP, myocardial O2 demand.
2. Morphine is first-line for pain relief (also reduces preload and anxiety).
3. Pain relief also reduces risk of cardiogenic shock.
2. What is a contraindication for an exercise stress test?
Correct Answer: 48 hours after MI (recent MI within 2-5 days is contraindication).
1. Risk of arrhythmias, reinfarction, or cardiac rupture.
2. Alternative: pharmacological stress test (dobutamine, adenosine, regadenoson).
3. Uncontrolled heart failure, severe aortic stenosis also contraindications.
3. What is variant angina?
Correct Answer: Occurs at night or rest (Prinzmetal angina — coronary artery vasospasm).
1. Not related to exertion; often occurs between midnight and early morning.
2. ST-segment elevation during pain (transient).
3. Treatment: calcium channel blockers, nitrates; avoid beta-blockers (may worsen vasospasm).
4. What is endocarditis?
Correct Answer: Inflammation of the inner layer of the heart (endocardium, typically heart valves).
1. Infective endocarditis: bacterial colonization of valves, vegetations.
2. Risk factors: prosthetic valves, IV drug use, structural heart disease.
3. Treatment: prolonged IV antibiotics (4-6 weeks).
5. What is a risk factor for atrial fibrillation (AFib)?
Correct Answer: High blood pressure, diabetes, congestive heart failure.
1. Hypertension is most common risk factor (LA enlargement, fibrosis).
2. Valvular disease (especially mitral stenosis), hyperthyroidism, obesity, sleep apnea, alcohol
use.
3. Advanced age (incidence increases with age).
, 6. What does the QRS wave represent and what is its normal duration?
Correct Answer: Ventricular depolarization (contraction); should be <0.12 seconds.
1. Narrow QRS (<0.12 sec) = supraventricular origin (sinus, atrial, junctional).
2. Wide QRS (≥0.12 sec) = ventricular origin or bundle branch block.
3. QRS amplitude varies by lead; low voltage may indicate pericardial effusion.
7. What is the treatment for mitral stenosis?
Correct Answer: Anticoagulants (for atrial fibrillation prevention of thromboembolism).
1. Mitral stenosis increases risk of AFib → anticoagulation (warfarin, DOAC) to prevent stroke.
2. Diuretics for pulmonary congestion; beta-blockers or CCB for rate control if AFib.
3. Definitive treatment: valvuloplasty or valve replacement.
8. Patient education for cardiac stress test?
Correct Answer: NPO 3+ hours before, avoid stimulants, no smoking before test, must be physically
able to exercise.
1. Fasting reduces risk of aspiration and nausea during exercise.
2. Avoid caffeine, beta-blockers (may alter results).
3. Wear comfortable shoes/clothes; report chest pain, dizziness, SOB during test.
9. What is a risk of uncontrolled atrial fibrillation (AFib)?
Correct Answer: Thrombi — lead to heart failure or stroke.
1. Atrial stasis → thrombus formation in left atrial appendage → embolization → stroke.
2. CHA₂DS₂-VASc score guides anticoagulation (warfarin, DOAC).
3. Rapid ventricular response can cause tachycardia-induced cardiomyopathy, HF.
10. What should the nurse do with telemetry if a patient has atrial fibrillation (AFib)?
Correct Answer: Turn off irregular HR alarm (prevents nuisance alarms).
1. AFib is characteristically irregularly irregular; alarm would trigger constantly.
2. Nurse still monitors rate and rhythm changes (e.g., sustained bradycardia or rapid rate).
3. Alarm parameters adjusted for patients with known chronic arrhythmias.
11. What lab value is used to diagnose myocardial infarction (MI)?
Correct Answer: Elevated creatine kinase-MB (CK-MB) and troponin (troponin is gold standard).
1. Troponin I or T is most specific (rises 4-6 hrs, peaks 12-24 hrs).
2. CK-MB rises 4-6 hrs, peaks 12-24 hrs, returns to normal in 48-72 hrs.
3. CK-MB helpful for reinfarction (troponin remains elevated longer).
