I am not a nvidia expert, but I do use the nvidia driver and have direct rendering running successfully.
This probably isn't the easy answer that you want to hear, however it is very easy just to use Slax and use the nvidia module provided and it works in a flash for most. And you get the added benefit of a distro running entirely from RAM if you use the copy2ram boot code. The benefit of this is that you dont wait for information to be read from the hard-drive on every minor occasion. RAM distros are certainly the way of the future unless you prefer a slow computer.
Other comments ..
-perhaps your kde monitor settings are over-riding your xorg.conf settings
-try removing all other resolutions from your xorg.conf and see what happens
-forget using nv as you said you want to be using nvidia. nv is just the xorg driver. you want the nvidia driver which is the special nvidia driver
Here is my xorg.conf for reference ...
# nvidia-settings: X configuration file generated by nvidia-settings
# nvidia-settings: version 1.0 (buildmeister@builder3) Fri Dec 15 10:13:06 PST 2006
Section "ServerLayout"
Identifier "Layout0"
Screen 0 "Screen0" 0 0
InputDevice "Keyboard0" "CoreKeyboard"
InputDevice "Mouse0" "CorePointer"
EndSection
Section "Files"
RgbPath "/usr/X11R6/lib/X11/rgb"
FontPath "/usr/X11R6/lib/X11/fonts/misc/:unscaled"
FontPath "/usr/X11R6/lib/X11/fonts/misc/"
FontPath "/usr/X11R6/lib/X11/fonts/CID/"
FontPath "/usr/X11R6/lib/X11/fonts/TTF/"
EndSection
Section "Module"
Load "dbe"
Load "extmod"
Load "type1"
Load "freetype"
Load "glx"
EndSection
Section "ServerFlags"
Option "Xinerama" "0"
EndSection
Section "InputDevice"
# generated from default
Identifier "Mouse0"
Driver "mouse"
Option "Protocol" "auto"
Option "Device" "/dev/psaux"
Option "Emulate3Buttons" "no"
Option "ZAxisMapping" "4 5"
EndSection
Section "InputDevice"
# generated from default
Identifier "Keyboard0"
Driver "kbd"
EndSection
Section "Monitor"
# HorizSync source: edid, VertRefresh source: edid
Identifier "Monitor0"
VendorName "Unknown"
ModelName "LG L204WT"
HorizSync 28.0 - 83.0
VertRefresh 56.0 - 75.0
Option "DPMS"
EndSection
Section "Device"
Identifier "Videocard0"
Driver "nvidia"
VendorName "NVIDIA Corporation"
BoardName "GeForce Go 7300"
EndSection
Section "Screen"
Identifier "Screen0"
Device "Videocard0"
Monitor "Monitor0"
DefaultDepth 24
Option "metamodes" "CRT: 1680x1050 +0+0; CRT: 800x600 +0+0; CRT: 640x480 +0+0"
SubSection "Display"
Depth 24
Modes "1680x1050"
EndSubSection
EndSection