NRCME QUESTIONS AND MULTIPLE CHOICE CORRECT
ANSWERS 2025(108 PAGES EXAM), Exams of Nursing
3 factors to consider when deciding certificationANSWER- The cardiovascular condition's rate of
progression,
- Degree of control, and the
- Likelihood of sudden incapacitation.
A-fib maximum certification periodANSWER1 year if:
- Anticoagulated adequately
- The heart rate is controlled
- There is no disqualifying underlying heart disease
- Cleared by cardiovascular specialist who understands the functions and demands of commercial
driving
A-fib minimum waiting periodANSWER1 month
Abdominal aortic aneurysm: cert/recert?ANSWERDisqualify if >5 cm.
Do not certify if symptomatic or fast-growing (>.5 cm over 6 mos)
Disqualified if repair is recommended
Otherwise 1 year max certification
3 mos waiting period for surgical repair
ABGs: don't certify if:ANSWERRecommend not certifying the driver when the ABG measurements show:
Partial pressure of arterial oxygen (PaO2) less than: - 65 millimeters of mercury (mmHg) at altitudes
below 5,000 feet. - 60 mm Hg at altitudes above 5,000 feet
Partial pressure of arterial carbon dioxide (PaCO2) greater than 45 mmHg at any altitude
ADHD: cert/recert?ANSWERWaiting period:
- No recommended time frame
- Maximum certification- 1 year
,NRCME QUESTIONS AND MULTIPLE CHOICE CORRECT
ANSWERS 2025(108 PAGES EXAM), Exams of Nursing
- Recommend certifying a driver who complies with his/her treatment plan and tolerates treatment
without disqualifying side effects (e.g., sedation or impaired coordination).
The CMV driver should have annual medical examinations.
Allergies: symptoms/tx side effects that disqualifyANSWERRecommend not certifying the driver if there
is a complication or if treatment impairs function:
severe conjunctivitis affecting vision
inability to keep eyes open
photophobia
uncontrollable sneezing fits
sinusitis with severe headaches
medications that cause sedation or other side effects that interfere with safe driving
Angina (stable)
Recommend certification ifANSWER- Meets general CAD certification
recommendations
- Has stable angina.
- Has a satisfactory biennial exercise tolerance
test (ETT). If the ETT is inconclusive, an
imaging test may be indicated
Angioedema/idiopathic anaphylaxis: cert?ANSWERRecommend certifying the driver with a history of an
allergy-related life-threatening condition who has an effective treatment regimen and successful
preventive measures. Certification may be up to two years.
Anticoagulation monitoring guidelinesANSWERRelief of symptoms
No other disqualifying cardiovascular disease
,NRCME QUESTIONS AND MULTIPLE CHOICE CORRECT
ANSWERS 2025(108 PAGES EXAM), Exams of Nursing
Asthma: cert?ANSWERRecommend certifying the driver with a history of an allergy-related life-
threatening condition who has an effective treatment regimen and successful preventive measures.
Certification may be up to two years.
The driver can be disqualified if there is ongoing, uncontrolled, symptomatic asthma, including status
asthmaticus, severe coughing spells and cough syncope; high dose steroids with adverse behavioral
effects; or significant impairment of pulmonary function with a forced expiratory volume less than 65
percent and a p02 less than 65 millimeters mercury.
Audiometry requirementANSWERAverage loss of equal to/less than 40 dB at 500, 1000 and 2000 Hz
Audiometry requirementANSWERAverage loss of equal to/less than 40 dB at 500, 1000 and 2000 Hz
Autonomic neuropathiesANSWERFMCSA recommends not certifying the CMV driver who has a
cardiovascular autonomic neuropathy that causes resting tachycardia and orthostatic blood pressure.
Gastrointestinal and urological autonomic neuropathies also may interfere with safe driving.
Biological prosthesis: cert/recert?ANSWERNOTE: Anticoagulant therapy not necessary in patients in
sinus rhythm (after initial 3 months), in absence of prior emboli or hypercoagulable state
Certification:
- YES if: At least 3 months postop;
- Asymptomatic;
- None of above disqualifying criteria for mechanical valves;
- Cleared by cardiologist
Recertification:
- At least 3 months postop;
- Asymptomatic;
- None of above disqualifying criteria for mechanical valves;
, NRCME QUESTIONS AND MULTIPLE CHOICE CORRECT
ANSWERS 2025(108 PAGES EXAM), Exams of Nursing
- Cleared by cardiologist
Can the examiner give the driver's medical examination report to the employerANSWERYes, with the
driver's consent
Cardiovascular physical exam should includeANSWER- Heart murmurs, extra sounds,
- Enlarged heart
- Pacemaker, implantable cardiac defibrillator
- Blood pressure and pulse (rate and rhythm) ---- Abnormal pulse and amplitude,
- Carotid or arterial bruits, varicose veins
- Additional signs of disease (e.g., edema)
- Abnormal respiratory breath sounds including wheezes and rales
Cause of death in CHFANSWER- Sudden death causes 10 percent to 30 percent of all deaths in
individuals with HF.
- Sudden death occurs in all functional classes, but is the major cause of death in mildly symptomatic
patients.
- Progressive HF is the major cause of death in those with severe symptoms.
Certification process for insulin-treated DMANSWER- Driver's treating clinician (specialty not mandated)
completes "Insulin-Treated Diabetes Mellitus Assessment Form", MCSA5870, attesting to stable insulin
regimen/proper control of DM
- Medical examiner receives form and starts evaluation within 45 days of date on signed form
- Medical examiner determines whether driver meets meets physical qualification standard based on
his/her medical judgement.
- Certified for up to 12 months
NOTE: Driver is required to provide 3 months of self-monitoring data to treating clinician. If this hasn't
happened, examiner can grant a 3 month certificate to allow time for data collection
Certification recommendation for acute/chronic peripheral vestibulopathy or benign positional
vertigoANSWER2 month symptom free waiting period
ANSWERS 2025(108 PAGES EXAM), Exams of Nursing
3 factors to consider when deciding certificationANSWER- The cardiovascular condition's rate of
progression,
- Degree of control, and the
- Likelihood of sudden incapacitation.
A-fib maximum certification periodANSWER1 year if:
- Anticoagulated adequately
- The heart rate is controlled
- There is no disqualifying underlying heart disease
- Cleared by cardiovascular specialist who understands the functions and demands of commercial
driving
A-fib minimum waiting periodANSWER1 month
Abdominal aortic aneurysm: cert/recert?ANSWERDisqualify if >5 cm.
Do not certify if symptomatic or fast-growing (>.5 cm over 6 mos)
Disqualified if repair is recommended
Otherwise 1 year max certification
3 mos waiting period for surgical repair
ABGs: don't certify if:ANSWERRecommend not certifying the driver when the ABG measurements show:
Partial pressure of arterial oxygen (PaO2) less than: - 65 millimeters of mercury (mmHg) at altitudes
below 5,000 feet. - 60 mm Hg at altitudes above 5,000 feet
Partial pressure of arterial carbon dioxide (PaCO2) greater than 45 mmHg at any altitude
ADHD: cert/recert?ANSWERWaiting period:
- No recommended time frame
- Maximum certification- 1 year
,NRCME QUESTIONS AND MULTIPLE CHOICE CORRECT
ANSWERS 2025(108 PAGES EXAM), Exams of Nursing
- Recommend certifying a driver who complies with his/her treatment plan and tolerates treatment
without disqualifying side effects (e.g., sedation or impaired coordination).
The CMV driver should have annual medical examinations.
Allergies: symptoms/tx side effects that disqualifyANSWERRecommend not certifying the driver if there
is a complication or if treatment impairs function:
severe conjunctivitis affecting vision
inability to keep eyes open
photophobia
uncontrollable sneezing fits
sinusitis with severe headaches
medications that cause sedation or other side effects that interfere with safe driving
Angina (stable)
Recommend certification ifANSWER- Meets general CAD certification
recommendations
- Has stable angina.
- Has a satisfactory biennial exercise tolerance
test (ETT). If the ETT is inconclusive, an
imaging test may be indicated
Angioedema/idiopathic anaphylaxis: cert?ANSWERRecommend certifying the driver with a history of an
allergy-related life-threatening condition who has an effective treatment regimen and successful
preventive measures. Certification may be up to two years.
Anticoagulation monitoring guidelinesANSWERRelief of symptoms
No other disqualifying cardiovascular disease
,NRCME QUESTIONS AND MULTIPLE CHOICE CORRECT
ANSWERS 2025(108 PAGES EXAM), Exams of Nursing
Asthma: cert?ANSWERRecommend certifying the driver with a history of an allergy-related life-
threatening condition who has an effective treatment regimen and successful preventive measures.
Certification may be up to two years.
The driver can be disqualified if there is ongoing, uncontrolled, symptomatic asthma, including status
asthmaticus, severe coughing spells and cough syncope; high dose steroids with adverse behavioral
effects; or significant impairment of pulmonary function with a forced expiratory volume less than 65
percent and a p02 less than 65 millimeters mercury.
Audiometry requirementANSWERAverage loss of equal to/less than 40 dB at 500, 1000 and 2000 Hz
Audiometry requirementANSWERAverage loss of equal to/less than 40 dB at 500, 1000 and 2000 Hz
Autonomic neuropathiesANSWERFMCSA recommends not certifying the CMV driver who has a
cardiovascular autonomic neuropathy that causes resting tachycardia and orthostatic blood pressure.
Gastrointestinal and urological autonomic neuropathies also may interfere with safe driving.
Biological prosthesis: cert/recert?ANSWERNOTE: Anticoagulant therapy not necessary in patients in
sinus rhythm (after initial 3 months), in absence of prior emboli or hypercoagulable state
Certification:
- YES if: At least 3 months postop;
- Asymptomatic;
- None of above disqualifying criteria for mechanical valves;
- Cleared by cardiologist
Recertification:
- At least 3 months postop;
- Asymptomatic;
- None of above disqualifying criteria for mechanical valves;
, NRCME QUESTIONS AND MULTIPLE CHOICE CORRECT
ANSWERS 2025(108 PAGES EXAM), Exams of Nursing
- Cleared by cardiologist
Can the examiner give the driver's medical examination report to the employerANSWERYes, with the
driver's consent
Cardiovascular physical exam should includeANSWER- Heart murmurs, extra sounds,
- Enlarged heart
- Pacemaker, implantable cardiac defibrillator
- Blood pressure and pulse (rate and rhythm) ---- Abnormal pulse and amplitude,
- Carotid or arterial bruits, varicose veins
- Additional signs of disease (e.g., edema)
- Abnormal respiratory breath sounds including wheezes and rales
Cause of death in CHFANSWER- Sudden death causes 10 percent to 30 percent of all deaths in
individuals with HF.
- Sudden death occurs in all functional classes, but is the major cause of death in mildly symptomatic
patients.
- Progressive HF is the major cause of death in those with severe symptoms.
Certification process for insulin-treated DMANSWER- Driver's treating clinician (specialty not mandated)
completes "Insulin-Treated Diabetes Mellitus Assessment Form", MCSA5870, attesting to stable insulin
regimen/proper control of DM
- Medical examiner receives form and starts evaluation within 45 days of date on signed form
- Medical examiner determines whether driver meets meets physical qualification standard based on
his/her medical judgement.
- Certified for up to 12 months
NOTE: Driver is required to provide 3 months of self-monitoring data to treating clinician. If this hasn't
happened, examiner can grant a 3 month certificate to allow time for data collection
Certification recommendation for acute/chronic peripheral vestibulopathy or benign positional
vertigoANSWER2 month symptom free waiting period
