CMC Exam Study Guide for 2025/2026
90 Practice Questions with Verified Answers
and Evidence-Based Clinical Rationales
Study Guide for Cardiac Medicine Certification
June 2025
Comprehensive Preparation for the Cardiac Medicine Subspecialty
Certification (CMC) Exam
90 High-Yield Questions Aligned with AACN Blueprint, Including NGN-Inspired
Formats and Case Studies
Introduction
This study guide is designed to prepare nurses for the **Cardiac Medicine Certifi-
cation (CMC) Exam** 2025/2026, a subspecialty certification offered by the Amer-
ican Association of Critical-Care Nurses (AACN). It includes 90 practice ques-
tions with verified answers and detailed, evidence-based clinical rationales, fully
aligned with the AACN CMC Exam Blueprint updated June 2022. The guide fea-
tures Next Generation NCLEX (NGN)-inspired clinical judgment formats, includ-
ing multiple-choice, select-all-that-apply, case studies, and highlight questions, to
enhance critical thinking skills. It covers key content areas: acute coronary syn-
dromes (ACS), heart failure management, cardiomyopathies and arrhythmias,
cardiac interventions (PCI, CABG, pacemakers, ICDs), hemodynamics, ECG inter-
pretation, pharmacology, patient/family education, ethics, and multidisciplinary
care. Ideal for critical care/telemetry nurses, CCRN-certified nurses, NPs, and
bedside RNs in cardiac stepdown or ICU settings, this printable PDF (100+ pages)
ensures high-yield preparation for initial certification or renewal.
Test Tips and Clinical Pearls
• Clinical Judgment Focus: NGN-style questions test prioritization and decision-
making; always consider ABCs (airway, breathing, circulation) first.
• Time Management: The CMC exam includes 90 questions (75 scored, 15
unscored) in 2 hours; allocate 1.3 minutes per question.
• ECG Mastery: Memorize key ECG findings (e.g., STEMI, arrhythmias) and
their clinical implications.
1
, • Clinical Pearl: Always verify lead placement before interpreting ECGs to
avoid false readings.
• Pharmacology Tip: Know indications, side effects, and contraindications
for cardiac medications (e.g., beta-blockers, anticoagulants).
• Ethics Focus: Questions may test patient autonomy and family communi-
cation in end-of-life scenarios.
Practice Questions 1–90
QUESTION 1 A 62-year-old patient presents to the ED with chest pain for 2 hours.
ECG shows ST-elevation in leads V1–V4. Which intervention should
the nurse prioritize?
A. Administer IV morphine 4 mg.
B. Initiate percutaneous coronary intervention (PCI).
C. Administer oral aspirin 325 mg.
D. Start IV nitroglycerin 5 mcg/min.
Answer: B. Initiate percutaneous coronary intervention (PCI).
Rationale: ST-elevation in V1–V4 indicates anterior wall STEMI
due to left anterior descending artery occlusion. PCI within 90
minutes is the definitive treatment to restore perfusion. Aspirin,
morphine, and nitroglycerin are adjunctive. Clinical Pearl: Chew
aspirin for rapid absorption in ACS.
QUESTION 2 A 58-year-old patient with heart failure is prescribed spironolac-
tone. Which monitoring parameters should the nurse prioritize?
(Select all that apply.)
A. Serum potassium
B. Serum creatinine
C. Blood pressure
D. Serum glucose
E. Platelet count
Answer: A, B, C
Rationale: Spironolactone can cause hyperkalemia, renal dysfunc-
tion, and hypotension, requiring potassium, creatinine, and sodium
monitoring. Glucose and platelets are unaffected. Clinical Pearl:
Avoid potassium supplements with spironolactone.
QUESTION 3 Case Study: A 70-year-old patient with a history of atrial fibrilla-
tion presents with fatigue, dyspnea (3), and pitting edema. Echocar-
diogram: EF 35
2
, A. IV furosemide
B. Oral digoxin
C. IV dopamine
D. Oral amiodarone
Answer: A. IV furosemide
Rationale: Symptoms and EF 35
QUESTION 4 A 55-year-old patient post-PCI has the following labs. Highlight
Select the text items requiring immediate follow-up.
Laboratory Results:
- Serum potassium 5.9 mEq/L.
Creatinine 1.3 mg/dL.
Troponin I 0.5 ng/mL.
Platelet count 200,000/mm³.
ECG shows peaked T waves.
Answer (Highlighted Text):
- Serum potassium 5.9 mEq/L.
- ECG shows peaked T waves.
Rationale: Hyperkalemia (>5.5 mEq/L) and peaked T waves in-
dicate risk of arrhythmias, requiring urgent treatment (e.g., cal-
cium gluconate, insulin/glucose). Troponin is expected post-PCI,
and creatinine/platelets are normal. Clinical Pearl: Monitor ECG
continuously during hyperkalemia treatment.
QUESTION 5 A 60-year-old patient with atrial fibrillation has a heart rate of
140/min and BP 85/50 mmHg. Which intervention should the nurse
prioritize?
A. Administer IV diltiazem 20 mg bolus.
B. Initiate synchronized cardioversion.
C. Administer IV heparin 80 units/kg bolus.
D. Administer IV amiodarone 150 mg bolus.
Answer: B. Administer synchronized cardioversion.
Rationale: Hemodynamic instability (hypotension, tachycardia)
in atrial fibrillation requires urgent cardioversion to restore sinus
rhythm. Diltiazem and amiodarone control rate, and heparin pre-
vents clots but doesn’t address instability. Clinical Pearl: Ensure
anticoagulation for stroke risk post-cardioversion.
QUESTION 6 A 65-year-old patient with acute coronary syndrome is prescribed
dual antiplatelet therapy. Which medications should the nurse ad-
minister? (Select all that apply.)
A. Aspirin
3
, B. Clopidogrel
C. Warfarin
D. Ticagrelor
E. Heparin
Answer: A, B, E
Rationale: Aspirin, clopidogrel (or ticagrelor), and heparin are
standard for ACS to inhibit platelet aggregation and thrombus for-
mation. Warfarin is for other indications (e.g., atrial fibrillation).
Ticagrelor is an alternative to clopidogrel. Clinical Pearl: Moni-
tor for bleeding with dual antiplatelet therapy.
QUESTION 7 Case Study: A 50-year-old patient post-CABG develops chest pain
and hypotension (BP 90/60 mmHg). ECG shows new Q waves in
leads II, III, aVF. Which intervention should the nurse prioritize?
A. Administer IV nitroglycerin
B. Notify the surgical team for possible graft occlusion.
C. Administer IV morphine
D. Administer oral nitro
E. Start IV fluids
Answer: B. Notify the surgical team for possible graft occlusion.
Rationale: New Q waves and hypotension suggest graft occlusion
or acute MI post-CABG, requiring urgent surgical evaluation. Ni-
troglycerin and morphine are adjunctive, and fluids may worsen
heart failure. Clinical Pearl: Monitor for signs of cardiogenic
shock.
QUESTION 8 A 68-year-old patient with heart failure has the following vital signs.
Highlight items requiring immediate follow-up.
Vital Signs:
- BP 88 mmHg/58 mmHg.
Heart rate 112/min.
Respiratory rate 26/min.
SpO2O2 89%
Temperature 37.1°C.
Answer (Highlighted Text):
- BP 88 mmHg/58 mmHg .
- Respiratory rate 26/min. - SpO2O2 89.
Rationale: Hypotension, tachypnea, and hypoxemia indicate de-
compensated heart failure, requiring urgent diuresis and oxygen
therapy. Tachycardia is expected, and temperature is normal. Clin-
ical Pearl: Assess for pulmonary edema with crackles.
QUESTION 9 A 45-year-old patient with a history of cardiomyopathy presents
4
90 Practice Questions with Verified Answers
and Evidence-Based Clinical Rationales
Study Guide for Cardiac Medicine Certification
June 2025
Comprehensive Preparation for the Cardiac Medicine Subspecialty
Certification (CMC) Exam
90 High-Yield Questions Aligned with AACN Blueprint, Including NGN-Inspired
Formats and Case Studies
Introduction
This study guide is designed to prepare nurses for the **Cardiac Medicine Certifi-
cation (CMC) Exam** 2025/2026, a subspecialty certification offered by the Amer-
ican Association of Critical-Care Nurses (AACN). It includes 90 practice ques-
tions with verified answers and detailed, evidence-based clinical rationales, fully
aligned with the AACN CMC Exam Blueprint updated June 2022. The guide fea-
tures Next Generation NCLEX (NGN)-inspired clinical judgment formats, includ-
ing multiple-choice, select-all-that-apply, case studies, and highlight questions, to
enhance critical thinking skills. It covers key content areas: acute coronary syn-
dromes (ACS), heart failure management, cardiomyopathies and arrhythmias,
cardiac interventions (PCI, CABG, pacemakers, ICDs), hemodynamics, ECG inter-
pretation, pharmacology, patient/family education, ethics, and multidisciplinary
care. Ideal for critical care/telemetry nurses, CCRN-certified nurses, NPs, and
bedside RNs in cardiac stepdown or ICU settings, this printable PDF (100+ pages)
ensures high-yield preparation for initial certification or renewal.
Test Tips and Clinical Pearls
• Clinical Judgment Focus: NGN-style questions test prioritization and decision-
making; always consider ABCs (airway, breathing, circulation) first.
• Time Management: The CMC exam includes 90 questions (75 scored, 15
unscored) in 2 hours; allocate 1.3 minutes per question.
• ECG Mastery: Memorize key ECG findings (e.g., STEMI, arrhythmias) and
their clinical implications.
1
, • Clinical Pearl: Always verify lead placement before interpreting ECGs to
avoid false readings.
• Pharmacology Tip: Know indications, side effects, and contraindications
for cardiac medications (e.g., beta-blockers, anticoagulants).
• Ethics Focus: Questions may test patient autonomy and family communi-
cation in end-of-life scenarios.
Practice Questions 1–90
QUESTION 1 A 62-year-old patient presents to the ED with chest pain for 2 hours.
ECG shows ST-elevation in leads V1–V4. Which intervention should
the nurse prioritize?
A. Administer IV morphine 4 mg.
B. Initiate percutaneous coronary intervention (PCI).
C. Administer oral aspirin 325 mg.
D. Start IV nitroglycerin 5 mcg/min.
Answer: B. Initiate percutaneous coronary intervention (PCI).
Rationale: ST-elevation in V1–V4 indicates anterior wall STEMI
due to left anterior descending artery occlusion. PCI within 90
minutes is the definitive treatment to restore perfusion. Aspirin,
morphine, and nitroglycerin are adjunctive. Clinical Pearl: Chew
aspirin for rapid absorption in ACS.
QUESTION 2 A 58-year-old patient with heart failure is prescribed spironolac-
tone. Which monitoring parameters should the nurse prioritize?
(Select all that apply.)
A. Serum potassium
B. Serum creatinine
C. Blood pressure
D. Serum glucose
E. Platelet count
Answer: A, B, C
Rationale: Spironolactone can cause hyperkalemia, renal dysfunc-
tion, and hypotension, requiring potassium, creatinine, and sodium
monitoring. Glucose and platelets are unaffected. Clinical Pearl:
Avoid potassium supplements with spironolactone.
QUESTION 3 Case Study: A 70-year-old patient with a history of atrial fibrilla-
tion presents with fatigue, dyspnea (3), and pitting edema. Echocar-
diogram: EF 35
2
, A. IV furosemide
B. Oral digoxin
C. IV dopamine
D. Oral amiodarone
Answer: A. IV furosemide
Rationale: Symptoms and EF 35
QUESTION 4 A 55-year-old patient post-PCI has the following labs. Highlight
Select the text items requiring immediate follow-up.
Laboratory Results:
- Serum potassium 5.9 mEq/L.
Creatinine 1.3 mg/dL.
Troponin I 0.5 ng/mL.
Platelet count 200,000/mm³.
ECG shows peaked T waves.
Answer (Highlighted Text):
- Serum potassium 5.9 mEq/L.
- ECG shows peaked T waves.
Rationale: Hyperkalemia (>5.5 mEq/L) and peaked T waves in-
dicate risk of arrhythmias, requiring urgent treatment (e.g., cal-
cium gluconate, insulin/glucose). Troponin is expected post-PCI,
and creatinine/platelets are normal. Clinical Pearl: Monitor ECG
continuously during hyperkalemia treatment.
QUESTION 5 A 60-year-old patient with atrial fibrillation has a heart rate of
140/min and BP 85/50 mmHg. Which intervention should the nurse
prioritize?
A. Administer IV diltiazem 20 mg bolus.
B. Initiate synchronized cardioversion.
C. Administer IV heparin 80 units/kg bolus.
D. Administer IV amiodarone 150 mg bolus.
Answer: B. Administer synchronized cardioversion.
Rationale: Hemodynamic instability (hypotension, tachycardia)
in atrial fibrillation requires urgent cardioversion to restore sinus
rhythm. Diltiazem and amiodarone control rate, and heparin pre-
vents clots but doesn’t address instability. Clinical Pearl: Ensure
anticoagulation for stroke risk post-cardioversion.
QUESTION 6 A 65-year-old patient with acute coronary syndrome is prescribed
dual antiplatelet therapy. Which medications should the nurse ad-
minister? (Select all that apply.)
A. Aspirin
3
, B. Clopidogrel
C. Warfarin
D. Ticagrelor
E. Heparin
Answer: A, B, E
Rationale: Aspirin, clopidogrel (or ticagrelor), and heparin are
standard for ACS to inhibit platelet aggregation and thrombus for-
mation. Warfarin is for other indications (e.g., atrial fibrillation).
Ticagrelor is an alternative to clopidogrel. Clinical Pearl: Moni-
tor for bleeding with dual antiplatelet therapy.
QUESTION 7 Case Study: A 50-year-old patient post-CABG develops chest pain
and hypotension (BP 90/60 mmHg). ECG shows new Q waves in
leads II, III, aVF. Which intervention should the nurse prioritize?
A. Administer IV nitroglycerin
B. Notify the surgical team for possible graft occlusion.
C. Administer IV morphine
D. Administer oral nitro
E. Start IV fluids
Answer: B. Notify the surgical team for possible graft occlusion.
Rationale: New Q waves and hypotension suggest graft occlusion
or acute MI post-CABG, requiring urgent surgical evaluation. Ni-
troglycerin and morphine are adjunctive, and fluids may worsen
heart failure. Clinical Pearl: Monitor for signs of cardiogenic
shock.
QUESTION 8 A 68-year-old patient with heart failure has the following vital signs.
Highlight items requiring immediate follow-up.
Vital Signs:
- BP 88 mmHg/58 mmHg.
Heart rate 112/min.
Respiratory rate 26/min.
SpO2O2 89%
Temperature 37.1°C.
Answer (Highlighted Text):
- BP 88 mmHg/58 mmHg .
- Respiratory rate 26/min. - SpO2O2 89.
Rationale: Hypotension, tachypnea, and hypoxemia indicate de-
compensated heart failure, requiring urgent diuresis and oxygen
therapy. Tachycardia is expected, and temperature is normal. Clin-
ical Pearl: Assess for pulmonary edema with crackles.
QUESTION 9 A 45-year-old patient with a history of cardiomyopathy presents
4
