**Core Concept**
The sodium-calcium exchanger (NCX) is a critical membrane protein responsible for maintaining calcium homeostasis in cardiac and skeletal muscle cells. It operates by exchanging three sodium ions (Na+) for one calcium ion (Ca++), thus regulating the intracellular calcium concentration.

**Why the Correct Answer is Right**
The correct answer is 3:1, indicating that for every one calcium ion that is extruded, three sodium ions are imported into the cell. This process is essential for maintaining the delicate balance between intracellular calcium and sodium levels, which is crucial for proper muscle contraction and relaxation. The NCX is electrogenic, meaning it generates a net movement of positive charge into the cell, which helps to regulate the resting membrane potential.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not accurately reflect the stoichiometry of the sodium-calcium exchanger. A 1:1 ratio would imply that one sodium ion is exchanged for one calcium ion, which is not the case.

**Option B:** This option is also incorrect because it suggests a 2:1 ratio, which is not supported by the available evidence. The 3:1 ratio is well-established in the literature and is a critical aspect of NCX function.

**Option C:** This option is incorrect because it implies a 4:1 ratio, which is not consistent with the known properties of the sodium-calcium exchanger.

**Clinical Pearl / High-Yield Fact**
The sodium-calcium exchanger plays a critical role in the pathophysiology of cardiac arrhythmias, particularly those associated with abnormal calcium handling. In conditions such as long QT syndrome, the NCX can contribute to abnormal calcium influx, leading to arrhythmias.

**Correct Answer: C. 3:1 ratio**