Cardiac Medicine Subspecialty Certification
(CMC®) Exam 2025/2026 | Complete Exam with
Verified Questions & 100% Correct Answers
CMC® Certification Exam | Key Concepts: Advanced Cardiac Assessment, Hemodynamics,
Acute Coronary Syndromes, Heart Failure, Arrhythmias, Diagnostic Testing, Pharmacology in
Cardiac Care, Mechanical Circulatory Support, and Evidence-Based Interventions |
Expert-Verified Q&A | Clinical & Exam-Ready
Introduction
This updated 2025/2026 Cardiac Medicine Subspecialty Certification (CMC®) Exam resource
provides 150 fully verified questions with 100% correct answers, matching the structure of the
AACN CMC® exam (125 scored and 25 unscored questions). Content covers advanced cardiac
nursing, including comprehensive patient assessment, ECG interpretation, hemodynamic
monitoring, pharmacologic management, and priority nursing interventions for complex cardiac
patients. All answers are graded A+ and ensure complete preparation for CMC® certification
exam success, reflecting evidence-based practice and standards from the American Heart
Association (AHA) and AACN.
Answer Format
All correct answers are highlighted in bold and green, with rationales that explain cardiac care
priorities, reinforce safe evidence-based practice, and strengthen advanced critical care nursing
knowledge for exam readiness.
Questions 1–150
1. A 58-year-old patient with acute chest pain has ST elevation in leads
V1–V4 on ECG. What is the most likely diagnosis?
a) Pericarditis
b) Anterior wall STEMI
c) Pulmonary embolism
d) Aortic dissection
b) Anterior wall STEMI
Rationale: ST elevation in leads V1–V4 indicates an anterior wall ST-elevation myocardial
infarction (STEMI), typically due to occlusion of the left anterior descending artery, per AHA
guidelines.
2. A patient with heart failure has a pulmonary artery catheter showing a
cardiac index of 1.8 L/min/m². What is the most appropriate initial
,intervention?
a) Administer IV furosemide
b) Start dobutamine
c) Administer IV nitroglycerin
d) Increase fluid administration
b) Start dobutamine
Rationale: A low cardiac index (normal: 2.5–4.0 L/min/m²) indicates reduced cardiac output,
requiring an inotrope like dobutamine to improve contractility, per AHA heart failure
guidelines.
3. A patient with atrial fibrillation has a heart rate of 160 bpm and blood
pressure of 90/60 mmHg. What is the most appropriate initial treatment?
a) Administer amiodarone
b) Perform synchronized cardioversion
c) Administer diltiazem
d) Start heparin
b) Perform synchronized cardioversion
Rationale: Unstable atrial fibrillation with hypotension requires synchronized cardioversion to
restore sinus rhythm, per AHA Advanced Cardiac Life Support (ACLS) guidelines.
4. A patient with acute coronary syndrome is prescribed clopidogrel. What
is the mechanism of action?
a) Inhibits thrombin
b) Inhibits platelet aggregation
c) Inhibits fibrin formation
d) Enhances fibrinolysis
b) Inhibits platelet aggregation
Rationale: Clopidogrel is a P2Y12 inhibitor that prevents platelet aggregation, reducing
thrombus formation in acute coronary syndrome, per AHA guidelines.
5. A patient with a pulmonary artery catheter shows a pulmonary capillary
wedge pressure (PCWP) of 22 mmHg. What is the most likely condition?
a) Hypovolemia
b) Left ventricular failure
c) Pulmonary hypertension
d) Right ventricular failure
b) Left ventricular failure
Rationale: Elevated PCWP (>18 mmHg) indicates increased left ventricular end-diastolic
pressure, consistent with left ventricular failure, per AACN hemodynamic monitoring
guidelines.
6. A patient with acute myocardial infarction develops ventricular
tachycardia with a pulse. What is the most appropriate initial treatment?
a) Administer lidocaine
b) Perform synchronized cardioversion
,c) Administer amiodarone
d) Start magnesium sulfate
b) Perform synchronized cardioversion
Rationale: Stable ventricular tachycardia with a pulse requires synchronized cardioversion, per
AHA ACLS guidelines. Amiodarone is used if cardioversion fails.
7. A patient with heart failure is prescribed spironolactone. What
electrolyte must be monitored closely?
a) Sodium
b) Potassium
c) Calcium
d) Magnesium
b) Potassium
Rationale: Spironolactone, a potassium-sparing diuretic, can cause hyperkalemia, requiring
close potassium monitoring, per AHA heart failure guidelines.
8. A patient with acute coronary syndrome has a troponin level of 0.8
ng/mL and no ST elevation. What is the most likely diagnosis?
a) Stable angina
b) Non-ST-elevation myocardial infarction (NSTEMI)
c) Pericarditis
d) Aortic dissection
b) Non-ST-elevation myocardial infarction (NSTEMI)
Rationale: Elevated troponin without ST elevation indicates NSTEMI, per AHA acute coronary
syndrome guidelines.
9. A patient with a left ventricular assist device (LVAD) presents with low
flow alarms. What is the most likely cause?
a) Pump thrombosis
b) Hypervolemia
c) Hypertension
d) Battery failure
a) Pump thrombosis
Rationale: Low flow alarms in an LVAD patient often indicate pump thrombosis, requiring
urgent anticoagulation and evaluation, per AHA mechanical circulatory support guidelines.
10. A patient with heart failure presents with jugular venous distension and
crackles. What is the most appropriate initial treatment?
a) Administer IV furosemide
b) Start dobutamine
c) Administer IV nitroglycerin
d) Order an echocardiogram
a) Administer IV furosemide
Rationale: Jugular venous distension and crackles indicate fluid overload in heart failure,
requiring IV furosemide to reduce preload, per AHA guidelines.
, 11. A patient with a history of myocardial infarction develops sudden
dyspnea and hypoxia. What is the most likely diagnosis?
a) Pneumothorax
b) Pulmonary edema
c) Pneumonia
d) Pulmonary embolism
b) Pulmonary edema
Rationale: Sudden dyspnea and hypoxia in a patient with a history of myocardial infarction
suggest pulmonary edema due to left ventricular dysfunction, per AHA guidelines.
12. A patient with a history of atrial fibrillation is prescribed warfarin. What
is the therapeutic INR range?
a) 1.5–2.0
b) 2.0–3.0
c) 3.0–4.0
d) 4.0–5.0
b) 2.0–3.0
Rationale: The therapeutic INR range for atrial fibrillation is 2.0–3.0 to balance anticoagulation
and bleeding risk, per AHA guidelines.
13. A patient with acute heart failure has a blood pressure of 90/60 mmHg.
Which medication is contraindicated?
a) Dobutamine
b) Norepinephrine
c) Nitroglycerin
d) Milrinone
c) Nitroglycerin
Rationale: Nitroglycerin is contraindicated in hypotensive heart failure due to its vasodilatory
effects, which can worsen hypotension, per AHA guidelines.
14. A patient with a suspected acute coronary syndrome has a normal ECG.
What is the next diagnostic step?
a) Stress test
b) Troponin levels
c) Echocardiogram
d) Coronary angiography
b) Troponin levels
Rationale: Troponin levels are the next step to detect myocardial injury in suspected acute
coronary syndrome with a normal ECG, per AHA guidelines.
15. A patient with a history of heart failure is prescribed digoxin. What is a
sign of digoxin toxicity?
a) Hypertension
b) Visual disturbances
c) Hyperglycemia
(CMC®) Exam 2025/2026 | Complete Exam with
Verified Questions & 100% Correct Answers
CMC® Certification Exam | Key Concepts: Advanced Cardiac Assessment, Hemodynamics,
Acute Coronary Syndromes, Heart Failure, Arrhythmias, Diagnostic Testing, Pharmacology in
Cardiac Care, Mechanical Circulatory Support, and Evidence-Based Interventions |
Expert-Verified Q&A | Clinical & Exam-Ready
Introduction
This updated 2025/2026 Cardiac Medicine Subspecialty Certification (CMC®) Exam resource
provides 150 fully verified questions with 100% correct answers, matching the structure of the
AACN CMC® exam (125 scored and 25 unscored questions). Content covers advanced cardiac
nursing, including comprehensive patient assessment, ECG interpretation, hemodynamic
monitoring, pharmacologic management, and priority nursing interventions for complex cardiac
patients. All answers are graded A+ and ensure complete preparation for CMC® certification
exam success, reflecting evidence-based practice and standards from the American Heart
Association (AHA) and AACN.
Answer Format
All correct answers are highlighted in bold and green, with rationales that explain cardiac care
priorities, reinforce safe evidence-based practice, and strengthen advanced critical care nursing
knowledge for exam readiness.
Questions 1–150
1. A 58-year-old patient with acute chest pain has ST elevation in leads
V1–V4 on ECG. What is the most likely diagnosis?
a) Pericarditis
b) Anterior wall STEMI
c) Pulmonary embolism
d) Aortic dissection
b) Anterior wall STEMI
Rationale: ST elevation in leads V1–V4 indicates an anterior wall ST-elevation myocardial
infarction (STEMI), typically due to occlusion of the left anterior descending artery, per AHA
guidelines.
2. A patient with heart failure has a pulmonary artery catheter showing a
cardiac index of 1.8 L/min/m². What is the most appropriate initial
,intervention?
a) Administer IV furosemide
b) Start dobutamine
c) Administer IV nitroglycerin
d) Increase fluid administration
b) Start dobutamine
Rationale: A low cardiac index (normal: 2.5–4.0 L/min/m²) indicates reduced cardiac output,
requiring an inotrope like dobutamine to improve contractility, per AHA heart failure
guidelines.
3. A patient with atrial fibrillation has a heart rate of 160 bpm and blood
pressure of 90/60 mmHg. What is the most appropriate initial treatment?
a) Administer amiodarone
b) Perform synchronized cardioversion
c) Administer diltiazem
d) Start heparin
b) Perform synchronized cardioversion
Rationale: Unstable atrial fibrillation with hypotension requires synchronized cardioversion to
restore sinus rhythm, per AHA Advanced Cardiac Life Support (ACLS) guidelines.
4. A patient with acute coronary syndrome is prescribed clopidogrel. What
is the mechanism of action?
a) Inhibits thrombin
b) Inhibits platelet aggregation
c) Inhibits fibrin formation
d) Enhances fibrinolysis
b) Inhibits platelet aggregation
Rationale: Clopidogrel is a P2Y12 inhibitor that prevents platelet aggregation, reducing
thrombus formation in acute coronary syndrome, per AHA guidelines.
5. A patient with a pulmonary artery catheter shows a pulmonary capillary
wedge pressure (PCWP) of 22 mmHg. What is the most likely condition?
a) Hypovolemia
b) Left ventricular failure
c) Pulmonary hypertension
d) Right ventricular failure
b) Left ventricular failure
Rationale: Elevated PCWP (>18 mmHg) indicates increased left ventricular end-diastolic
pressure, consistent with left ventricular failure, per AACN hemodynamic monitoring
guidelines.
6. A patient with acute myocardial infarction develops ventricular
tachycardia with a pulse. What is the most appropriate initial treatment?
a) Administer lidocaine
b) Perform synchronized cardioversion
,c) Administer amiodarone
d) Start magnesium sulfate
b) Perform synchronized cardioversion
Rationale: Stable ventricular tachycardia with a pulse requires synchronized cardioversion, per
AHA ACLS guidelines. Amiodarone is used if cardioversion fails.
7. A patient with heart failure is prescribed spironolactone. What
electrolyte must be monitored closely?
a) Sodium
b) Potassium
c) Calcium
d) Magnesium
b) Potassium
Rationale: Spironolactone, a potassium-sparing diuretic, can cause hyperkalemia, requiring
close potassium monitoring, per AHA heart failure guidelines.
8. A patient with acute coronary syndrome has a troponin level of 0.8
ng/mL and no ST elevation. What is the most likely diagnosis?
a) Stable angina
b) Non-ST-elevation myocardial infarction (NSTEMI)
c) Pericarditis
d) Aortic dissection
b) Non-ST-elevation myocardial infarction (NSTEMI)
Rationale: Elevated troponin without ST elevation indicates NSTEMI, per AHA acute coronary
syndrome guidelines.
9. A patient with a left ventricular assist device (LVAD) presents with low
flow alarms. What is the most likely cause?
a) Pump thrombosis
b) Hypervolemia
c) Hypertension
d) Battery failure
a) Pump thrombosis
Rationale: Low flow alarms in an LVAD patient often indicate pump thrombosis, requiring
urgent anticoagulation and evaluation, per AHA mechanical circulatory support guidelines.
10. A patient with heart failure presents with jugular venous distension and
crackles. What is the most appropriate initial treatment?
a) Administer IV furosemide
b) Start dobutamine
c) Administer IV nitroglycerin
d) Order an echocardiogram
a) Administer IV furosemide
Rationale: Jugular venous distension and crackles indicate fluid overload in heart failure,
requiring IV furosemide to reduce preload, per AHA guidelines.
, 11. A patient with a history of myocardial infarction develops sudden
dyspnea and hypoxia. What is the most likely diagnosis?
a) Pneumothorax
b) Pulmonary edema
c) Pneumonia
d) Pulmonary embolism
b) Pulmonary edema
Rationale: Sudden dyspnea and hypoxia in a patient with a history of myocardial infarction
suggest pulmonary edema due to left ventricular dysfunction, per AHA guidelines.
12. A patient with a history of atrial fibrillation is prescribed warfarin. What
is the therapeutic INR range?
a) 1.5–2.0
b) 2.0–3.0
c) 3.0–4.0
d) 4.0–5.0
b) 2.0–3.0
Rationale: The therapeutic INR range for atrial fibrillation is 2.0–3.0 to balance anticoagulation
and bleeding risk, per AHA guidelines.
13. A patient with acute heart failure has a blood pressure of 90/60 mmHg.
Which medication is contraindicated?
a) Dobutamine
b) Norepinephrine
c) Nitroglycerin
d) Milrinone
c) Nitroglycerin
Rationale: Nitroglycerin is contraindicated in hypotensive heart failure due to its vasodilatory
effects, which can worsen hypotension, per AHA guidelines.
14. A patient with a suspected acute coronary syndrome has a normal ECG.
What is the next diagnostic step?
a) Stress test
b) Troponin levels
c) Echocardiogram
d) Coronary angiography
b) Troponin levels
Rationale: Troponin levels are the next step to detect myocardial injury in suspected acute
coronary syndrome with a normal ECG, per AHA guidelines.
15. A patient with a history of heart failure is prescribed digoxin. What is a
sign of digoxin toxicity?
a) Hypertension
b) Visual disturbances
c) Hyperglycemia
