BSN 266
CARDIAC CARE
Remotely Proctored Exam
Questions and Answers • 2026 Update
With Complete Solutions
Total Questions 50 (Multiple Choice, A-D)
4 (Hemodynamics/ECG | ACS/EP | HF/Valves |
Sections
Pharmacology/2026 Updates)
Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Item Style 75% Scenario-based | 25% Direct
Point Value 2 points per item | 100 points total
Passing Threshold 75% (Proficient / Level 3)
Guideline Alignment 2026 AHA / ACC / HFSA
Reference Materials Restricted (closed-book, proctored)
This high-stakes proctored examination assesses mastery-level clinical judgment in
advanced cardiovascular nursing. Scenarios emphasize prioritization,
hemodynamic interpretation, ECG analysis, and pharmacologic decision-making
consistent with 2026 AHA/ACC/HFSA guidelines.
Page 1
,BSN 266 Cardiac Care | Remotely Proctored Exam | 2026 Update With Complete Solutions
Examination Overview
This 50-item remotely proctored examination evaluates mastery-level competency in advanced
cardiac nursing consistent with BSN 266 objectives and the 2026 AHA/ACC/HFSA guideline updates.
The exam is closed-book; reference materials are restricted. Each item is multiple choice with four
options (A-D) and exactly one best answer. Items are weighted 75% scenario-based (complex clinical
vignettes emphasizing prioritization, hemodynamic interpretation, ECG analysis, and pharmacologic
decision-making) and 25% direct (definitions, ECG criteria, mechanisms). The cognitive distribution is
approximately 30% recall, 50% application, and 20% analysis. Complete solutions with step-by-step
pathophysiologic rationales and explicit identification of why each distractor is incorrect follow every
question.
Section Content Domain Items Points
1 Cardiovascular Assessment, Hemodynamics, & Advanced ECG Interpretation
Q1-Q13 26
2 Acute Coronary Syndromes, Arrhythmias, & Electrophysiology Q14-Q26 26
3 Heart Failure, Valvular Disorders, & Cardiomyopathies Q27-Q38 24
4 Cardiac Pharmacology, Interventions, Post-Op Care, & 2026 Updates Q39-Q50 24
Total 50 100
Part 1 ■ Examination Items
Each item below includes the question stem, four options (A-D), the identified correct answer, and a complete
rationale explaining the underlying pathophysiology, the priority nursing intervention, and why each distractor
represents a common clinical or calculation error.
Section 1 ■ Cardiovascular Assessment, Hemodynamics, & Advanced
ECG Interpretation
Page 2
, BSN 266 Cardiac Care | Remotely Proctored Exam | 2026 Update With Complete Solutions
Q1. A 68-year-old male is post-inferior STEMI day 1. Pulmonary artery catheter data: PA wedge
pressure 22 mmHg, cardiac index 1.9 L/min/m², SVR 1900 dynes·s/cm■. Which interpretation
is most accurate?
A. Hypovolemic shock; administer a 500 mL crystalloid bolus
B. Cardiogenic shock with elevated LV filling pressure; consider inotrope and diuresis
[CORRECT]
C. Distributive shock; initiate norepinephrine
D. Obstructive shock from tamponade; prepare for pericardiocentesis
Correct Answer: B
Rationale: PAWP >18 mmHg with low cardiac index (<2.2) and high SVR (>1500) is the classic
hemodynamic profile of cardiogenic shock: backward failure (congestion) with poor forward output.
Hypovolemia would show a low PAWP; distributive shock (septic) shows a low SVR; tamponade shows
equalization of diastolic pressures (RA, RV diastolic, PA diastolic, PAWP within 5 mmHg) with a low
PAWP. The priority is inotropic support (dobutamine/milrinone) and diuresis to reduce congestion, with
mechanical support (IABP/Impella) if refractory.
Q2. During pulmonary artery catheter insertion, the nurse observes a sudden loss of the
pulmonary artery waveform, a persistent wedge tracing without balloon deflation, and the
patient becomes tachycardic. What is the priority action?
A. Rezero and recalibrate the transducer
B. Withdraw the catheter 1-2 cm and reposition; catheter is overwedged [CORRECT]
C. Inflate the balloon further to obtain a cleaner wedge
D. Administer a 500 mL fluid bolus for the tachycardia
Correct Answer: B
Rationale: A persistent wedge tracing with loss of the PA waveform indicates
overwedging/overinflation, which risks pulmonary infarction from distal vessel occlusion. The priority is
to withdraw the catheter 1-2 cm and reposition. Rezeroing will not correct a mechanical catheter-tip
issue; further balloon inflation worsens the risk of PA rupture/infarction; the tachycardia is
compensatory and will resolve once the mechanical cause is corrected.
Q3. An intra-aortic balloon pump (IABP) arterial waveform shows balloon inflation occurring
after the dicrotic notch, with diminished and delayed diastolic augmentation. The priority
nursing action is to:
A. Adjust timing so inflation occurs at the dicrotic notch (inflate earlier) [CORRECT]
B. Adjust timing so inflation occurs later in diastole
C. Increase the balloon inflation pressure
D. Switch to a 1:3 ratio and reassess in 30 minutes
Correct Answer: A
Rationale: Correct IABP timing inflates the balloon at the dicrotic notch (aortic valve closure) to
maximize diastolic coronary perfusion and deflate precisely before systole to reduce afterload. Inflation
after the dicrotic notch is too late, missing peak diastolic augmentation and reducing coronary perfusion
pressure; the correction is to inflate earlier. Increasing inflation pressure does not fix a timing error, and
changing to a 1:3 ratio only obscures the timing problem rather than resolving it.
Page 3
CARDIAC CARE
Remotely Proctored Exam
Questions and Answers • 2026 Update
With Complete Solutions
Total Questions 50 (Multiple Choice, A-D)
4 (Hemodynamics/ECG | ACS/EP | HF/Valves |
Sections
Pharmacology/2026 Updates)
Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Item Style 75% Scenario-based | 25% Direct
Point Value 2 points per item | 100 points total
Passing Threshold 75% (Proficient / Level 3)
Guideline Alignment 2026 AHA / ACC / HFSA
Reference Materials Restricted (closed-book, proctored)
This high-stakes proctored examination assesses mastery-level clinical judgment in
advanced cardiovascular nursing. Scenarios emphasize prioritization,
hemodynamic interpretation, ECG analysis, and pharmacologic decision-making
consistent with 2026 AHA/ACC/HFSA guidelines.
Page 1
,BSN 266 Cardiac Care | Remotely Proctored Exam | 2026 Update With Complete Solutions
Examination Overview
This 50-item remotely proctored examination evaluates mastery-level competency in advanced
cardiac nursing consistent with BSN 266 objectives and the 2026 AHA/ACC/HFSA guideline updates.
The exam is closed-book; reference materials are restricted. Each item is multiple choice with four
options (A-D) and exactly one best answer. Items are weighted 75% scenario-based (complex clinical
vignettes emphasizing prioritization, hemodynamic interpretation, ECG analysis, and pharmacologic
decision-making) and 25% direct (definitions, ECG criteria, mechanisms). The cognitive distribution is
approximately 30% recall, 50% application, and 20% analysis. Complete solutions with step-by-step
pathophysiologic rationales and explicit identification of why each distractor is incorrect follow every
question.
Section Content Domain Items Points
1 Cardiovascular Assessment, Hemodynamics, & Advanced ECG Interpretation
Q1-Q13 26
2 Acute Coronary Syndromes, Arrhythmias, & Electrophysiology Q14-Q26 26
3 Heart Failure, Valvular Disorders, & Cardiomyopathies Q27-Q38 24
4 Cardiac Pharmacology, Interventions, Post-Op Care, & 2026 Updates Q39-Q50 24
Total 50 100
Part 1 ■ Examination Items
Each item below includes the question stem, four options (A-D), the identified correct answer, and a complete
rationale explaining the underlying pathophysiology, the priority nursing intervention, and why each distractor
represents a common clinical or calculation error.
Section 1 ■ Cardiovascular Assessment, Hemodynamics, & Advanced
ECG Interpretation
Page 2
, BSN 266 Cardiac Care | Remotely Proctored Exam | 2026 Update With Complete Solutions
Q1. A 68-year-old male is post-inferior STEMI day 1. Pulmonary artery catheter data: PA wedge
pressure 22 mmHg, cardiac index 1.9 L/min/m², SVR 1900 dynes·s/cm■. Which interpretation
is most accurate?
A. Hypovolemic shock; administer a 500 mL crystalloid bolus
B. Cardiogenic shock with elevated LV filling pressure; consider inotrope and diuresis
[CORRECT]
C. Distributive shock; initiate norepinephrine
D. Obstructive shock from tamponade; prepare for pericardiocentesis
Correct Answer: B
Rationale: PAWP >18 mmHg with low cardiac index (<2.2) and high SVR (>1500) is the classic
hemodynamic profile of cardiogenic shock: backward failure (congestion) with poor forward output.
Hypovolemia would show a low PAWP; distributive shock (septic) shows a low SVR; tamponade shows
equalization of diastolic pressures (RA, RV diastolic, PA diastolic, PAWP within 5 mmHg) with a low
PAWP. The priority is inotropic support (dobutamine/milrinone) and diuresis to reduce congestion, with
mechanical support (IABP/Impella) if refractory.
Q2. During pulmonary artery catheter insertion, the nurse observes a sudden loss of the
pulmonary artery waveform, a persistent wedge tracing without balloon deflation, and the
patient becomes tachycardic. What is the priority action?
A. Rezero and recalibrate the transducer
B. Withdraw the catheter 1-2 cm and reposition; catheter is overwedged [CORRECT]
C. Inflate the balloon further to obtain a cleaner wedge
D. Administer a 500 mL fluid bolus for the tachycardia
Correct Answer: B
Rationale: A persistent wedge tracing with loss of the PA waveform indicates
overwedging/overinflation, which risks pulmonary infarction from distal vessel occlusion. The priority is
to withdraw the catheter 1-2 cm and reposition. Rezeroing will not correct a mechanical catheter-tip
issue; further balloon inflation worsens the risk of PA rupture/infarction; the tachycardia is
compensatory and will resolve once the mechanical cause is corrected.
Q3. An intra-aortic balloon pump (IABP) arterial waveform shows balloon inflation occurring
after the dicrotic notch, with diminished and delayed diastolic augmentation. The priority
nursing action is to:
A. Adjust timing so inflation occurs at the dicrotic notch (inflate earlier) [CORRECT]
B. Adjust timing so inflation occurs later in diastole
C. Increase the balloon inflation pressure
D. Switch to a 1:3 ratio and reassess in 30 minutes
Correct Answer: A
Rationale: Correct IABP timing inflates the balloon at the dicrotic notch (aortic valve closure) to
maximize diastolic coronary perfusion and deflate precisely before systole to reduce afterload. Inflation
after the dicrotic notch is too late, missing peak diastolic augmentation and reducing coronary perfusion
pressure; the correction is to inflate earlier. Increasing inflation pressure does not fix a timing error, and
changing to a 1:3 ratio only obscures the timing problem rather than resolving it.
Page 3
