Change ahead : Revised CMC test plan from AACN’s 2025 study of practice · AACN
Non-cardiac conditions, in a cardiac patient
CMC · Section II · 21% of the revised plan
Section II asks about the rest of the body, always in someone admitted for the heart: the kidney after contrast, the lungs in heart failure, the thyroid on amiodarone. It carries 21% of the revised exam.
Respiratory: acute pulmonary embolism, acute respiratory failure, ARDS (a separate line since the revision), pleural space problems, pulmonary hypertension, sleep apnea.
Endocrine: diabetes, metabolic syndrome, thyroid disorders. Adrenal disorders left the plan.
Blood: coagulopathies and anemia.
Neurologic: delirium, new on this plan, and stroke.
Multisystem: multiple organ dysfunction, shock states, chest pain that is not cardiac.
Behavioral: substance use disorder.
12 questions on the rest of the body
0 of 12 attempted · 0 correct · 0 missed
Non-Cardiovascular Conditions · 21%
A patient with long-standing diabetes becomes dizzy on standing. Supine BP is 138/80 mm Hg with HR 102; standing BP is 104/62 mm Hg with HR 103. The patient reports no recent fluid loss. The MOST LIKELY cause is
Answer and why, all 4 options
A large drop in BP on standing with no compensatory rise in heart rate, plus a fixed resting tachycardia, is typical of diabetic cardiovascular autonomic neuropathy. The baroreflex cannot respond.
Volume depletion produces a brisk heart-rate rise on standing. The patient also reports no fluid loss.
Vasovagal syncope has a trigger and a prodrome, with bradycardia. It is not a reproducible orthostatic fall with a fixed heart rate.
No alpha-blocker is mentioned. A drug cause would also usually allow some reflex rise in heart rate.
Item 1048119
Non-Cardiovascular Conditions · 21%
A patient with HFrEF and B12-deficiency anemia (Hgb 7.8 g/dL) has dyspnea at rest and is ordered 1 unit of packed RBCs. Which nursing action BEST prevents transfusion-associated circulatory overload?
Answer and why, all 4 options
Giving 2 units back to back doubles the volume load and removes the chance to reassess between units.
Diphenhydramine targets allergic reactions. It does nothing to prevent volume overload.
Infusing a unit over 60 minutes loads volume too quickly for a failing ventricle.
In HFrEF, the main defense against circulatory overload is a slow infusion of a single unit with close watching of vital signs, breath sounds and oxygen saturation. A diuretic may be given between units if ordered.
Item 1048730
Non-Cardiovascular Conditions · 21%
After 3 months of anticoagulation for PE, a patient with CAD still has dyspnea and exercise intolerance. To screen for chronic thromboembolic pulmonary hypertension, the nurse should anticipate
Answer and why, all 4 options
Pulmonary function tests evaluate airway and parenchymal disease and are usually near normal in CTEPH.
D-dimer is often normal in chronic thromboembolic disease and does not screen for CTEPH.
A ventilation-perfusion scan is the preferred screening test for chronic thromboembolic pulmonary hypertension. A normal scan essentially rules it out, and it is more sensitive than CT angiography.
A leg duplex looks for new DVT. It does not evaluate the pulmonary vascular obstruction behind the symptoms.
Item 1049376
Non-Cardiovascular Conditions · 21%
A patient with pulmonary arterial hypertension is starting oral selexipag. Which statement by the patient indicates understanding of the teaching?
Answer and why, all 4 options
Jaw pain, headache and diarrhea are expected prostacyclin effects. They are handled by slowing the titration, not by stopping the drug for good.
Selexipag, an oral prostacyclin-receptor agonist, starts at a low dose and is raised weekly to the highest dose the patient tolerates.
A central line is needed for IV epoprostenol or treprostinil. Selexipag is a tablet.
Monthly liver tests belong to endothelin receptor antagonists such as bosentan, not to selexipag.
Item 1049569
Non-Cardiovascular Conditions · 21%
A patient has burning substernal pain 30 minutes after meals, worse when lying down and relieved by antacids. Serial hs-troponins are normal and the 12-lead ECG is unchanged. The MOST LIKELY cause of the pain is
Answer and why, all 4 options
Pericarditis causes sharp pain that eases when leaning forward, often with a rub or diffuse ST elevation. It is not tied to meals or antacids.
Burning after meals that worsens lying down and eases with antacids, with normal serial troponins and an unchanged ECG, fits gastroesophageal reflux. It is a common cause of noncardiac chest pain.
Esophageal spasm causes squeezing pain often triggered by swallowing and may ease with nitrates. It is not linked to meal timing or relieved by antacids.
Costochondritis causes chest wall pain reproduced by pressing on the costal cartilages. It is not related to meals.
Item 1050290
Non-Cardiovascular Conditions · 21%
A patient admitted with NSTEMI who uses heroin daily last used 8 hours ago and asks to start buprenorphine. The Clinical Opiate Withdrawal Scale (COWS) score is 4, with mild anxiety and normal pupils. The nurse should anticipate
Answer and why, all 4 options
Buprenorphine 8 mg at a COWS of 4, only 8 hours after heroin, risks severe precipitated withdrawal.
Clonidine only treats symptoms. Buprenorphine treats opioid use disorder and lowers mortality, and the patient wants it.
Starting buprenorphine before moderate withdrawal can cause precipitated withdrawal, because it displaces the full agonist from receptors. A COWS of about 8 to 12 shows enough withdrawal to start safely.
A naloxone challenge itself causes withdrawal and is not needed to confirm daily opioid use.
Item 1102475
Non-Cardiovascular Conditions · 21%
On day 2 after PCI, a 78-year-old patient in the CCU has fluctuating attention, disorganized speech and picks at the sheets, worse at night; CAM-ICU is positive. The nurse should FIRST
Answer and why, all 4 options
Benzodiazepines worsen and prolong delirium in older adults, except in alcohol or benzodiazepine withdrawal.
Antipsychotics are not first-line and do not shorten delirium. Haloperidol is reserved for danger to self or others after causes are addressed.
Restraints raise agitation, injury and delirium duration. They are a last resort, not a first step.
A positive CAM-ICU after PCI is delirium, and the first step is to find and treat reversible triggers such as hypoxia, pain, infection, urinary retention and drugs, alongside reorientation and sleep support.
Item 1103209
Non-Cardiovascular Conditions · 21%
A patient started methimazole for hyperthyroidism and AF 3 weeks ago. The patient now reports a temperature of 38.9 °C and a painful sore throat. The nurse should FIRST
Answer and why, all 4 options
Treating the fever while continuing the drug ignores possible agranulocytosis and delays diagnosis.
Propylthiouracil can cause agranulocytosis too, through the same reaction. Switching before checking the CBC is unsafe.
A throat culture while the drug continues misses the drug-induced neutropenia that needs ruling out first.
Fever and a sore throat on methimazole may signal agranulocytosis. The drug is held and an urgent CBC with differential is drawn before anything else.
Item 1103212
Non-Cardiovascular Conditions · 21%
A patient with ADHF, AKI, and K 7.0 mEq/L refractory to medical therapy needs emergent hemodialysis tonight. The nurse should anticipate placement of
Answer and why, all 4 options
A fistula takes weeks to mature and cannot be used tonight.
Emergent dialysis needs immediate vascular access, which means a non-tunneled temporary catheter, usually in the right internal jugular vein.
Tunneled catheters are for longer-term access, and the subclavian site is avoided because it can cause stenosis that ruins future arm access.
Peritoneal dialysis is too slow for refractory hyperkalemia of 7.0 and needs time for catheter healing.
Item 1103405
Non-Cardiovascular Conditions · 21%
A patient who injects fentanyl is being discharged after treatment for tricuspid valve endocarditis and has declined buprenorphine. Which discharge intervention MOST reduces the patient's risk of death in the first weeks at home?
Answer and why, all 4 options
Counseling a month out leaves the highest-risk early period uncovered. It does not protect against overdose in the first weeks.
Clonidine eases withdrawal symptoms but does not prevent fatal overdose if the patient resumes using fentanyl.
Overdose deaths spike in the weeks after hospital discharge because tolerance has dropped. Take-home naloxone with teaching for the patient and companions is the intervention that most directly prevents death when buprenorphine is declined.
No-use contracts do not reduce drug use or overdose. They can push patients away from care.
Item 1104972
Non-Cardiovascular Conditions · 21%
A patient in shock has BP 78/50, HR 118 and SpO2 88% on 4 L/min. The differential is massive pulmonary embolism versus acute MI. Which finding MOST strongly favors acute MI?
Answer and why, all 4 options
ST elevation with reciprocal depression is the most specific sign of an acute coronary occlusion. PE can cause nonspecific ST changes but rarely a territorial STEMI pattern.
S1Q3T3 with right axis deviation reflects acute right heart strain, which favors PE.
A dilated, hypokinetic RV points to acute pressure overload from PE. RV infarction would usually come with inferior ST elevation.
Troponin rises in both massive PE, from RV strain, and MI. It does not separate them.
Item 1105066
Non-Cardiovascular Conditions · 21%
Twelve hours after contrast angiography, a patient with chronic kidney disease has had urine output of 20 mL/hr for 4 hours and new bibasilar crackles. Prophylactic 0.9% saline at 1 mL/kg/hr is still running. The nurse should FIRST
Answer and why, all 4 options
Oliguria with new crackles means the kidneys are not excreting the prophylactic fluid and the lungs are becoming congested. The infusion is reduced and the provider is notified.
A fluid challenge assumes the patient is dry. New crackles show the patient is already overloaded.
Measuring output for another 4 hours delays action on a problem that is already evident.
More saline treats oliguria as if it were dehydration and worsens pulmonary congestion.
Item 2032374
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Section II decisions that trip cardiac nurses
Heparin-induced thrombocytopenia handled halfway. Suspected HIT means every source of heparin stops, flushes and heparin-coated catheters included, and a non-heparin anticoagulant starts. The ASH 2018 HIT guideline advises against routine platelet transfusion and holds warfarin until the platelet count has recovered.
Contrast kidney injury prevented with extras. Isotonic IV fluid for at-risk patients is the measure with support; the PRESERVE trial (2018) found no benefit from sodium bicarbonate or acetylcysteine.
Amiodarone and the thyroid in one direction only. It can cause hypothyroidism or thyrotoxicosis, so thyroid tests are taken before and during therapy, and a return of atrial arrhythmia on the drug is a reason to recheck them.
A beta-blocker for cocaine chest pain. With signs of acute intoxication, benzodiazepines and nitroglycerin come first; the AHA's 2008 scientific statement on cocaine-associated chest pain advises against a beta-blocker at that stage.
Pulmonary hypertension managed like left heart failure. Hypoxia, hypercapnia and acidosis each raise pulmonary vascular resistance, so oxygenation and ventilation matter as much as the drug list (2022 ESC/ERS pulmonary hypertension guideline).
Non-cardiac topics placed elsewhere on this site
Stroke: listed in this section of the plan, but stroke questions on this site sit with the stroke exam, from hyperacute care to prevention.
Sepsis, DKA and other general ICU emergencies in transport:medical emergencies in transport. Without a cardiac angle, general ICU care belongs to the CCRN exams, whose pages are still to come.
Because cardiac patients have strokes: with atrial fibrillation, after a procedure, with endocarditis. The plan lists stroke under neurology; on this site those questions sit with the stroke exam.
Are general ICU topics like sepsis tested?
The plan names shock states and multiple organ dysfunction inside a cardiac exam, and the questions here place them in cardiac patients, such as sepsis in someone with heart failure.