(CV-BC™) EXAM 2026
CARDIAC-VASCULAR NURSING BOARD
CERTIFICATION (CV-BC™) EXAMINATION REVIEW:
200 PRACTICE QUESTIONS WITH CORRECT ANSWERS
& DETAILED CLINICAL RATIONALES - LATEST
2026/2027 ANCC GUIDELINES
CARDIAC-VASCULAR NURSING BOARD CERTIFIED (CV-BC) EXAMINATION
Practice Questions with Correct Answers & Detailed Rationales
Latest 2026/2027 Version
SECTION 1: ASSESSMENT AND DIAGNOSIS (Questions 1-50)
QUESTION 1:
A 62-year-old male patient presents to the emergency department with substernal chest pain
radiating to his left jaw. The 12-lead ECG reveals ST-segment depression in leads V3 and V4. Which
condition is most likely indicated by these findings?
A. ST-elevation myocardial infarction (STEMI)
B. Unstable angina or NSTEMI
C. Acute pericarditis
D. Prinzmetal's angina
ANSWER:
B. Unstable angina or NSTEMI
RATIONALE:
ST-segment depression is a classic indicator of myocardial ischemia or non-ST-elevation myocardial
infarction (NSTEMI) . ST-elevation characterizes a full-thickness injury (STEMI) and would be
expected in that condition . Acute pericarditis typically presents with diffuse ST-segment elevation
and PR-segment depression. Prinzmetal's angina (variant angina) usually shows transient ST-
segment elevation during episodes of vasospasm, not depression. The clinical presentation of
substernal chest pain radiating to the jaw combined with ST-depression is most consistent with
NSTEMI or unstable angina, requiring immediate intervention .
QUESTION 2:
A patient's blood pressure reading is 140/90 mmHg. What is the patient's pulse pressure?
A. 30 mmHg
B. 40 mmHg
, (CV-BC™) EXAM 2026
C. 50 mmHg
D. 90 mmHg
ANSWER:
C. 50 mmHg
RATIONALE:
Pulse pressure is calculated by subtracting diastolic pressure from systolic pressure (140 - 90 = 50) .
A normal pulse pressure is approximately 40 mmHg. Option A (30 mmHg) would represent a narrow
pulse pressure, which may indicate conditions such as cardiac tamponade or aortic stenosis. Option
B (40 mmHg) is within normal range but is not the correct calculation for this specific patient's blood
pressure. Option D (90 mmHg) represents the diastolic pressure, not the pulse pressure. Pulse
pressure is an important hemodynamic parameter that reflects stroke volume and arterial
compliance .
QUESTION 3:
During a routine morning assessment of a patient with chronic heart failure, the nurse notes a 3-
pound weight gain over 24 hours and increased bilateral peripheral edema. What is the priority
nursing action?
A. Encourage increased oral fluid intake
B. Check the patient's blood pressure
C. Notify the provider and anticipate diuretic adjustment
D. Document the findings as expected for chronic heart failure
ANSWER:
C. Notify the provider and anticipate diuretic adjustment
RATIONALE:
A 3-pound weight gain over 24 hours in a heart failure patient indicates significant fluid retention
and worsening heart failure . This requires prompt intervention, typically with diuretic adjustment,
to prevent further decompensation. Encouraging increased fluid intake (Option A) would worsen
fluid overload. While checking blood pressure (Option B) is important, it should not delay notifying
the provider. Documenting findings as expected (Option D) would be negligent, as this represents a
change from baseline requiring intervention. The priority is to notify the provider so that appropriate
adjustments to the treatment plan can be made to manage the fluid overload .
QUESTION 4:
Which biomarker is considered most specific for myocardial injury?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin I or T
D. B-type natriuretic peptide (BNP)
ANSWER:
C. Troponin I or T
, (CV-BC™) EXAM 2026
RATIONALE:
Cardiac troponins (troponin I and troponin T) are the most specific biomarkers for myocardial injury
and are the preferred markers for diagnosing acute myocardial infarction . They are highly sensitive
and specific to cardiac muscle and are not found in significant quantities in skeletal muscle, making
them superior to CK-MB, which can be elevated in skeletal muscle injury. Myoglobin (Option B) is an
early marker but lacks cardiac specificity and is no longer recommended as a primary diagnostic
marker. BNP (Option D) is a marker for ventricular stretch and heart failure, not myocardial injury .
Elevations in troponin indicate myocardial necrosis and are central to the diagnosis of acute
coronary syndrome.
QUESTION 5:
A patient with acute ST-elevation myocardial infarction (STEMI) presents to the emergency
department within 60 minutes of symptom onset. What is the priority intervention?
A. Administer beta-blocker
B. Obtain cardiac enzymes
C. Initiate heparin infusion
D. Activate the cardiac catheterization laboratory for primary PCI
ANSWER:
D. Activate the cardiac catheterization laboratory for primary PCI
RATIONALE:
Primary percutaneous coronary intervention (PCI) within 90 minutes of arrival (and ideally within
120 minutes of symptom onset) is the gold standard for STEMI reperfusion . Activating the cardiac
catheterization laboratory is the priority intervention to restore blood flow to the affected
myocardium. While administering beta-blockers (Option A), obtaining cardiac enzymes (Option B),
and initiating heparin infusion (Option C) are all components of STEMI management, they should not
delay activation of the catheterization laboratory for primary PCI, as time to reperfusion is critical for
preserving myocardial function and improving outcomes .
QUESTION 6:
A 55-year-old male who had coronary artery bypass surgery two days ago has vital signs: Temp
96.8°F (36°C); HR 162 beats/min; Resp 30 breaths/min; BP 82/30 mmHg with pulsus paradoxus. His
echocardiogram shows a large pericardial effusion. What is the most likely cause of his symptoms?
A. Ventricular tachycardia
B. Acute heart failure
C. Cardiogenic shock
D. Cardiac tamponade
ANSWER:
D. Cardiac tamponade
RATIONALE:
The patient's presentation of hypotension, tachycardia, pulsus paradoxus, and a large pericardial
effusion on echocardiogram is classic for cardiac tamponade . Cardiac tamponade occurs when fluid
, (CV-BC™) EXAM 2026
accumulates in the pericardial space, compressing the heart and impairing diastolic filling. The pulsus
paradoxus (an exaggerated drop in systolic blood pressure during inspiration) is a hallmark sign.
While ventricular tachycardia (Option A) could explain tachycardia, it does not account for the
pericardial effusion or pulsus paradoxus. Acute heart failure (Option B) and cardiogenic shock
(Option C) do not typically present with pulsus paradoxus and a large pericardial effusion in a post-
CABG patient .
QUESTION 7:
A nurse is assessing a patient with a 5-year history of poorly controlled hypertension. What cardiac
finding does the nurse expect to find?
A. Right atrial dilation
B. Right ventricular hypertrophy
C. Left atrial dilation
D. Left ventricular hypertrophy
ANSWER:
D. Left ventricular hypertrophy
RATIONALE:
Chronic poorly controlled hypertension causes increased afterload on the left ventricle, which
responds with concentric hypertrophy of the left ventricular wall . This is a compensatory
mechanism to maintain cardiac output against increased systemic vascular resistance. Right atrial
dilation (Option A), right ventricular hypertrophy (Option B), and left atrial dilation (Option C) are
more commonly associated with pulmonary hypertension, tricuspid valve disease, or mitral valve
disease, respectively, rather than systemic hypertension . Left ventricular hypertrophy is a hallmark
finding in chronic hypertension and is an important predictor of adverse cardiovascular outcomes.
QUESTION 8:
Which heart sound is suggestive of mitral regurgitation?
A. A diastolic murmur
B. A systolic murmur
C. An extra heart sound heard early in diastole
D. An extra heart sound heard early in systole
ANSWER:
B. A systolic murmur
RATIONALE:
Mitral regurgitation produces a holosystolic (pansystolic) murmur heard best at the apex with
radiation to the left axilla . This occurs because blood flows backward from the left ventricle to the
left atrium during systole. A diastolic murmur (Option A) is characteristic of mitral stenosis or aortic
regurgitation. An extra heart sound heard early in diastole (Option C) describes an S3 gallop, which is
associated with heart failure or volume overload. An extra heart sound heard early in systole (Option
D) describes a systolic ejection click, often associated with mitral valve prolapse or aortic stenosis .
CARDIAC-VASCULAR NURSING BOARD
CERTIFICATION (CV-BC™) EXAMINATION REVIEW:
200 PRACTICE QUESTIONS WITH CORRECT ANSWERS
& DETAILED CLINICAL RATIONALES - LATEST
2026/2027 ANCC GUIDELINES
CARDIAC-VASCULAR NURSING BOARD CERTIFIED (CV-BC) EXAMINATION
Practice Questions with Correct Answers & Detailed Rationales
Latest 2026/2027 Version
SECTION 1: ASSESSMENT AND DIAGNOSIS (Questions 1-50)
QUESTION 1:
A 62-year-old male patient presents to the emergency department with substernal chest pain
radiating to his left jaw. The 12-lead ECG reveals ST-segment depression in leads V3 and V4. Which
condition is most likely indicated by these findings?
A. ST-elevation myocardial infarction (STEMI)
B. Unstable angina or NSTEMI
C. Acute pericarditis
D. Prinzmetal's angina
ANSWER:
B. Unstable angina or NSTEMI
RATIONALE:
ST-segment depression is a classic indicator of myocardial ischemia or non-ST-elevation myocardial
infarction (NSTEMI) . ST-elevation characterizes a full-thickness injury (STEMI) and would be
expected in that condition . Acute pericarditis typically presents with diffuse ST-segment elevation
and PR-segment depression. Prinzmetal's angina (variant angina) usually shows transient ST-
segment elevation during episodes of vasospasm, not depression. The clinical presentation of
substernal chest pain radiating to the jaw combined with ST-depression is most consistent with
NSTEMI or unstable angina, requiring immediate intervention .
QUESTION 2:
A patient's blood pressure reading is 140/90 mmHg. What is the patient's pulse pressure?
A. 30 mmHg
B. 40 mmHg
, (CV-BC™) EXAM 2026
C. 50 mmHg
D. 90 mmHg
ANSWER:
C. 50 mmHg
RATIONALE:
Pulse pressure is calculated by subtracting diastolic pressure from systolic pressure (140 - 90 = 50) .
A normal pulse pressure is approximately 40 mmHg. Option A (30 mmHg) would represent a narrow
pulse pressure, which may indicate conditions such as cardiac tamponade or aortic stenosis. Option
B (40 mmHg) is within normal range but is not the correct calculation for this specific patient's blood
pressure. Option D (90 mmHg) represents the diastolic pressure, not the pulse pressure. Pulse
pressure is an important hemodynamic parameter that reflects stroke volume and arterial
compliance .
QUESTION 3:
During a routine morning assessment of a patient with chronic heart failure, the nurse notes a 3-
pound weight gain over 24 hours and increased bilateral peripheral edema. What is the priority
nursing action?
A. Encourage increased oral fluid intake
B. Check the patient's blood pressure
C. Notify the provider and anticipate diuretic adjustment
D. Document the findings as expected for chronic heart failure
ANSWER:
C. Notify the provider and anticipate diuretic adjustment
RATIONALE:
A 3-pound weight gain over 24 hours in a heart failure patient indicates significant fluid retention
and worsening heart failure . This requires prompt intervention, typically with diuretic adjustment,
to prevent further decompensation. Encouraging increased fluid intake (Option A) would worsen
fluid overload. While checking blood pressure (Option B) is important, it should not delay notifying
the provider. Documenting findings as expected (Option D) would be negligent, as this represents a
change from baseline requiring intervention. The priority is to notify the provider so that appropriate
adjustments to the treatment plan can be made to manage the fluid overload .
QUESTION 4:
Which biomarker is considered most specific for myocardial injury?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin I or T
D. B-type natriuretic peptide (BNP)
ANSWER:
C. Troponin I or T
, (CV-BC™) EXAM 2026
RATIONALE:
Cardiac troponins (troponin I and troponin T) are the most specific biomarkers for myocardial injury
and are the preferred markers for diagnosing acute myocardial infarction . They are highly sensitive
and specific to cardiac muscle and are not found in significant quantities in skeletal muscle, making
them superior to CK-MB, which can be elevated in skeletal muscle injury. Myoglobin (Option B) is an
early marker but lacks cardiac specificity and is no longer recommended as a primary diagnostic
marker. BNP (Option D) is a marker for ventricular stretch and heart failure, not myocardial injury .
Elevations in troponin indicate myocardial necrosis and are central to the diagnosis of acute
coronary syndrome.
QUESTION 5:
A patient with acute ST-elevation myocardial infarction (STEMI) presents to the emergency
department within 60 minutes of symptom onset. What is the priority intervention?
A. Administer beta-blocker
B. Obtain cardiac enzymes
C. Initiate heparin infusion
D. Activate the cardiac catheterization laboratory for primary PCI
ANSWER:
D. Activate the cardiac catheterization laboratory for primary PCI
RATIONALE:
Primary percutaneous coronary intervention (PCI) within 90 minutes of arrival (and ideally within
120 minutes of symptom onset) is the gold standard for STEMI reperfusion . Activating the cardiac
catheterization laboratory is the priority intervention to restore blood flow to the affected
myocardium. While administering beta-blockers (Option A), obtaining cardiac enzymes (Option B),
and initiating heparin infusion (Option C) are all components of STEMI management, they should not
delay activation of the catheterization laboratory for primary PCI, as time to reperfusion is critical for
preserving myocardial function and improving outcomes .
QUESTION 6:
A 55-year-old male who had coronary artery bypass surgery two days ago has vital signs: Temp
96.8°F (36°C); HR 162 beats/min; Resp 30 breaths/min; BP 82/30 mmHg with pulsus paradoxus. His
echocardiogram shows a large pericardial effusion. What is the most likely cause of his symptoms?
A. Ventricular tachycardia
B. Acute heart failure
C. Cardiogenic shock
D. Cardiac tamponade
ANSWER:
D. Cardiac tamponade
RATIONALE:
The patient's presentation of hypotension, tachycardia, pulsus paradoxus, and a large pericardial
effusion on echocardiogram is classic for cardiac tamponade . Cardiac tamponade occurs when fluid
, (CV-BC™) EXAM 2026
accumulates in the pericardial space, compressing the heart and impairing diastolic filling. The pulsus
paradoxus (an exaggerated drop in systolic blood pressure during inspiration) is a hallmark sign.
While ventricular tachycardia (Option A) could explain tachycardia, it does not account for the
pericardial effusion or pulsus paradoxus. Acute heart failure (Option B) and cardiogenic shock
(Option C) do not typically present with pulsus paradoxus and a large pericardial effusion in a post-
CABG patient .
QUESTION 7:
A nurse is assessing a patient with a 5-year history of poorly controlled hypertension. What cardiac
finding does the nurse expect to find?
A. Right atrial dilation
B. Right ventricular hypertrophy
C. Left atrial dilation
D. Left ventricular hypertrophy
ANSWER:
D. Left ventricular hypertrophy
RATIONALE:
Chronic poorly controlled hypertension causes increased afterload on the left ventricle, which
responds with concentric hypertrophy of the left ventricular wall . This is a compensatory
mechanism to maintain cardiac output against increased systemic vascular resistance. Right atrial
dilation (Option A), right ventricular hypertrophy (Option B), and left atrial dilation (Option C) are
more commonly associated with pulmonary hypertension, tricuspid valve disease, or mitral valve
disease, respectively, rather than systemic hypertension . Left ventricular hypertrophy is a hallmark
finding in chronic hypertension and is an important predictor of adverse cardiovascular outcomes.
QUESTION 8:
Which heart sound is suggestive of mitral regurgitation?
A. A diastolic murmur
B. A systolic murmur
C. An extra heart sound heard early in diastole
D. An extra heart sound heard early in systole
ANSWER:
B. A systolic murmur
RATIONALE:
Mitral regurgitation produces a holosystolic (pansystolic) murmur heard best at the apex with
radiation to the left axilla . This occurs because blood flows backward from the left ventricle to the
left atrium during systole. A diastolic murmur (Option A) is characteristic of mitral stenosis or aortic
regurgitation. An extra heart sound heard early in diastole (Option C) describes an S3 gallop, which is
associated with heart failure or volume overload. An extra heart sound heard early in systole (Option
D) describes a systolic ejection click, often associated with mitral valve prolapse or aortic stenosis .
