CVICU Competency Exam –
Cardiovascular Intensive Care Unit
Study Guide and Practice Questions.
COMPLETE 100-QUESTION EXAM — All sections match the verified real-exam distribution per
AACN CCRN cardiovascular critical care blueprint.
SECTION 1: HEMODYNAMIC MONITORING & WAVEFORM INTERPRETATION (Q1–Q18)
Q1: A patient in the CVICU has a pulmonary artery catheter. The waveform shows a gradual
upstroke, a peak systolic pressure of 24 mmHg, a dicrotic notch, and an end-diastolic pressure of
12 mmHg. This waveform is located in which cardiac or vascular structure?
A. Right atrium
B. Right ventricle
C. Pulmonary artery [CORRECT]
D. Pulmonary capillary wedge position
Correct Answer: C
Rationale: Correct because the pulmonary artery waveform has a gradual systolic upstroke (vs.
sharp RV upstroke), dicrotic notch (pulmonic valve closure), and diastolic decay; PCWP has
smaller amplitude without dicrotic notch.
Q2: A post-operative CABG patient has a cardiac index of 1.9 L/min/m², MAP of 52 mmHg, CVP of
2 mmHg, and PCWP of 4 mmHg. The most appropriate initial intervention is:
A. Start norepinephrine infusion
B. Administer fluid bolus [CORRECT]
C. Start dobutamine infusion
D. Start milrinone infusion
Correct Answer: B
Rationale: Correct because low PCWP (4 mmHg) and low CVP (2 mmHg) indicate hypovolemia as
the cause of low CI and hypotension; fluid resuscitation is first-line before vasoactive agents.
Q3: An arterial line waveform appears overdamped. Which finding would confirm this diagnosis?
A. Overshoot of the systolic peak with ringing artifact
B. Slurred upstroke, loss of dicrotic notch, and delayed systolic peak [CORRECT]
C. Normal square wave test (one rapid oscillation then flat)
D. Systolic pressure artificially elevated by 10–20 mmHg
Correct Answer: B
Rationale: Correct because overdamped waveform shows slow upstroke, rounded or absent
dicrotic notch, underestimation of systolic pressure, and delayed peak; caused by air bubbles,
clots, kinked tubing, or loose connections.
,Q4: The phlebostatic axis is located at the:
A. 2nd intercostal space at the midclavicular line
B. 4th intercostal space at the mid-axillary line [CORRECT]
C. 5th intercostal space at the sternal border
D. 3rd intercostal space at the midclavicular line
Correct Answer: B
Rationale: Correct because the phlebostatic axis at the 4th intercostal space mid-axillary line
approximates the level of the right atrium; the transducer must be leveled to this point for
accurate hemodynamic readings.
Q5: A CVP waveform shows prominent cannon a waves. This is most consistent with:
A. Atrial fibrillation
B. Tricuspid regurgitation
C. Atrioventricular dissociation (complete heart block) [CORRECT]
D. Fluid overload
Correct Answer: C
Rationale: Correct because cannon a waves occur when the atrium contracts against a closed
tricuspid valve, seen in AV dissociation (complete heart block) or junctional rhythms with
retrograde conduction.
Q6: A PA catheter is advanced and the waveform suddenly shows a damped tracing with a mean
pressure of 8 mmHg and small undulations without distinct systolic or diastolic components. The
balloon is deflated. This indicates:
A. Normal pulmonary artery waveform
B. Catheter in right ventricle
C. Catheter overwedged in pulmonary capillary wedge position [CORRECT]
D. Catheter coiled in right atrium
Correct Answer: C
Rationale: Correct because an overwedged catheter shows a damped waveform with small
undulations and no distinct systolic/diastolic components; the mean approximates PCWP and
requires balloon deflation and catheter withdrawal.
Q7: During thermodilution cardiac output measurement, the injectate temperature curve shows a
prolonged, low-amplitude temperature change. The most likely cause is:
A. Tricuspid regurgitation [CORRECT]
B. Mitral regurgitation
C. High cardiac output state
D. Injectate that is too cold
Correct Answer: A
, Rationale: Correct because tricuspid regurgitation causes injectate recirculation in the right
ventricle, producing a prolonged, low-amplitude thermodilution curve that falsely lowers or makes
CO unreliable.
Q8: A patient has an arterial line with an underdamped system. Which hemodynamic parameter is
most likely to be falsely elevated?
A. Mean arterial pressure
B. Diastolic blood pressure
C. Systolic blood pressure [CORRECT]
D. Pulse pressure
Correct Answer: C
Rationale: Correct because underdamped systems exhibit overshoot and ringing artifact, causing
systolic pressure to be artificially elevated while diastolic may be falsely low; MAP remains
relatively accurate.
Q9: The Fick method for calculating cardiac output uses which formula?
A. CO = HR × SV
B. CO = VO₂ / (CaO₂ – CvO₂) [CORRECT]
C. CO = Thermodilution curve area
D. CO = MAP / SVR
Correct Answer: B
Rationale: Correct because the Fick principle calculates CO by dividing oxygen consumption
(VO₂) by the arteriovenous oxygen content difference (CaO₂ – CvO₂), providing a gold standard
reference method.
Q10: A patient's mixed venous oxygen saturation (SvO₂) is 48%. This is most consistent with:
A. Hyperdynamic septic shock
B. High cardiac output state
C. Low cardiac output with increased oxygen extraction [CORRECT]
D. Cyanide toxicity
Correct Answer: C
Rationale: Correct because SvO₂ below 60% indicates inadequate oxygen delivery or excessive
extraction, seen in low cardiac output states, shock, or increased metabolic demand; normal SvO₂
is 60–80%.
Q11: During a square wave test (dynamic response test), the waveform shows multiple
oscillations before returning to baseline. This indicates:
A. An optimally damped system
B. An underdamped system [CORRECT]
C. An overdamped system
D. A properly zeroed transducer
Correct Answer: B
Cardiovascular Intensive Care Unit
Study Guide and Practice Questions.
COMPLETE 100-QUESTION EXAM — All sections match the verified real-exam distribution per
AACN CCRN cardiovascular critical care blueprint.
SECTION 1: HEMODYNAMIC MONITORING & WAVEFORM INTERPRETATION (Q1–Q18)
Q1: A patient in the CVICU has a pulmonary artery catheter. The waveform shows a gradual
upstroke, a peak systolic pressure of 24 mmHg, a dicrotic notch, and an end-diastolic pressure of
12 mmHg. This waveform is located in which cardiac or vascular structure?
A. Right atrium
B. Right ventricle
C. Pulmonary artery [CORRECT]
D. Pulmonary capillary wedge position
Correct Answer: C
Rationale: Correct because the pulmonary artery waveform has a gradual systolic upstroke (vs.
sharp RV upstroke), dicrotic notch (pulmonic valve closure), and diastolic decay; PCWP has
smaller amplitude without dicrotic notch.
Q2: A post-operative CABG patient has a cardiac index of 1.9 L/min/m², MAP of 52 mmHg, CVP of
2 mmHg, and PCWP of 4 mmHg. The most appropriate initial intervention is:
A. Start norepinephrine infusion
B. Administer fluid bolus [CORRECT]
C. Start dobutamine infusion
D. Start milrinone infusion
Correct Answer: B
Rationale: Correct because low PCWP (4 mmHg) and low CVP (2 mmHg) indicate hypovolemia as
the cause of low CI and hypotension; fluid resuscitation is first-line before vasoactive agents.
Q3: An arterial line waveform appears overdamped. Which finding would confirm this diagnosis?
A. Overshoot of the systolic peak with ringing artifact
B. Slurred upstroke, loss of dicrotic notch, and delayed systolic peak [CORRECT]
C. Normal square wave test (one rapid oscillation then flat)
D. Systolic pressure artificially elevated by 10–20 mmHg
Correct Answer: B
Rationale: Correct because overdamped waveform shows slow upstroke, rounded or absent
dicrotic notch, underestimation of systolic pressure, and delayed peak; caused by air bubbles,
clots, kinked tubing, or loose connections.
,Q4: The phlebostatic axis is located at the:
A. 2nd intercostal space at the midclavicular line
B. 4th intercostal space at the mid-axillary line [CORRECT]
C. 5th intercostal space at the sternal border
D. 3rd intercostal space at the midclavicular line
Correct Answer: B
Rationale: Correct because the phlebostatic axis at the 4th intercostal space mid-axillary line
approximates the level of the right atrium; the transducer must be leveled to this point for
accurate hemodynamic readings.
Q5: A CVP waveform shows prominent cannon a waves. This is most consistent with:
A. Atrial fibrillation
B. Tricuspid regurgitation
C. Atrioventricular dissociation (complete heart block) [CORRECT]
D. Fluid overload
Correct Answer: C
Rationale: Correct because cannon a waves occur when the atrium contracts against a closed
tricuspid valve, seen in AV dissociation (complete heart block) or junctional rhythms with
retrograde conduction.
Q6: A PA catheter is advanced and the waveform suddenly shows a damped tracing with a mean
pressure of 8 mmHg and small undulations without distinct systolic or diastolic components. The
balloon is deflated. This indicates:
A. Normal pulmonary artery waveform
B. Catheter in right ventricle
C. Catheter overwedged in pulmonary capillary wedge position [CORRECT]
D. Catheter coiled in right atrium
Correct Answer: C
Rationale: Correct because an overwedged catheter shows a damped waveform with small
undulations and no distinct systolic/diastolic components; the mean approximates PCWP and
requires balloon deflation and catheter withdrawal.
Q7: During thermodilution cardiac output measurement, the injectate temperature curve shows a
prolonged, low-amplitude temperature change. The most likely cause is:
A. Tricuspid regurgitation [CORRECT]
B. Mitral regurgitation
C. High cardiac output state
D. Injectate that is too cold
Correct Answer: A
, Rationale: Correct because tricuspid regurgitation causes injectate recirculation in the right
ventricle, producing a prolonged, low-amplitude thermodilution curve that falsely lowers or makes
CO unreliable.
Q8: A patient has an arterial line with an underdamped system. Which hemodynamic parameter is
most likely to be falsely elevated?
A. Mean arterial pressure
B. Diastolic blood pressure
C. Systolic blood pressure [CORRECT]
D. Pulse pressure
Correct Answer: C
Rationale: Correct because underdamped systems exhibit overshoot and ringing artifact, causing
systolic pressure to be artificially elevated while diastolic may be falsely low; MAP remains
relatively accurate.
Q9: The Fick method for calculating cardiac output uses which formula?
A. CO = HR × SV
B. CO = VO₂ / (CaO₂ – CvO₂) [CORRECT]
C. CO = Thermodilution curve area
D. CO = MAP / SVR
Correct Answer: B
Rationale: Correct because the Fick principle calculates CO by dividing oxygen consumption
(VO₂) by the arteriovenous oxygen content difference (CaO₂ – CvO₂), providing a gold standard
reference method.
Q10: A patient's mixed venous oxygen saturation (SvO₂) is 48%. This is most consistent with:
A. Hyperdynamic septic shock
B. High cardiac output state
C. Low cardiac output with increased oxygen extraction [CORRECT]
D. Cyanide toxicity
Correct Answer: C
Rationale: Correct because SvO₂ below 60% indicates inadequate oxygen delivery or excessive
extraction, seen in low cardiac output states, shock, or increased metabolic demand; normal SvO₂
is 60–80%.
Q11: During a square wave test (dynamic response test), the waveform shows multiple
oscillations before returning to baseline. This indicates:
A. An optimally damped system
B. An underdamped system [CORRECT]
C. An overdamped system
D. A properly zeroed transducer
Correct Answer: B
