BARKLEY CVRN CARDIOVASCULAR NURSING REVIEW EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains:
Hemodynamics and Hemodynamic Monitoring
Cardiovascular Pathophysiology and Disease Processes
Pharmacology and Medication Management
Electrocardiography (ECG) Interpretation
Acute and Critical Care Nursing Interventions
Chronic Cardiovascular Disease Management
Patient Education and Self-Management Support
Ethical and Legal Considerations in Cardiovascular Care
Introduction:
This comprehensive examination is designed to assess the advanced knowledge and clinical judgment essential for
the cardiovascular nursing professional. The assessment evaluates proficiency in critical areas including
hemodynamic monitoring, cardiac pathophysiology, pharmacological interventions, and the interpretation of
complex electrocardiographic rhythms. Through a combination of multiple-choice questions and clinical scenarios,
this exam emphasizes real-world application, ethical reasoning, and decisive action in both acute and chronic care
settings. Successful completion demonstrates readiness for the complexities and high-stakes decision-making
required in cardiovascular nursing practice.
SECTION ONE: QUESTIONS AND ANSWERS (QUESTIONS 1 - 100)
,1. A patient with aortic stenosis is being evaluated for surgical intervention. Which hemodynamic parameter
is most critical for determining the severity of the stenosis and timing of surgery?
A. Cardiac output
B. Pulmonary capillary wedge pressure
C. Left ventricular ejection fraction
D. Mean transvalvular gradient
🟢D
🔴 RATIONALE: The mean transvalvular gradient is a direct measure of the pressure difference across the aortic
valve during systole and is a primary determinant of stenosis severity. A high gradient (>40 mmHg) is indicative
of severe stenosis and guides the need for intervention. While cardiac output, ejection fraction, and wedge
pressure provide important clinical context, the gradient is the most specific measure of the valve's obstruction.
2. A patient is receiving a continuous infusion of nitroprusside for hypertensive emergency. The nurse's most
critical action is to:
A. Monitor the urine output hourly.
B. Protect the IV infusion from light.
C. Assess for cyanide toxicity.
D. Maintain the patient in a supine position.
🟢B
🔴 RATIONALE: Nitroprusside is extremely light-sensitive and degrades rapidly when exposed to light, forming
toxic byproducts. The IV bag and tubing must be protected with an opaque covering to ensure drug stability
and patient safety. While monitoring renal function, assessing for cyanide toxicity (a risk with prolonged use),
and positioning are important, protecting the infusion from light is the most critical immediate action to
maintain drug efficacy and prevent toxicity.
,3. A patient in the cardiac intensive care unit has a pulmonary artery catheter in place. The nurse observes a
sudden, sustained elevation in the pulmonary artery wedge pressure (PAWP) from 12 mmHg to 28 mmHg.
Which complication should the nurse suspect first?
A. Rupture of the pulmonary artery
B. Development of acute mitral regurgitation
C. Catheter migration into the right ventricle
D. A rapid decline in systemic vascular resistance
🟢B
🔴 RATIONALE: A sudden and significant rise in PAWP is indicative of acute left-sided heart failure. This is most
commonly caused by an acute event such as severe mitral regurgitation (due to papillary muscle rupture) or an
acute myocardial infarction. This is a classic finding of acute cardiogenic shock. Pulmonary artery rupture would
present with hemoptysis, catheter migration with a ventricular waveform, and a decline in SVR would lower, not
raise, the wedge pressure.
4. Which finding on a 12-lead ECG is most characteristic of a true posterior wall myocardial infarction?
A. ST-segment elevation in leads V1-V3
B. ST-segment depression in leads V1-V3
C. Pathological Q waves in leads II, III, and aVF
D. ST-segment elevation in leads I and aVL
🟢B
🔴 RATIONALE: A true posterior MI is electrically silent on standard 12-lead ECG as the posterior wall is not
directly viewed. The ECG reveals reciprocal changes in the anterior leads (V1-V3), which appear as horizontal ST-
segment depression and tall, upright R waves. ST elevation in V1-V3 is characteristic of an anterior or septal MI,
while ST elevation in II, III, aVF indicates an inferior MI.
, 5. A patient is on a dobutamine infusion for cardiogenic shock. Which assessment finding indicates the
therapy is having its desired therapeutic effect?
A. Heart rate decreases from 110 to 90 bpm.
B. Systolic blood pressure increases from 80 to 100 mmHg.
C. Urine output increases from 15 to 40 mL/hr.
D. Pulmonary capillary wedge pressure increases from 20 to 28 mmHg.
🟢C
🔴 RATIONALE: Dobutamine is a beta-1 agonist that increases cardiac contractility (positive inotrope) and
improves cardiac output. The ultimate goal of therapy is improved end-organ perfusion, which is best reflected
by an increase in urine output as renal perfusion improves. An increase in blood pressure is a secondary and
variable effect; dobutamine can also cause vasodilation. A decreasing heart rate suggests improved
hemodynamics but is not the primary goal. An increase in PAWP is a sign of worsening heart failure.
6. A patient with chronic heart failure is prescribed sacubitril/valsartan (Entresto). The nurse understands
that the primary mechanism of action for the beneficial effects of this combination drug is:
A. Inhibition of the renin-angiotensin-aldosterone system (RAAS) only.
B. Enhancement of the natriuretic peptide system and inhibition of RAAS.
C. Direct positive inotropic effect on myocardial contractility.
D. Selective beta-1 receptor blockade to reduce cardiac workload.
🟢B
🔴 RATIONALE: Sacubitril/valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor). Valsartan blocks the
RAAS, while sacubitril inhibits neprilysin, the enzyme that breaks down natriuretic peptides. This leads to
increased levels of endogenous vasodilators (like ANP and BNP), promoting vasodilation and diuresis. This dual
action reduces preload, afterload, and neurohormonal activation, leading to improved outcomes in heart failure.
It is not a direct inotrope or a beta-blocker.
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains:
Hemodynamics and Hemodynamic Monitoring
Cardiovascular Pathophysiology and Disease Processes
Pharmacology and Medication Management
Electrocardiography (ECG) Interpretation
Acute and Critical Care Nursing Interventions
Chronic Cardiovascular Disease Management
Patient Education and Self-Management Support
Ethical and Legal Considerations in Cardiovascular Care
Introduction:
This comprehensive examination is designed to assess the advanced knowledge and clinical judgment essential for
the cardiovascular nursing professional. The assessment evaluates proficiency in critical areas including
hemodynamic monitoring, cardiac pathophysiology, pharmacological interventions, and the interpretation of
complex electrocardiographic rhythms. Through a combination of multiple-choice questions and clinical scenarios,
this exam emphasizes real-world application, ethical reasoning, and decisive action in both acute and chronic care
settings. Successful completion demonstrates readiness for the complexities and high-stakes decision-making
required in cardiovascular nursing practice.
SECTION ONE: QUESTIONS AND ANSWERS (QUESTIONS 1 - 100)
,1. A patient with aortic stenosis is being evaluated for surgical intervention. Which hemodynamic parameter
is most critical for determining the severity of the stenosis and timing of surgery?
A. Cardiac output
B. Pulmonary capillary wedge pressure
C. Left ventricular ejection fraction
D. Mean transvalvular gradient
🟢D
🔴 RATIONALE: The mean transvalvular gradient is a direct measure of the pressure difference across the aortic
valve during systole and is a primary determinant of stenosis severity. A high gradient (>40 mmHg) is indicative
of severe stenosis and guides the need for intervention. While cardiac output, ejection fraction, and wedge
pressure provide important clinical context, the gradient is the most specific measure of the valve's obstruction.
2. A patient is receiving a continuous infusion of nitroprusside for hypertensive emergency. The nurse's most
critical action is to:
A. Monitor the urine output hourly.
B. Protect the IV infusion from light.
C. Assess for cyanide toxicity.
D. Maintain the patient in a supine position.
🟢B
🔴 RATIONALE: Nitroprusside is extremely light-sensitive and degrades rapidly when exposed to light, forming
toxic byproducts. The IV bag and tubing must be protected with an opaque covering to ensure drug stability
and patient safety. While monitoring renal function, assessing for cyanide toxicity (a risk with prolonged use),
and positioning are important, protecting the infusion from light is the most critical immediate action to
maintain drug efficacy and prevent toxicity.
,3. A patient in the cardiac intensive care unit has a pulmonary artery catheter in place. The nurse observes a
sudden, sustained elevation in the pulmonary artery wedge pressure (PAWP) from 12 mmHg to 28 mmHg.
Which complication should the nurse suspect first?
A. Rupture of the pulmonary artery
B. Development of acute mitral regurgitation
C. Catheter migration into the right ventricle
D. A rapid decline in systemic vascular resistance
🟢B
🔴 RATIONALE: A sudden and significant rise in PAWP is indicative of acute left-sided heart failure. This is most
commonly caused by an acute event such as severe mitral regurgitation (due to papillary muscle rupture) or an
acute myocardial infarction. This is a classic finding of acute cardiogenic shock. Pulmonary artery rupture would
present with hemoptysis, catheter migration with a ventricular waveform, and a decline in SVR would lower, not
raise, the wedge pressure.
4. Which finding on a 12-lead ECG is most characteristic of a true posterior wall myocardial infarction?
A. ST-segment elevation in leads V1-V3
B. ST-segment depression in leads V1-V3
C. Pathological Q waves in leads II, III, and aVF
D. ST-segment elevation in leads I and aVL
🟢B
🔴 RATIONALE: A true posterior MI is electrically silent on standard 12-lead ECG as the posterior wall is not
directly viewed. The ECG reveals reciprocal changes in the anterior leads (V1-V3), which appear as horizontal ST-
segment depression and tall, upright R waves. ST elevation in V1-V3 is characteristic of an anterior or septal MI,
while ST elevation in II, III, aVF indicates an inferior MI.
, 5. A patient is on a dobutamine infusion for cardiogenic shock. Which assessment finding indicates the
therapy is having its desired therapeutic effect?
A. Heart rate decreases from 110 to 90 bpm.
B. Systolic blood pressure increases from 80 to 100 mmHg.
C. Urine output increases from 15 to 40 mL/hr.
D. Pulmonary capillary wedge pressure increases from 20 to 28 mmHg.
🟢C
🔴 RATIONALE: Dobutamine is a beta-1 agonist that increases cardiac contractility (positive inotrope) and
improves cardiac output. The ultimate goal of therapy is improved end-organ perfusion, which is best reflected
by an increase in urine output as renal perfusion improves. An increase in blood pressure is a secondary and
variable effect; dobutamine can also cause vasodilation. A decreasing heart rate suggests improved
hemodynamics but is not the primary goal. An increase in PAWP is a sign of worsening heart failure.
6. A patient with chronic heart failure is prescribed sacubitril/valsartan (Entresto). The nurse understands
that the primary mechanism of action for the beneficial effects of this combination drug is:
A. Inhibition of the renin-angiotensin-aldosterone system (RAAS) only.
B. Enhancement of the natriuretic peptide system and inhibition of RAAS.
C. Direct positive inotropic effect on myocardial contractility.
D. Selective beta-1 receptor blockade to reduce cardiac workload.
🟢B
🔴 RATIONALE: Sacubitril/valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor). Valsartan blocks the
RAAS, while sacubitril inhibits neprilysin, the enzyme that breaks down natriuretic peptides. This leads to
increased levels of endogenous vasodilators (like ANP and BNP), promoting vasodilation and diuresis. This dual
action reduces preload, afterload, and neurohormonal activation, leading to improved outcomes in heart failure.
It is not a direct inotrope or a beta-blocker.
