CMC Practice Questions – AACN 2026 |
Certified Medical-Surgical Nurse Exam Prep
Practice Tests Questions with Answers and In-
Depth Explanation PDF
SECTION 1: PATIENT ASSESSMENT
Question 1
A patient is admitted with acute decompensated heart failure (ADHF). Which
hemodynamic parameter provides the most accurate assessment of left
ventricular preload?
A) Central venous pressure (CVP)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac index (CI)
D) Systemic vascular resistance (SVR)
Correct Answer: B
Rationale: PAWP is the most accurate reflection of left ventricular preload. CVP
reflects right ventricular preload. Cardiac index measures cardiac output relative
to body size. SVR measures afterload. In left-sided heart failure, PAWP is elevated
(>18 mmHg).
,Question 2
A patient with chest pain has an ECG showing ST-segment elevation in leads V1–
V4. Which coronary artery is most likely occluded?
A) Left anterior descending artery (LAD)
B) Right coronary artery (RCA)
C) Left circumflex artery (LCX)
D) Posterior descending artery (PDA)
Correct Answer: A
Rationale: ST elevation in leads V1–V4 indicates anterior wall MI, which is caused
by occlusion of the left anterior descending artery. RCA occlusion causes inferior
wall MI (leads II, III, aVF). LCX occlusion causes lateral wall MI (leads I, aVL, V5–
V6).
Question 3
A patient with a myocardial infarction has a new systolic murmur heard best at the
apex. What is the most likely cause?
A) Papillary muscle rupture
B) Ventricular septal defect
C) Pericarditis
D) Aortic stenosis
Correct Answer: A
Rationale: Papillary muscle rupture is a complication of MI, causing acute mitral
regurgitation. The murmur is holosystolic and best heard at the apex. Ventricular
septal defect causes a holosystolic murmur best heard at the left sternal border.
Pericarditis causes a friction rub.
,Question 4
A patient is recovering from cardiac surgery. The nurse notes jugular venous
distension, hypotension, and muffled heart sounds. Which complication should
the nurse suspect?
A) Cardiac tamponade
B) Pulmonary embolism
C) Myocardial infarction
D) Pneumothorax
Correct Answer: A
Rationale: Beck's triad—hypotension, muffled heart sounds, and JVD—is classic for
cardiac tamponade. This is a medical emergency caused by fluid accumulation in
the pericardial sac, compressing the heart.
Question 5
A patient with heart failure has crackles in the lung bases. Which medication
should the nurse expect to administer?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Lisinopril
Correct Answer: B
Rationale: Crackles indicate pulmonary edema from fluid overload. Furosemide is
a loop diuretic that reduces fluid volume and pulmonary congestion. Digoxin
improves contractility but does not remove fluid. Metoprolol and lisinopril are
chronic management medications.
, Question 6
Which finding is most characteristic of right-sided heart failure?
A) Crackles in the lung bases
B) Jugular venous distension and peripheral edema
C) Orthopnea
D) Paroxysmal nocturnal dyspnea
Correct Answer: B
Rationale: JVD and peripheral edema are hallmarks of right-sided heart failure.
Crackles, orthopnea, and PND are signs of left-sided heart failure. Right-sided
heart failure results from fluid backing up into the systemic venous system.
Question 7
A patient with acute MI is in cardiogenic shock. The nurse notes hypotension,
tachycardia, and cool, clammy skin. Which intervention should the nurse
anticipate?
A) Administration of inotropic agents (e.g., dobutamine)
B) Administration of diuretics
C) Administration of beta-blockers
D) Administration of nitroglycerin
Correct Answer: A
Rationale: Cardiogenic shock requires inotropic support to improve cardiac
contractility. Dobutamine is a positive inotrope that increases cardiac output.
Diuretics would worsen hypotension. Beta-blockers decrease contractility.
Nitroglycerin reduces preload but does not improve contractility.
Certified Medical-Surgical Nurse Exam Prep
Practice Tests Questions with Answers and In-
Depth Explanation PDF
SECTION 1: PATIENT ASSESSMENT
Question 1
A patient is admitted with acute decompensated heart failure (ADHF). Which
hemodynamic parameter provides the most accurate assessment of left
ventricular preload?
A) Central venous pressure (CVP)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac index (CI)
D) Systemic vascular resistance (SVR)
Correct Answer: B
Rationale: PAWP is the most accurate reflection of left ventricular preload. CVP
reflects right ventricular preload. Cardiac index measures cardiac output relative
to body size. SVR measures afterload. In left-sided heart failure, PAWP is elevated
(>18 mmHg).
,Question 2
A patient with chest pain has an ECG showing ST-segment elevation in leads V1–
V4. Which coronary artery is most likely occluded?
A) Left anterior descending artery (LAD)
B) Right coronary artery (RCA)
C) Left circumflex artery (LCX)
D) Posterior descending artery (PDA)
Correct Answer: A
Rationale: ST elevation in leads V1–V4 indicates anterior wall MI, which is caused
by occlusion of the left anterior descending artery. RCA occlusion causes inferior
wall MI (leads II, III, aVF). LCX occlusion causes lateral wall MI (leads I, aVL, V5–
V6).
Question 3
A patient with a myocardial infarction has a new systolic murmur heard best at the
apex. What is the most likely cause?
A) Papillary muscle rupture
B) Ventricular septal defect
C) Pericarditis
D) Aortic stenosis
Correct Answer: A
Rationale: Papillary muscle rupture is a complication of MI, causing acute mitral
regurgitation. The murmur is holosystolic and best heard at the apex. Ventricular
septal defect causes a holosystolic murmur best heard at the left sternal border.
Pericarditis causes a friction rub.
,Question 4
A patient is recovering from cardiac surgery. The nurse notes jugular venous
distension, hypotension, and muffled heart sounds. Which complication should
the nurse suspect?
A) Cardiac tamponade
B) Pulmonary embolism
C) Myocardial infarction
D) Pneumothorax
Correct Answer: A
Rationale: Beck's triad—hypotension, muffled heart sounds, and JVD—is classic for
cardiac tamponade. This is a medical emergency caused by fluid accumulation in
the pericardial sac, compressing the heart.
Question 5
A patient with heart failure has crackles in the lung bases. Which medication
should the nurse expect to administer?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Lisinopril
Correct Answer: B
Rationale: Crackles indicate pulmonary edema from fluid overload. Furosemide is
a loop diuretic that reduces fluid volume and pulmonary congestion. Digoxin
improves contractility but does not remove fluid. Metoprolol and lisinopril are
chronic management medications.
, Question 6
Which finding is most characteristic of right-sided heart failure?
A) Crackles in the lung bases
B) Jugular venous distension and peripheral edema
C) Orthopnea
D) Paroxysmal nocturnal dyspnea
Correct Answer: B
Rationale: JVD and peripheral edema are hallmarks of right-sided heart failure.
Crackles, orthopnea, and PND are signs of left-sided heart failure. Right-sided
heart failure results from fluid backing up into the systemic venous system.
Question 7
A patient with acute MI is in cardiogenic shock. The nurse notes hypotension,
tachycardia, and cool, clammy skin. Which intervention should the nurse
anticipate?
A) Administration of inotropic agents (e.g., dobutamine)
B) Administration of diuretics
C) Administration of beta-blockers
D) Administration of nitroglycerin
Correct Answer: A
Rationale: Cardiogenic shock requires inotropic support to improve cardiac
contractility. Dobutamine is a positive inotrope that increases cardiac output.
Diuretics would worsen hypotension. Beta-blockers decrease contractility.
Nitroglycerin reduces preload but does not improve contractility.
