NSG-430 Exam 2: (Latest 2026/2027 Update) ACS, Dysrhythmias, AKI, &
Cardiac Care | Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Advanced Medical-Surgical / Critical Care
Source: NSG-430 Exam 2 – Comprehensive Review Format: Q&A Guide with Clinical Rationale
1: What is the first step to produce the greatest reduction in risk for CAD?
Correct Answer: First, assess for the readiness to change and health literacy. Then, help the
patient select the lifestyle changes.
1. Assessing readiness to change ensures patient engagement and sustainable behavior modification.
2. Health literacy assessment prevents misunderstanding and improves adherence to lifestyle
changes.
3. Lifestyle modifications include diet, exercise, smoking cessation, and medication adherence.
2: What is Acute Coronary Syndrome (ACS)?
Correct Answer: Chest pain from ischemia that is prolonged and not immediately reversible
(includes STEMI and NSTEMI).
1. ACS represents a spectrum from unstable angina to myocardial infarction.
2. Pathophysiology involves plaque rupture and thrombus formation.
3. Immediate recognition and treatment reduce mortality.
3: What is Unstable Angina (UA)?
Correct Answer: Chest pain that is new in onset, occurs at rest. The pain usually lasts 10
minutes or more.
1. Unstable angina is a medical emergency indicating high risk for MI.
2. Unlike stable angina, it occurs with minimal exertion or at rest.
3. Requires hospitalization and anti-ischemic therapy.
4: What is a Myocardial Infarction (MI)?
Correct Answer: Occurs because of an abrupt stoppage of blood flow through a coronary
artery with a thrombus caused by platelet aggregation.
1. Prolonged ischemia leads to irreversible myocardial necrosis.
2. "Time is muscle" — rapid reperfusion limits infarct size.
3. Diagnosis: ECG changes + elevated cardiac biomarkers.
,5: What is STEMI?
Correct Answer: Occlusive thrombus resulting in ST-elevation. The artery must be opened
within 90 minutes of presentation to restore blood and O2 to the heart muscle (by PCI or
thrombolytic therapy).
1. Door-to-balloon time ≤90 minutes is national standard.
2. Door-to-needle time ≤30 minutes if thrombolytics used.
3. Delayed reperfusion increases mortality and heart failure risk.
6: What is PCI (Percutaneous Coronary Intervention)?
Correct Answer: Done in Cath lab; first-line treatment for MI. Confirms which artery has the
occlusive thrombus so it can be opened with a balloon and stent. Performed with local
anesthesia; patient ambulatory shortly after; hospital stay about 3-4 days after MI.
1. PCI is preferred over thrombolytics when available.
2. Stents may be bare-metal or drug-eluting.
3. Dual antiplatelet therapy required after stent placement.
7: What is Thrombolytic Therapy for STEMI?
Correct Answer: Done in hospitals without cath lab for STEMI. Limits infarction size by
dissolving thrombus. Give within 30 minutes of arrival. All thrombolytics (e.g., tenecteplase,
alteplase) given IV.
1. Thrombolytics activate plasminogen to plasmin, which dissolves clots.
2. Major risk: intracranial hemorrhage (0.5-1%).
3. Contraindicated in active bleeding, recent stroke, or major surgery.
8: Who are not candidates for PCI (requiring CABG instead)?
Correct Answer: Diabetes, left ventricle dysfunction, chronic kidney disease, failed PCI with
ongoing chest pain, blockages that are long or difficult to access.
1. CABG provides more complete revascularization for complex multivessel disease.
2. Diabetics have better outcomes with CABG than PCI.
3. Left main coronary artery disease often requires CABG.
9: What is CABG (Coronary Artery Bypass Graft)?
Correct Answer: Placement of arterial or venous grafts to provide blood from aorta to
heart muscle distal to blocked coronary arteries. Requires sternotomy and cardiopulmonary
bypass. Internal mammary artery (IMA) is most common graft used.
1. IMA grafts have better long-term patency than saphenous vein grafts.
2. Cardiopulmonary bypass diverts blood from heart to oxygenation machine.
3. Post-op risks: bleeding, infection, dysrhythmias, cognitive changes.
, 10: What are MIDCAB, OPCAB, and TECAB?
Correct Answer: MIDCAB: Minimally invasive direct coronary artery bypass (no sternotomy
or CPB). OPCAB: Off-pump coronary artery bypass (sternotomy but no CPB, beating heart).
TECAB: Totally endoscopic coronary artery bypass (robotic technology, no CPB).
1. Off-pump techniques avoid complications of cardiopulmonary bypass.
2. May reduce post-op cognitive decline and bleeding risks.
3. Not suitable for all patients or all coronary lesions.
11: Are PCI and thrombolytic therapy curative or palliative?
Correct Answer: Palliative, not a cure.
1. These treatments open blocked arteries but do not stop underlying atherosclerosis.
2. Lifestyle changes and medications are lifelong requirements.
3. Restenosis can occur over time.
12: What is the procedure sequence for thrombolytic therapy?
Correct Answer: 1) Draw blood for baseline labs; 2) Start 2 or 3 IV lines; Perform all invasive
procedures BEFORE giving thrombolytic; Therapy given in 1 IV bolus or over 30-90 minutes.
1. Invasive procedures after thrombolytics increase bleeding risk.
2. Monitor for bleeding: avoid unnecessary venipunctures.
3. Apply pressure to any bleeding site for longer than usual.
13: What are signs that reperfusion occurred after thrombolytic therapy?
Correct Answer: 1) Return of ST segment to baseline on ECG; 2) Resolution of chest pain; 3)
Rapid rise of serum cardiac biomarkers within 3 hours of therapy (necrotic heart cells
release proteins after perfusion restored).
1. Reperfusion arrhythmias may also occur (e.g., accelerated idioventricular rhythm).
2. Lack of these signs suggests failed reperfusion requiring rescue PCI.
3. Biomarker rise earlier than expected indicates successful reperfusion.
14: What is NSTEMI?
Correct Answer: Nonocclusive thrombus, does not cause ST segment elevation. Patients
usually undergo catheterization within 12 to 72 hours. Thrombolytic therapy is not
indicated.
1. NSTEMI diagnosed by elevated troponin without ST elevation.
2. May have ST depression or T wave inversion.
3. Risk stratification determines urgency of catheterization.
15: How do diabetics with MI present differently?
Correct Answer: May have silent (asymptomatic) MIs because of cardiac neuropathy or
atypical symptoms (e.g., shortness of breath). NOT candidates for PCI = CABG surgery.
1. Autonomic neuropathy blunts anginal warning signals.
2. Diabetics have worse outcomes after MI and require aggressive risk factor management.
3. May present with fatigue, nausea, or dyspnea without chest pain.
Cardiac Care | Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Advanced Medical-Surgical / Critical Care
Source: NSG-430 Exam 2 – Comprehensive Review Format: Q&A Guide with Clinical Rationale
1: What is the first step to produce the greatest reduction in risk for CAD?
Correct Answer: First, assess for the readiness to change and health literacy. Then, help the
patient select the lifestyle changes.
1. Assessing readiness to change ensures patient engagement and sustainable behavior modification.
2. Health literacy assessment prevents misunderstanding and improves adherence to lifestyle
changes.
3. Lifestyle modifications include diet, exercise, smoking cessation, and medication adherence.
2: What is Acute Coronary Syndrome (ACS)?
Correct Answer: Chest pain from ischemia that is prolonged and not immediately reversible
(includes STEMI and NSTEMI).
1. ACS represents a spectrum from unstable angina to myocardial infarction.
2. Pathophysiology involves plaque rupture and thrombus formation.
3. Immediate recognition and treatment reduce mortality.
3: What is Unstable Angina (UA)?
Correct Answer: Chest pain that is new in onset, occurs at rest. The pain usually lasts 10
minutes or more.
1. Unstable angina is a medical emergency indicating high risk for MI.
2. Unlike stable angina, it occurs with minimal exertion or at rest.
3. Requires hospitalization and anti-ischemic therapy.
4: What is a Myocardial Infarction (MI)?
Correct Answer: Occurs because of an abrupt stoppage of blood flow through a coronary
artery with a thrombus caused by platelet aggregation.
1. Prolonged ischemia leads to irreversible myocardial necrosis.
2. "Time is muscle" — rapid reperfusion limits infarct size.
3. Diagnosis: ECG changes + elevated cardiac biomarkers.
,5: What is STEMI?
Correct Answer: Occlusive thrombus resulting in ST-elevation. The artery must be opened
within 90 minutes of presentation to restore blood and O2 to the heart muscle (by PCI or
thrombolytic therapy).
1. Door-to-balloon time ≤90 minutes is national standard.
2. Door-to-needle time ≤30 minutes if thrombolytics used.
3. Delayed reperfusion increases mortality and heart failure risk.
6: What is PCI (Percutaneous Coronary Intervention)?
Correct Answer: Done in Cath lab; first-line treatment for MI. Confirms which artery has the
occlusive thrombus so it can be opened with a balloon and stent. Performed with local
anesthesia; patient ambulatory shortly after; hospital stay about 3-4 days after MI.
1. PCI is preferred over thrombolytics when available.
2. Stents may be bare-metal or drug-eluting.
3. Dual antiplatelet therapy required after stent placement.
7: What is Thrombolytic Therapy for STEMI?
Correct Answer: Done in hospitals without cath lab for STEMI. Limits infarction size by
dissolving thrombus. Give within 30 minutes of arrival. All thrombolytics (e.g., tenecteplase,
alteplase) given IV.
1. Thrombolytics activate plasminogen to plasmin, which dissolves clots.
2. Major risk: intracranial hemorrhage (0.5-1%).
3. Contraindicated in active bleeding, recent stroke, or major surgery.
8: Who are not candidates for PCI (requiring CABG instead)?
Correct Answer: Diabetes, left ventricle dysfunction, chronic kidney disease, failed PCI with
ongoing chest pain, blockages that are long or difficult to access.
1. CABG provides more complete revascularization for complex multivessel disease.
2. Diabetics have better outcomes with CABG than PCI.
3. Left main coronary artery disease often requires CABG.
9: What is CABG (Coronary Artery Bypass Graft)?
Correct Answer: Placement of arterial or venous grafts to provide blood from aorta to
heart muscle distal to blocked coronary arteries. Requires sternotomy and cardiopulmonary
bypass. Internal mammary artery (IMA) is most common graft used.
1. IMA grafts have better long-term patency than saphenous vein grafts.
2. Cardiopulmonary bypass diverts blood from heart to oxygenation machine.
3. Post-op risks: bleeding, infection, dysrhythmias, cognitive changes.
, 10: What are MIDCAB, OPCAB, and TECAB?
Correct Answer: MIDCAB: Minimally invasive direct coronary artery bypass (no sternotomy
or CPB). OPCAB: Off-pump coronary artery bypass (sternotomy but no CPB, beating heart).
TECAB: Totally endoscopic coronary artery bypass (robotic technology, no CPB).
1. Off-pump techniques avoid complications of cardiopulmonary bypass.
2. May reduce post-op cognitive decline and bleeding risks.
3. Not suitable for all patients or all coronary lesions.
11: Are PCI and thrombolytic therapy curative or palliative?
Correct Answer: Palliative, not a cure.
1. These treatments open blocked arteries but do not stop underlying atherosclerosis.
2. Lifestyle changes and medications are lifelong requirements.
3. Restenosis can occur over time.
12: What is the procedure sequence for thrombolytic therapy?
Correct Answer: 1) Draw blood for baseline labs; 2) Start 2 or 3 IV lines; Perform all invasive
procedures BEFORE giving thrombolytic; Therapy given in 1 IV bolus or over 30-90 minutes.
1. Invasive procedures after thrombolytics increase bleeding risk.
2. Monitor for bleeding: avoid unnecessary venipunctures.
3. Apply pressure to any bleeding site for longer than usual.
13: What are signs that reperfusion occurred after thrombolytic therapy?
Correct Answer: 1) Return of ST segment to baseline on ECG; 2) Resolution of chest pain; 3)
Rapid rise of serum cardiac biomarkers within 3 hours of therapy (necrotic heart cells
release proteins after perfusion restored).
1. Reperfusion arrhythmias may also occur (e.g., accelerated idioventricular rhythm).
2. Lack of these signs suggests failed reperfusion requiring rescue PCI.
3. Biomarker rise earlier than expected indicates successful reperfusion.
14: What is NSTEMI?
Correct Answer: Nonocclusive thrombus, does not cause ST segment elevation. Patients
usually undergo catheterization within 12 to 72 hours. Thrombolytic therapy is not
indicated.
1. NSTEMI diagnosed by elevated troponin without ST elevation.
2. May have ST depression or T wave inversion.
3. Risk stratification determines urgency of catheterization.
15: How do diabetics with MI present differently?
Correct Answer: May have silent (asymptomatic) MIs because of cardiac neuropathy or
atypical symptoms (e.g., shortness of breath). NOT candidates for PCI = CABG surgery.
1. Autonomic neuropathy blunts anginal warning signals.
2. Diabetics have worse outcomes after MI and require aggressive risk factor management.
3. May present with fatigue, nausea, or dyspnea without chest pain.
