CMC – Cardiac Medicine Certification
Comprehensive Study Guide, Cardiovascular Nursing,
Cardiac Disorders, ECG Interpretation, Patient
Management, and Certification Exam Review
1. The nurse is caring for a patient with acute decompensated heart failure.
Which hemodynamic parameter best reflects left ventricular preload?
a. Central venous pressure (CVP)
b. Pulmonary capillary wedge pressure (PCWP)
c. Systemic vascular resistance (SVR)
d. Cardiac output (CO)
ANSWER: B
Rationale: PCWP reflects left ventricular end-diastolic pressure (LVEDP), which
is the best measure of left ventricular preload in the absence of mitral valve
disease. CVP (A) reflects right ventricular preload. SVR (C) measures afterload.
CO (D) measures overall cardiac pump function.
DIF: Cognitive Level: Understand
TOP: Hemodynamic Monitoring
2. A patient with septic shock has a cardiac index of 2.1 L/min/m², SVR of 450
dynes-sec/cm⁵, and a PCWP of 8 mmHg. The nurse correctly identifies this
hemodynamic profile as:
a. Distributive shock with low SVR
b. Cardiogenic shock with low cardiac output
c. Hypovolemic shock with low filling pressures
d. Obstructive shock with high SVR
ANSWER: A
Rationale: Septic shock is a distributive shock characterized by low SVR (normal
800-1200) due to profound vasodilation. The CI is low-normal (normal 2.5-4.0),
and PCWP is normal. Cardiogenic shock (B) would show low CI with high PCWP.
Hypovolemic shock (C) would show low CI with low PCWP. Obstructive shock
(D) would show variable CI with high SVR.
,DIF: Cognitive Level: Analyze
TOP: Shock States
3. The nurse is interpreting an arterial blood gas (ABG) with the following
results: pH 7.28, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L. What is the correct
interpretation?
a. Respiratory acidosis (uncompensated)
b. Respiratory acidosis (partially compensated)
c. Metabolic acidosis (uncompensated)
d. Metabolic acidosis (partially compensated)
ANSWER: A
Rationale: The pH is below 7.35 (acidemia), PaCO₂ is elevated (>45 mmHg)
indicating a respiratory acidosis, and HCO₃⁻ is normal (22-26 mEq/L) indicating
no metabolic compensation. This is an uncompensated respiratory acidosis. Partial
compensation would show elevated HCO₃⁻. Metabolic acidosis would show low
HCO₃⁻.
DIF: Cognitive Level: Analyze
TOP: ABG Interpretation
4. The nurse is caring for a patient with a pulmonary artery catheter. The
waveform transitions from a PA pressure waveform to a PCWP waveform
during balloon inflation. The nurse understands that the PCWP measurement
reflects:
a. Left ventricular end-diastolic pressure
b. Right ventricular systolic pressure
c. Pulmonary artery systolic pressure
d. Central venous pressure
ANSWER: A
Rationale: PCWP reflects left ventricular end-diastolic pressure (LVEDP) in the
absence of mitral valve disease, as the pulmonary circulation provides a continuous
column of blood to the left heart. CVP (D) reflects right ventricular pressure.
Options B and C are pulmonary artery pressures.
,DIF: Cognitive Level: Understand
TOP: Hemodynamics
5. The nurse is calculating cardiac index (CI) for a patient with a cardiac
output of 4.5 L/min and a body surface area of 1.8 m². What is the CI?
a. 2.0 L/min/m²
b. 2.5 L/min/m²
c. 3.0 L/min/m²
d. 3.5 L/min/m²
ANSWER: B
Rationale: CI = Cardiac Output / Body Surface Area = 4..8 = 2.5 L/min/m².
Normal CI is 2.5-4.0 L/min/m². Option A is below normal. Options C and D are
above the calculated value.
DIF: Cognitive Level: Analyze
TOP: Hemodynamic Calculations
6. The nurse is caring for a patient with acute myocardial infarction who
develops cardiogenic shock. Which hemodynamic finding would the nurse
expect?
a. Low PCWP, low CI, high SVR
b. High PCWP, low CI, high SVR
c. Low PCWP, high CI, low SVR
d. High PCWP, high CI, low SVR
ANSWER: B
Rationale: Cardiogenic shock is characterized by elevated PCWP (left-sided
filling pressures), low cardiac index, and elevated SVR (compensatory
vasoconstriction). Option A describes hypovolemic shock. Option C describes
distributive shock. Option D is not a typical pattern.
DIF: Cognitive Level: Analyze
TOP: Cardiogenic Shock
, 7. The nurse is assessing a patient with suspected pericarditis. Which finding
is most characteristic of this condition?
a. Pericardial friction rub
b. Jugular venous distension
c. Peripheral edema
d. Crackles on lung auscultation
ANSWER: A
Rationale: A pericardial friction rub is a hallmark sign of pericarditis, heard best
at the left lower sternal border with the patient leaning forward. JVD (B),
peripheral edema (C), and crackles (D) are more characteristic of heart failure.
DIF: Cognitive Level: Understand
TOP: Pericarditis
8. The nurse is caring for a patient with a newly diagnosed atrial septal defect
(ASD). Which hemodynamic change is most commonly associated with an
uncorrected ASD?
a. Left-to-right shunting and right heart volume overload
b. Right-to-left shunting and cyanosis
c. Decreased pulmonary blood flow
d. Left heart failure
ANSWER: A
Rationale: An uncorrected ASD results in left-to-right shunting due to the pressure
difference between the left and right atria, causing right heart volume overload.
Right-to-left shunting (B) occurs with Eisenmenger syndrome. Decreased
pulmonary blood flow (C) is seen in Tetralogy of Fallot. Left heart failure (D) is a
late complication.
DIF: Cognitive Level: Understand
TOP: Congenital Heart Disease
9. The nurse is evaluating a patient's hemodynamic status. Which of the
following is the most accurate measure of afterload?
a. Systemic vascular resistance (SVR)
Comprehensive Study Guide, Cardiovascular Nursing,
Cardiac Disorders, ECG Interpretation, Patient
Management, and Certification Exam Review
1. The nurse is caring for a patient with acute decompensated heart failure.
Which hemodynamic parameter best reflects left ventricular preload?
a. Central venous pressure (CVP)
b. Pulmonary capillary wedge pressure (PCWP)
c. Systemic vascular resistance (SVR)
d. Cardiac output (CO)
ANSWER: B
Rationale: PCWP reflects left ventricular end-diastolic pressure (LVEDP), which
is the best measure of left ventricular preload in the absence of mitral valve
disease. CVP (A) reflects right ventricular preload. SVR (C) measures afterload.
CO (D) measures overall cardiac pump function.
DIF: Cognitive Level: Understand
TOP: Hemodynamic Monitoring
2. A patient with septic shock has a cardiac index of 2.1 L/min/m², SVR of 450
dynes-sec/cm⁵, and a PCWP of 8 mmHg. The nurse correctly identifies this
hemodynamic profile as:
a. Distributive shock with low SVR
b. Cardiogenic shock with low cardiac output
c. Hypovolemic shock with low filling pressures
d. Obstructive shock with high SVR
ANSWER: A
Rationale: Septic shock is a distributive shock characterized by low SVR (normal
800-1200) due to profound vasodilation. The CI is low-normal (normal 2.5-4.0),
and PCWP is normal. Cardiogenic shock (B) would show low CI with high PCWP.
Hypovolemic shock (C) would show low CI with low PCWP. Obstructive shock
(D) would show variable CI with high SVR.
,DIF: Cognitive Level: Analyze
TOP: Shock States
3. The nurse is interpreting an arterial blood gas (ABG) with the following
results: pH 7.28, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L. What is the correct
interpretation?
a. Respiratory acidosis (uncompensated)
b. Respiratory acidosis (partially compensated)
c. Metabolic acidosis (uncompensated)
d. Metabolic acidosis (partially compensated)
ANSWER: A
Rationale: The pH is below 7.35 (acidemia), PaCO₂ is elevated (>45 mmHg)
indicating a respiratory acidosis, and HCO₃⁻ is normal (22-26 mEq/L) indicating
no metabolic compensation. This is an uncompensated respiratory acidosis. Partial
compensation would show elevated HCO₃⁻. Metabolic acidosis would show low
HCO₃⁻.
DIF: Cognitive Level: Analyze
TOP: ABG Interpretation
4. The nurse is caring for a patient with a pulmonary artery catheter. The
waveform transitions from a PA pressure waveform to a PCWP waveform
during balloon inflation. The nurse understands that the PCWP measurement
reflects:
a. Left ventricular end-diastolic pressure
b. Right ventricular systolic pressure
c. Pulmonary artery systolic pressure
d. Central venous pressure
ANSWER: A
Rationale: PCWP reflects left ventricular end-diastolic pressure (LVEDP) in the
absence of mitral valve disease, as the pulmonary circulation provides a continuous
column of blood to the left heart. CVP (D) reflects right ventricular pressure.
Options B and C are pulmonary artery pressures.
,DIF: Cognitive Level: Understand
TOP: Hemodynamics
5. The nurse is calculating cardiac index (CI) for a patient with a cardiac
output of 4.5 L/min and a body surface area of 1.8 m². What is the CI?
a. 2.0 L/min/m²
b. 2.5 L/min/m²
c. 3.0 L/min/m²
d. 3.5 L/min/m²
ANSWER: B
Rationale: CI = Cardiac Output / Body Surface Area = 4..8 = 2.5 L/min/m².
Normal CI is 2.5-4.0 L/min/m². Option A is below normal. Options C and D are
above the calculated value.
DIF: Cognitive Level: Analyze
TOP: Hemodynamic Calculations
6. The nurse is caring for a patient with acute myocardial infarction who
develops cardiogenic shock. Which hemodynamic finding would the nurse
expect?
a. Low PCWP, low CI, high SVR
b. High PCWP, low CI, high SVR
c. Low PCWP, high CI, low SVR
d. High PCWP, high CI, low SVR
ANSWER: B
Rationale: Cardiogenic shock is characterized by elevated PCWP (left-sided
filling pressures), low cardiac index, and elevated SVR (compensatory
vasoconstriction). Option A describes hypovolemic shock. Option C describes
distributive shock. Option D is not a typical pattern.
DIF: Cognitive Level: Analyze
TOP: Cardiogenic Shock
, 7. The nurse is assessing a patient with suspected pericarditis. Which finding
is most characteristic of this condition?
a. Pericardial friction rub
b. Jugular venous distension
c. Peripheral edema
d. Crackles on lung auscultation
ANSWER: A
Rationale: A pericardial friction rub is a hallmark sign of pericarditis, heard best
at the left lower sternal border with the patient leaning forward. JVD (B),
peripheral edema (C), and crackles (D) are more characteristic of heart failure.
DIF: Cognitive Level: Understand
TOP: Pericarditis
8. The nurse is caring for a patient with a newly diagnosed atrial septal defect
(ASD). Which hemodynamic change is most commonly associated with an
uncorrected ASD?
a. Left-to-right shunting and right heart volume overload
b. Right-to-left shunting and cyanosis
c. Decreased pulmonary blood flow
d. Left heart failure
ANSWER: A
Rationale: An uncorrected ASD results in left-to-right shunting due to the pressure
difference between the left and right atria, causing right heart volume overload.
Right-to-left shunting (B) occurs with Eisenmenger syndrome. Decreased
pulmonary blood flow (C) is seen in Tetralogy of Fallot. Left heart failure (D) is a
late complication.
DIF: Cognitive Level: Understand
TOP: Congenital Heart Disease
9. The nurse is evaluating a patient's hemodynamic status. Which of the
following is the most accurate measure of afterload?
a. Systemic vascular resistance (SVR)
