AACN CMC® (Cardiac Medicine) Certification
ACTUAL EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
CARDIOVASCULAR CONDITIONS (Acute Coronary Syndrome, Heart Failure, Valvular Disease)
Question 1
A 62-year-old male with a history of hypertension and hyperlipidemia presents with crushing
substernal chest pain radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1-V4. Which coronary artery is most likely occluded?
• A. Right coronary artery
• B. Left circumflex artery
• C. Left anterior descending artery
• D. Posterior descending artery
Answer: C. Left anterior descending artery
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior wall myocardial infarction.
The left anterior descending (LAD) artery supplies the anterior wall and interventricular septum.
The right coronary artery supplies the inferior wall (II, III, aVF). The left circumflex artery
supplies the lateral wall (I, aVL, V5-V6). Prompt recognition and reperfusion are critical in acute
coronary syndromes.
Question 2
A patient with acute decompensated heart failure presents with dyspnea, orthopnea, and
peripheral edema. Which laboratory finding is most consistent with this diagnosis?
, • A. BNP 1,500 pg/mL
• B. Troponin I 0.02 ng/mL
• C. Creatinine 0.8 mg/dL
• D. Hemoglobin 14 g/dL
Answer: A. BNP 1,500 pg/mL
Rationale: B-type natriuretic peptide (BNP) is elevated in heart failure and correlates with
ventricular wall stress. BNP >100 pg/mL suggests heart failure, with higher levels indicating
more severe volume overload. This finding helps distinguish cardiac from pulmonary causes of
dyspnea. Approximately 43% of the CMC exam focuses on cardiovascular disease.
Question 3
A patient with atrial fibrillation has a ventricular rate of 140 bpm and is hemodynamically
stable. Which medication is most appropriate for acute rate control?
• A. Adenosine
• B. Diltiazem
• C. Atropine
• D. Lidocaine
Answer: B. Diltiazem
Rationale: Diltiazem, a calcium channel blocker, is commonly used for rate control in stable
atrial fibrillation. Adenosine is used for supraventricular tachycardia. Atropine treats
bradycardia. Lidocaine is an antiarrhythmic used for ventricular arrhythmias. In
hemodynamically unstable patients, synchronized cardioversion would be indicated.
Question 4
A patient with an acute inferior wall MI develops bradycardia (heart rate 40 bpm) and
hypotension (BP 85/50 mmHg). The most appropriate initial intervention is:
• A. Atropine 0.5 mg IV
• B. Epinephrine infusion
• C. Immediate transcutaneous pacing
, • D. Norepinephrine infusion
Answer: A. Atropine 0.5 mg IV
Rationale: Inferior wall MIs often involve the right coronary artery, which supplies the SA and
AV nodes, leading to bradycardia and heart block. Atropine is first-line for symptomatic
bradycardia. Transcutaneous pacing is used if atropine is ineffective. Epinephrine and
norepinephrine are vasopressors for hypotension but do not specifically address
bradyarrhythmias.
Question 5
A patient presents with sudden, severe chest pain radiating to the back, with a 20 mmHg blood
pressure differential between arms. Which emergency should the nurse suspect?
• A. Pulmonary embolism
• B. Aortic dissection
• C. Myocardial infarction
• D. Pericarditis
Answer: B. Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe chest pain radiating to the
back, along with pulse or blood pressure differentials between arms. This is a life-threatening
emergency requiring immediate surgical consultation and blood pressure control. Hypertension
should be treated aggressively with agents such as esmolol or nitroprusside to reduce shear
stress on the aorta.
Question 6
A patient with heart failure has an ejection fraction of 25%. Which medication has been shown
to improve survival in this population?
• A. Digoxin
• B. Metoprolol succinate
• C. Furosemide
• D. Hydralazine
Answer: B. Metoprolol succinate
, Rationale: Beta-blockers (e.g., metoprolol succinate, carvedilol) are cornerstone therapy for
heart failure with reduced ejection fraction and have been shown to improve survival. Digoxin
improves symptoms but not mortality. Furosemide manages volume overload but does not
improve survival. Hydralazine is used in specific populations (e.g., African American patients).
Question 7
A patient with a known abdominal aortic aneurysm presents with sudden severe back pain and
hypotension. The nurse should prepare for:
• A. CT angiography
• B. Emergency surgical repair
• C. Pain management and observation
• D. Antibiotic therapy
Answer: B. Emergency surgical repair
Rationale: Sudden severe back pain with hypotension in a patient with a known abdominal
aortic aneurysm is a classic presentation of rupture. This is a life-threatening emergency
requiring immediate surgical intervention. The patient should be prepared for emergency
surgery with type and crossmatch, large-bore IV access, and rapid transport to the operating
room.
Question 8
A patient with aortic stenosis presents with syncope, angina, and dyspnea on exertion. Which
physical examination finding is most consistent with this diagnosis?
• A. Systolic ejection murmur at the right upper sternal border radiating to the carotids
• B. Diastolic rumble murmur at the apex
• C. Holosystolic murmur at the apex radiating to the axilla
• D. Continuous murmur at the left upper sternal border
Answer: A. Systolic ejection murmur at the right upper sternal border radiating to the carotids
Rationale: Aortic stenosis produces a systolic ejection murmur best heard at the right upper
sternal border (aortic area) with radiation to the carotids. The classic triad of aortic stenosis is
ACTUAL EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
CARDIOVASCULAR CONDITIONS (Acute Coronary Syndrome, Heart Failure, Valvular Disease)
Question 1
A 62-year-old male with a history of hypertension and hyperlipidemia presents with crushing
substernal chest pain radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1-V4. Which coronary artery is most likely occluded?
• A. Right coronary artery
• B. Left circumflex artery
• C. Left anterior descending artery
• D. Posterior descending artery
Answer: C. Left anterior descending artery
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior wall myocardial infarction.
The left anterior descending (LAD) artery supplies the anterior wall and interventricular septum.
The right coronary artery supplies the inferior wall (II, III, aVF). The left circumflex artery
supplies the lateral wall (I, aVL, V5-V6). Prompt recognition and reperfusion are critical in acute
coronary syndromes.
Question 2
A patient with acute decompensated heart failure presents with dyspnea, orthopnea, and
peripheral edema. Which laboratory finding is most consistent with this diagnosis?
, • A. BNP 1,500 pg/mL
• B. Troponin I 0.02 ng/mL
• C. Creatinine 0.8 mg/dL
• D. Hemoglobin 14 g/dL
Answer: A. BNP 1,500 pg/mL
Rationale: B-type natriuretic peptide (BNP) is elevated in heart failure and correlates with
ventricular wall stress. BNP >100 pg/mL suggests heart failure, with higher levels indicating
more severe volume overload. This finding helps distinguish cardiac from pulmonary causes of
dyspnea. Approximately 43% of the CMC exam focuses on cardiovascular disease.
Question 3
A patient with atrial fibrillation has a ventricular rate of 140 bpm and is hemodynamically
stable. Which medication is most appropriate for acute rate control?
• A. Adenosine
• B. Diltiazem
• C. Atropine
• D. Lidocaine
Answer: B. Diltiazem
Rationale: Diltiazem, a calcium channel blocker, is commonly used for rate control in stable
atrial fibrillation. Adenosine is used for supraventricular tachycardia. Atropine treats
bradycardia. Lidocaine is an antiarrhythmic used for ventricular arrhythmias. In
hemodynamically unstable patients, synchronized cardioversion would be indicated.
Question 4
A patient with an acute inferior wall MI develops bradycardia (heart rate 40 bpm) and
hypotension (BP 85/50 mmHg). The most appropriate initial intervention is:
• A. Atropine 0.5 mg IV
• B. Epinephrine infusion
• C. Immediate transcutaneous pacing
, • D. Norepinephrine infusion
Answer: A. Atropine 0.5 mg IV
Rationale: Inferior wall MIs often involve the right coronary artery, which supplies the SA and
AV nodes, leading to bradycardia and heart block. Atropine is first-line for symptomatic
bradycardia. Transcutaneous pacing is used if atropine is ineffective. Epinephrine and
norepinephrine are vasopressors for hypotension but do not specifically address
bradyarrhythmias.
Question 5
A patient presents with sudden, severe chest pain radiating to the back, with a 20 mmHg blood
pressure differential between arms. Which emergency should the nurse suspect?
• A. Pulmonary embolism
• B. Aortic dissection
• C. Myocardial infarction
• D. Pericarditis
Answer: B. Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe chest pain radiating to the
back, along with pulse or blood pressure differentials between arms. This is a life-threatening
emergency requiring immediate surgical consultation and blood pressure control. Hypertension
should be treated aggressively with agents such as esmolol or nitroprusside to reduce shear
stress on the aorta.
Question 6
A patient with heart failure has an ejection fraction of 25%. Which medication has been shown
to improve survival in this population?
• A. Digoxin
• B. Metoprolol succinate
• C. Furosemide
• D. Hydralazine
Answer: B. Metoprolol succinate
, Rationale: Beta-blockers (e.g., metoprolol succinate, carvedilol) are cornerstone therapy for
heart failure with reduced ejection fraction and have been shown to improve survival. Digoxin
improves symptoms but not mortality. Furosemide manages volume overload but does not
improve survival. Hydralazine is used in specific populations (e.g., African American patients).
Question 7
A patient with a known abdominal aortic aneurysm presents with sudden severe back pain and
hypotension. The nurse should prepare for:
• A. CT angiography
• B. Emergency surgical repair
• C. Pain management and observation
• D. Antibiotic therapy
Answer: B. Emergency surgical repair
Rationale: Sudden severe back pain with hypotension in a patient with a known abdominal
aortic aneurysm is a classic presentation of rupture. This is a life-threatening emergency
requiring immediate surgical intervention. The patient should be prepared for emergency
surgery with type and crossmatch, large-bore IV access, and rapid transport to the operating
room.
Question 8
A patient with aortic stenosis presents with syncope, angina, and dyspnea on exertion. Which
physical examination finding is most consistent with this diagnosis?
• A. Systolic ejection murmur at the right upper sternal border radiating to the carotids
• B. Diastolic rumble murmur at the apex
• C. Holosystolic murmur at the apex radiating to the axilla
• D. Continuous murmur at the left upper sternal border
Answer: A. Systolic ejection murmur at the right upper sternal border radiating to the carotids
Rationale: Aortic stenosis produces a systolic ejection murmur best heard at the right upper
sternal border (aortic area) with radiation to the carotids. The classic triad of aortic stenosis is
