Change ahead : Revised CMC test plan from AACN’s 2025 study of practice · AACN
Cardiovascular conditions, the diagnosis in front of you
CMC · Section I · 21% of the revised plan
Section I covers the cardiac and vascular diagnoses themselves, 21% of the revised exam. Typical stems put the patient in the CCU or on telemetry and ask what the findings mean or which step comes first.
From the revised test plan, grouped (test plan, p. 1):
Coronary: acute coronary syndromes (STEMI, NSTEMI, unstable angina) including SCAD, new on this plan; dyslipidemia.
Pump and rhythm: heart failure, cardiomyopathies, dysrhythmias, syncope, pulmonary edema.
Pericardium, valves, infection: pericardial effusion and tamponade, valvular disorders, inflammatory and infectious conditions.
Pressure and arrest: hypertensive urgency and emergency; cardiac arrest, a line of its own since the revision.
Vessels: aortic aneurysm and dissection, acute arterial occlusion, acute venous thrombosis, complications at the vessel after an intervention.
15 questions on cardiac and vascular diagnoses
0 of 15 attempted · 0 correct · 0 missed
Cardiovascular Conditions · 21%
A patient with a known type 1 Brugada ECG pattern is admitted with pneumonia and a temperature of 102.9°F (39.4°C). Telemetry shows occasional PVCs. The nurse should anticipate
Answer and why, all 4 options
Procainamide is a sodium-channel blocker that worsens the Brugada pattern and is used to provoke it during testing. Giving it can trigger the arrhythmia it is meant to stop.
Amiodarone has sodium-channel effects and does not prevent Brugada-related VT. Prophylactic loading treats PVCs that are not the danger.
Fever slows sodium-channel recovery and can unmask the Brugada pattern and trigger polymorphic VT or VF. Prompt, aggressive fever control is the priority while the patient is monitored.
Beta-blockers do not prevent Brugada VT and can worsen it by slowing the heart, since arrhythmias tend to occur at slow rates.
Item 1047741
Cardiovascular Conditions · 21%
A patient with prior MI on atorvastatin, with triglycerides of 220 mg/dL, is starting icosapent ethyl. Which teaching is accurate?
Answer and why, all 4 options
Icosapent ethyl is added to statin therapy, not used in place of it. Stopping atorvastatin removes the main LDL-lowering drug after an MI.
Icosapent ethyl is taken with food, which improves absorption. An empty stomach reduces what is absorbed.
Vitamin K intake matters for warfarin, not for omega-3 fatty acids. This mixes up two drugs that both affect bleeding.
Icosapent ethyl raises the risk of atrial fibrillation and flutter, which was seen in its outcome trial. Patients are taught to report palpitations, and bleeding as well.
Item 1049207
Cardiovascular Conditions · 21%
A patient with a mechanical aortic valve reports fatigue and dark urine. Labs: hemoglobin 9.1 g/dL, LDH 980 U/L, undetectable haptoglobin, and schistocytes on the smear. Echo shows a new paravalvular jet. The MOST likely cause of the anemia is
Answer and why, all 4 options
Low haptoglobin, high LDH, schistocytes and dark urine show intravascular hemolysis. A new paravalvular leak around a mechanical valve shears red cells, which ties the anemia to the valve.
A retroperitoneal bleed lowers hemoglobin but does not cause fragmented cells or dark urine.
Iron deficiency from GI loss does not produce schistocytes, high LDH or undetectable haptoglobin.
B12 deficiency causes a macrocytic anemia with hypersegmented neutrophils, not schistocytes and hemoglobinuria.
Item 1103626
Cardiovascular Conditions · 21%
A 42-year-old woman with no coronary risk factors develops chest pain during intense exercise and has an NSTEMI. Angiography shows a long, smooth narrowing of the mid-LAD consistent with spontaneous coronary artery dissection, with normal distal flow. She is pain-free and stable. The nurse should anticipate
Answer and why, all 4 options
Emergency bypass is for left main or extensive dissection with ongoing ischemia when PCI is not possible. It is not used for a stable patient with normal flow.
A stable patient with SCAD and preserved distal flow is managed conservatively. Most dissections heal on their own, and PCI in a dissected artery risks extending the tear.
Fibrinolytics can enlarge the intramural hematoma, and SCAD is not a thrombotic occlusion. Treating it like plaque-rupture ACS can be harmful.
Stenting dissected tissue often pushes the false lumen and extends the dissection. It is reserved for ongoing ischemia or compromised flow.
Item 1103781
Cardiovascular Conditions · 21%
Six hours after an anterior STEMI, a patient has BP 82/56, HR 118, cool clammy extremities, lactate 4.2 mmol/L, urine output 15 mL/h, CI 1.7 L/min/m² and PAOP 26 mm Hg. No vasoactive agents have been started. By the SCAI classification, this is shock stage
Answer and why, all 4 options
Stage D means deterioration despite initial vasoactive or mechanical support. None has been given yet.
Stage B is hypotension or tachycardia without hypoperfusion. A lactate of 4.2 and urine output of 15 mL/h show hypoperfusion is present.
Stage E is extremis: ongoing CPR, ECMO or refractory collapse. This patient is hypotensive but not in arrest.
Stage C is hypoperfusion (high lactate, oliguria, cool skin) that needs treatment beyond fluids, such as vasoactive drugs or mechanical support. No agent has been started yet, so the patient cannot already be failing one.
Item 1103818
Cardiovascular Conditions · 21%
A patient with 5 days of AF is cardioverted after a negative TEE on heparin. CHA2DS2-VASc is 1, and the patient is now in sinus rhythm and asks to stop anticoagulation. The nurse should explain that anticoagulation should be
Answer and why, all 4 options
After cardioversion of AF lasting 48 hours or more, anticoagulation continues for at least 4 weeks, even with a negative TEE and a low CHA2DS2-VASc score. The atria are stunned and can form clot after sinus rhythm returns.
48 hours is far shorter than the recommended 4 weeks. It confuses the 48-hour AF duration threshold with the length of anticoagulation.
Stopping now and restarting only on recurrence leaves the patient unprotected while the stunned atria recover, which is when clots form even in sinus rhythm.
Stopping at discharge ignores post-cardioversion atrial stunning. The thromboembolic risk peaks in the first weeks.
Item 1103915
Cardiovascular Conditions · 21%
A patient with fatigue and weight gain has a large pericardial effusion on echo without chamber collapse. BP is 128/80 mm Hg, HR 62, there is no pulsus paradoxus, and TSH is 48 mU/L. The nurse should anticipate
Answer and why, all 4 options
A TSH of 48 explains the effusion as myxedema, and the stable BP, absent pulsus paradoxus and lack of chamber collapse rule out tamponade. Treating the hypothyroidism resolves the fluid slowly, followed with serial echoes.
A surgical window is for recurrent or loculated effusions. It is not first-line when the cause is treatable.
NSAIDs and colchicine treat inflammatory pericarditis. This effusion is caused by hypothyroidism, not inflammation.
Emergency pericardiocentesis is for tamponade physiology. Draining a hemodynamically stable hypothyroid effusion adds procedural risk without benefit.
Item 1104578
Cardiovascular Conditions · 21%
A patient with heart failure has taken tolvaptan 15 mg daily for 3 weeks for hyponatremia and now reports fatigue, right upper quadrant pain, and dark urine. The nurse should anticipate
Answer and why, all 4 options
Frequent sodium checks guard against overcorrection in the first days of tolvaptan. After 3 weeks, the urgent issue is the liver.
Fluid restriction addresses hyponatremia but ignores signs of drug-induced liver injury.
Tolvaptan can cause serious liver injury, and its FDA labeling warns about this. Fatigue, right upper quadrant pain and dark urine call for stopping the drug and checking liver tests right away.
Adding demeclocycline treats the sodium and misses the new hepatotoxicity. It is also nephrotoxic.
Item 1104778
Cardiovascular Conditions · 21%
A patient with acute viral myocarditis has LVEF 40%, mild HF symptoms and chest discomfort, with no heart block or ventricular arrhythmia. The nurse should anticipate treatment with
Answer and why, all 4 options
NSAIDs can worsen myocardial injury in myocarditis. They help pericarditis, which this choice confuses with myocarditis.
Most viral myocarditis with mild LV dysfunction and no high-risk features is managed with standard guideline-directed HF therapy and activity restriction, while the ventricle recovers.
High-dose steroids are for specific forms, such as giant cell, eosinophilic or checkpoint-inhibitor myocarditis. They are not routine for viral myocarditis.
There is no proven empiric antiviral therapy for typical viral myocarditis. This choice assumes treating the virus treats the heart.
Item 1105063
Cardiovascular Conditions · 21%
On day 2 after cardiac arrest, about 24 hours after reaching normothermia, the family of a comatose patient asks whether the patient will wake up. The nurse should explain that
Answer and why, all 4 options
Absent pupillary reflexes on day 2, about 24 hours after normothermia, are too early to predict outcome reliably. Residual sedation and the recent temperature control can blunt them.
A single head CT is one piece of a multimodal assessment. Early CT can look normal and does not decide the outcome by itself.
Sedatives and analgesics, which clear more slowly after temperature control, clearly depress the neurologic exam. That is a main reason to wait.
Early findings after arrest are unreliable because of sedation, recent temperature control and evolving injury. Guidelines advise waiting at least 72 hours and combining exam, EEG, imaging and biomarkers before judging recovery.
Item 1106043
Cardiovascular Conditions · 21%
A patient with a known aortic dissection becomes confused, urine output falls to 10 mL/hr, and the left leg becomes cold and pale with absent pulses. BP is 148/86 mm Hg. These findings MOST likely indicate
Answer and why, all 4 options
Rupture causes sudden hypotension and collapse. The BP here is maintained.
Contrast injury would explain the kidneys but not the confusion and the pulseless limb at the same time.
Confusion, oliguria and a pulseless cold leg together show branches of the aorta being compromised by the dissection flap. This is malperfusion of the brain, kidneys and limb.
Tamponade would cause hypotension, distended neck veins and pulsus paradoxus. The BP here is 148/86.
Item 2032599
Cardiovascular Conditions · 21%
Six hours after thoracic endovascular aortic repair (TEVAR), a patient cannot move the legs and has decreased sensation below the umbilicus. The nurse should anticipate
Answer and why, all 4 options
Bilateral paralysis with a sensory level is not positional nerve compression. Repositioning delays treatment that is time-sensitive.
New paraplegia after TEVAR suggests spinal cord ischemia from intercostal arteries covered by the graft. Raising MAP and draining CSF lower spinal canal pressure and improve cord perfusion.
A stroke would cause unilateral or cortical deficits. A sensory level below the umbilicus with both legs paralyzed points to the spinal cord.
Lowering MAP reduces spinal cord perfusion pressure and worsens the ischemia. This applies dissection BP targets to a perfusion problem.
Item 2032604
Cardiovascular Conditions · 21%
Which patient on the vascular unit should the nurse assess FIRST?
Answer and why, all 4 options
Calf swelling in a patient already on heparin is a DVT that is being treated, and the patient is stable.
Hypotension with a groin hematoma after catheterization means active bleeding with circulatory compromise. A threat to life comes before threats to a limb.
A cool foot that still has a Doppler signal is perfused and needs prompt reassessment, but it is not as urgent as bleeding with hypotension.
A low-grade fever on day 1 after EVAR is usually post-implantation syndrome, an inflammatory reaction to the graft, not an emergency.
Item 2032648
Cardiovascular Conditions · 21%
Two weeks after pacemaker implantation through the left subclavian vein, a patient has new swelling and aching of the left arm with dilated veins over the shoulder. The radial pulse is strong, and the pocket is flat. The MOST LIKELY cause is
Answer and why, all 4 options
A pocket hematoma presents as a tense, swollen pocket. The stem says the pocket is flat.
Lymphedema does not develop after a small device incision and does not cause dilated superficial veins.
Arm swelling and aching with dilated collateral veins over the shoulder, two weeks after a lead was placed through the subclavian vein, point to lead-related upper-extremity venous thrombosis.
Arterial occlusion causes a cold, pale, pulseless arm. Here the radial pulse is strong.
Item 2032708
Cardiovascular Conditions · 21%
A 46-year-old woman is recovering from an NSTEMI caused by spontaneous coronary artery dissection. She is pain-free and stable. Before discharge, the nurse should anticipate an order for
Answer and why, all 4 options
SCAD is closely linked to fibromuscular dysplasia and other arteriopathies. A one-time CT or MR angiogram from the brain to the pelvis screens for aneurysms and dissections elsewhere.
SCAD is caused by an intramural hematoma, not thrombophilia. A clotting work-up does not change management.
Treadmill testing before discharge is not used to evaluate SCAD and does not look for the arteriopathy behind it.
Routine early repeat invasive angiography adds a risk of catheter-induced dissection in fragile arteries. Healing is usually confirmed noninvasively, if at all.
Item 9740001
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Where Section I answers go wrong
Oxygen for every chest pain. The acute coronary syndromes guideline (ACC/AHA, 2025) gives supplemental oxygen when saturation is below 90% and does not recommend it routinely above that.
A nitrate before the checks. Hold it for hypotension, a suspected right ventricular infarction, or a phosphodiesterase-5 inhibitor taken recently (24 hours for sildenafil, 48 for tadalafil). With an inferior STEMI, record right-sided leads first.
Calling a STEMI from the troponin. A raised troponin with a non-diagnostic ECG is an NSTEMI; the ECG decides the reperfusion pathway. ST depression in V1–V3 is the exception worth knowing: record posterior leads before settling on NSTEMI.
A vasodilator first in aortic dissection. The 2022 ACC/AHA aortic disease guideline slows the heart rate with an IV beta-blocker before lowering systolic pressure; a vasodilator given alone first brings a reflex tachycardia that adds stress on the aortic wall.
Stopping heart failure medicines on admission. The heart failure guideline (AHA/ACC/HFSA, 2022) continues GDMT through a hospitalization unless the patient is hemodynamically unstable or has a contraindication.
Compressions judged by eye. In the AHA adult arrest algorithm, a low or falling end-tidal CO2 during CPR is the cue to improve compressions; after return of circulation, the AHA 2025 update keeps deliberate temperature control for adults who do not follow commands.
Cardiac diagnoses that other pages here own
Stroke, including stroke after atrial fibrillation:SCRN stroke prevention. Anticoagulation for AF without a stroke stays in this exam and on pharmacology.
From November 19, 2026, yes: the revised plan names spontaneous coronary artery dissection inside acute coronary syndromes. The older plan did not.
Are rhythm strips part of this section?
Dysrhythmias belong to Section I, and the ECG appears again under monitoring. Our questions describe rhythms in words; there are no strip images in the set for now.