A 39-year-old woman who gave birth 3 weeks ago presents with chest pain and is diagnosed with NSTEMI. Angiography shows spontaneous coronary artery dissection of the mid left anterior descending artery with TIMI 3 flow. She is now pain free with BP 118/72 mm Hg, HR 78/min and no dysrhythmias. Which plan of care does the nurse anticipate?

Conservative medical therapy with several days of inpatient monitoring

Fibrinolytic therapy to dissolve the intramural hematoma

Urgent coronary artery bypass grafting to the LAD

Immediate PCI with stent placement covering the entire dissected segment

A 74-year-old with atrial fibrillation who stopped anticoagulation has had sudden right leg pain for 3 hours. The foot is pale and cool, pedal Doppler signals are absent, toe sensation is diminished, and ankle dorsiflexion is mildly weak. What is the nurse's PRIORITY action?

Notify the provider for emergent revascularization and anticipate IV heparin

Arrange an ankle-brachial index and vascular follow-up within the week

Elevate the leg above heart level and apply warm compresses to the foot

Obtain a venous duplex to exclude deep vein thrombosis before anticoagulating

A 34-year-old patient presents with chest pain 1 hour after smoking crack cocaine. BP 186/108 mm Hg, HR 128, temperature 37.9 °C, and the patient is agitated and diaphoretic. ECG shows sinus tachycardia with 1-mm ST depression in V4–V6. Aspirin has been given. Which order should the nurse question?

Metoprolol 5 mg IV every 5 minutes for 3 doses

Nitroglycerin 0.4 mg sublingual every 5 minutes for pain

Lorazepam 2 mg IV now and may repeat for agitation

Serial high-sensitivity troponin and repeat 12-lead ECG

Six hours after TEVAR for a descending thoracic aortic aneurysm, a patient has new bilateral leg weakness with diminished sensation below the umbilicus. MAP is 68 mm Hg, and a lumbar CSF drain is in place with pressure 14 mm Hg. Which intervention should the nurse anticipate?

Raise MAP to ≥ 90 mm Hg and drain CSF to lower spinal fluid pressure to ≤ 10 mm Hg

Clamp the CSF drain and obtain a stat CT angiogram to evaluate for type I endoleak

Keep the head of bed flat for 24 hours and repeat the neurologic examination every 4 hours

Lower MAP to 60–65 mm Hg to reduce stress on the proximal and distal landing zones

Parameter Value BP 78/50 mm Hg HR 112/min, sinus Peak LVOT gradient 70 mm Hg LVEF 75%, hyperdynamic On the evening after transseptal transcatheter mitral valve replacement, a patient becomes hypotensive with a new harsh systolic murmur at the left sternal border. Echocardiography shows the valve frame displacing the anterior mitral leaflet toward the septum. Data are shown. Which treatment does the nurse anticipate?

An IV fluid bolus and phenylephrine, avoiding inotropes

IV nitroglycerin to lower afterload

IV furosemide to reduce preload

A dobutamine infusion to increase contractility

Sample site O₂ saturation Right atrium 64% Right ventricle 82% Pulmonary artery 83% Systemic artery 93% Three days after an anterior STEMI, a patient develops hypotension and a new harsh holosystolic murmur at the left lower sternal border with a palpable thrill. Oxygen saturations from a pulmonary artery catheter are shown. Which is the MOST likely cause?

Ventricular septal rupture with a left-to-right shunt

Free wall rupture with a contained pseudoaneurysm

Papillary muscle rupture with acute mitral regurgitation

Right ventricular infarction with reduced RV stroke volume

A patient with an acute iliofemoral deep vein thrombosis is receiving therapeutic enoxaparin. Which finding requires IMMEDIATE intervention?

Massive leg swelling, bluish skin and weak pedal pulses

Calf circumference 2 cm greater than on the opposite leg

Temperature of 37.9 °C with mild calf and thigh tenderness

Small ecchymoses at abdominal enoxaparin injection sites

A 52-year-old patient reports substernal squeezing chest pain that began while eating dinner and radiates to the back. The pain was relieved 5 minutes after sublingual nitroglycerin. The patient has diabetes and a history of esophageal spasm. The initial ECG shows no acute changes. What should the nurse do NEXT ?

Obtain serial ECGs and high-sensitivity troponins per protocol

Schedule outpatient esophageal manometry and start a calcium channel blocker

Attribute the pain to esophageal spasm because nitroglycerin relieved it

Request a GI cocktail and plan discharge if the pain does not recur

Lab Baseline 12 h Fibrinogen 310 mg/dL 118 mg/dL Hemoglobin 13.1 g/dL 12.4 g/dL Platelets 228 × 10³/µL 201 × 10³/µL aPTT 34 s 62 s A patient with a submassive pulmonary embolism is receiving catheter-directed thrombolysis through bilateral pulmonary artery catheters. Twelve hours into the infusion, the patient reports a severe headache and has new right arm drift. Lab values are shown below. What is the nurse's PRIORITY action?

Stop the thrombolytic and anticoagulant infusions and arrange an emergent head CT

Reduce the thrombolytic infusion rate by half and repeat the fibrinogen level in 2 hours

Continue the infusions and obtain a stat CT pulmonary angiogram to assess clot burden

Administer the ordered acetaminophen and perform neurologic checks every hour

A patient's chest tube for a pneumothorax disconnects from the drainage tubing while the patient is being turned. The drainage system is intact and on the floor beside the bed. What is the nurse's FIRST action?

Submerge the end of the chest tube 2–3 cm in sterile water

Clamp the chest tube close to the chest wall for 4 hours

Remove the tube and cover the site with petroleum gauze

Wipe the connector with alcohol and wait for the provider

CMC – Cardiac Medicine Certification

Free CMC Practice Questions

10 sample questions for the CMC – Cardiac Medicine Certification, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Non-Cardiovascular Conditions, Therapeutic Interventions, Monitoring and Diagnostics.

Question 1 · Non-Cardiovascular Conditions
A 39-year-old woman who gave birth 3 weeks ago presents with chest pain and is diagnosed with NSTEMI. Angiography shows spontaneous coronary artery dissection of the mid left anterior descending artery with TIMI 3 flow. She is now pain free with BP 118/72 mm Hg, HR 78/min and no dysrhythmias. Which plan of care does the nurse anticipate?
- A.Fibrinolytic therapy to dissolve the intramural hematoma
- B.Urgent coronary artery bypass grafting to the LAD
- C.Immediate PCI with stent placement covering the entire dissected segment
- D.Conservative medical therapy with several days of inpatient monitoring
Show answer and explanation
Answer: D. Conservative medical therapy with several days of inpatient monitoring
In a stable patient with spontaneous coronary artery dissection and preserved flow, conservative management is preferred because most dissections heal on their own within weeks, whereas PCI has high rates of technical failure and can propagate the dissection; several days of inpatient monitoring are advised because early extension can occur. Fibrinolysis can enlarge the intramural hematoma and is avoided. Bypass surgery is reserved for left main or extensive dissection with ongoing ischemia when PCI is not feasible.
Question 2 · Non-Cardiovascular Conditions
A 74-year-old with atrial fibrillation who stopped anticoagulation has had sudden right leg pain for 3 hours. The foot is pale and cool, pedal Doppler signals are absent, toe sensation is diminished, and ankle dorsiflexion is mildly weak. What is the nurse's PRIORITY action?
- A.Arrange an ankle-brachial index and vascular follow-up within the week
- B.Elevate the leg above heart level and apply warm compresses to the foot
- C.Obtain a venous duplex to exclude deep vein thrombosis before anticoagulating
- D.Notify the provider for emergent revascularization and anticipate IV heparin
Show answer and explanation
Answer: D. Notify the provider for emergent revascularization and anticipate IV heparin
Absent Doppler signals with sensory loss and early motor weakness indicate an immediately threatened limb from acute arterial embolism, requiring an IV heparin bolus and emergent revascularization to prevent irreversible ischemia. Elevation reduces arterial inflow and heat increases metabolic demand and burn risk in an insensate limb. Venous studies and outpatient testing delay definitive treatment.
Question 3 · Non-Cardiovascular Conditions
A 34-year-old patient presents with chest pain 1 hour after smoking crack cocaine. BP 186/108 mm Hg, HR 128, temperature 37.9 °C, and the patient is agitated and diaphoretic. ECG shows sinus tachycardia with 1-mm ST depression in V4–V6. Aspirin has been given. Which order should the nurse question?
- A.Nitroglycerin 0.4 mg sublingual every 5 minutes for pain
- B.Metoprolol 5 mg IV every 5 minutes for 3 doses
- C.Lorazepam 2 mg IV now and may repeat for agitation
- D.Serial high-sensitivity troponin and repeat 12-lead ECG
Show answer and explanation
Answer: B. Metoprolol 5 mg IV every 5 minutes for 3 doses
In acute cocaine intoxication, IV beta-blockers are avoided because they may leave alpha-adrenergic stimulation unopposed, worsening coronary vasospasm and hypertension. Benzodiazepines are first-line to reduce central sympathetic outflow, nitroglycerin relieves vasospasm and ischemic pain, and serial troponin and ECG monitoring are needed to evaluate for myocardial infarction.
Question 4 · Therapeutic Interventions
Six hours after TEVAR for a descending thoracic aortic aneurysm, a patient has new bilateral leg weakness with diminished sensation below the umbilicus. MAP is 68 mm Hg, and a lumbar CSF drain is in place with pressure 14 mm Hg. Which intervention should the nurse anticipate?
- A.Raise MAP to ≥ 90 mm Hg and drain CSF to lower spinal fluid pressure to ≤ 10 mm Hg
- B.Clamp the CSF drain and obtain a stat CT angiogram to evaluate for type I endoleak
- C.Keep the head of bed flat for 24 hours and repeat the neurologic examination every 4 hours
- D.Lower MAP to 60–65 mm Hg to reduce stress on the proximal and distal landing zones
Show answer and explanation
Answer: A. Raise MAP to ≥ 90 mm Hg and drain CSF to lower spinal fluid pressure to ≤ 10 mm Hg
New lower-extremity weakness after TEVAR indicates spinal cord ischemia from loss of intercostal perfusion; spinal cord perfusion pressure (MAP minus CSF pressure) is improved by raising MAP and draining CSF. Lowering MAP or clamping the drain worsens cord perfusion. Flat positioning with infrequent checks misses a time-sensitive window for reversing the deficit.
Question 5 · Therapeutic Interventions
Parameter Value
BP 78/50 mm Hg
HR 112/min, sinus
Peak LVOT gradient 70 mm Hg
LVEF 75%, hyperdynamic
On the evening after transseptal transcatheter mitral valve replacement, a patient becomes hypotensive with a new harsh systolic murmur at the left sternal border. Echocardiography shows the valve frame displacing the anterior mitral leaflet toward the septum. Data are shown. Which treatment does the nurse anticipate?
- A.IV nitroglycerin to lower afterload
- B.An IV fluid bolus and phenylephrine, avoiding inotropes
- C.IV furosemide to reduce preload
- D.A dobutamine infusion to increase contractility
Show answer and explanation
Answer: B. An IV fluid bolus and phenylephrine, avoiding inotropes
The findings describe dynamic left ventricular outflow tract obstruction, a recognized complication of transcatheter mitral valve replacement. Raising preload with fluid and afterload with a pure vasoconstrictor such as phenylephrine, often with a short-acting beta-blocker to slow the heart and lengthen filling, widens the outflow tract and lowers the gradient. Inotropes, vasodilators and diuretics all make the outflow tract smaller and worsen the obstruction; persistent obstruction may need a procedural correction.
Question 6 · Non-Cardiovascular Conditions
Sample site O₂ saturation
Right atrium 64%
Right ventricle 82%
Pulmonary artery 83%
Systemic artery 93%
Three days after an anterior STEMI, a patient develops hypotension and a new harsh holosystolic murmur at the left lower sternal border with a palpable thrill. Oxygen saturations from a pulmonary artery catheter are shown. Which is the MOST likely cause?
- A.Free wall rupture with a contained pseudoaneurysm
- B.Papillary muscle rupture with acute mitral regurgitation
- C.Ventricular septal rupture with a left-to-right shunt
- D.Right ventricular infarction with reduced RV stroke volume
Show answer and explanation
Answer: C. Ventricular septal rupture with a left-to-right shunt
An oxygen saturation step-up of more than 5–7% between the right atrium and right ventricle shows oxygenated blood entering the RV through a ruptured septum, which matches the harsh murmur and thrill at the left sternal border. Papillary muscle rupture produces an apical murmur and giant v waves without an RV oxygen step-up. RV infarction and free wall rupture do not create an intracardiac shunt.
Question 7 · Non-Cardiovascular Conditions
A patient with an acute iliofemoral deep vein thrombosis is receiving therapeutic enoxaparin. Which finding requires IMMEDIATE intervention?
- A.Calf circumference 2 cm greater than on the opposite leg
- B.Temperature of 37.9 °C with mild calf and thigh tenderness
- C.Small ecchymoses at abdominal enoxaparin injection sites
- D.Massive leg swelling, bluish skin and weak pedal pulses
Show answer and explanation
Answer: D. Massive leg swelling, bluish skin and weak pedal pulses
Massive swelling with cyanosis and diminishing arterial pulses indicates phlegmasia cerulea dolens, in which venous outflow obstruction raises compartment pressures enough to impair arterial inflow and threatens the limb, requiring urgent catheter-directed or surgical thrombus removal. Asymmetric calf size, low-grade fever and tenderness are expected findings with DVT, and minor injection-site bruising is common with low-molecular-weight heparin.
Question 8 · Non-Cardiovascular Conditions
A 52-year-old patient reports substernal squeezing chest pain that began while eating dinner and radiates to the back. The pain was relieved 5 minutes after sublingual nitroglycerin. The patient has diabetes and a history of esophageal spasm. The initial ECG shows no acute changes. What should the nurse do NEXT?
- A.Schedule outpatient esophageal manometry and start a calcium channel blocker
- B.Attribute the pain to esophageal spasm because nitroglycerin relieved it
- C.Request a GI cocktail and plan discharge if the pain does not recur
- D.Obtain serial ECGs and high-sensitivity troponins per protocol
Show answer and explanation
Answer: D. Obtain serial ECGs and high-sensitivity troponins per protocol
Nitroglycerin relaxes esophageal smooth muscle as well as coronary arteries, so pain relief does not distinguish esophageal spasm from ischemia; a patient with diabetes and cardiac risk needs ACS excluded with serial ECGs and high-sensitivity troponins. A single normal ECG does not rule out ACS. Response to a GI cocktail is equally nondiagnostic, and outpatient esophageal testing is appropriate only after a cardiac cause has been excluded.
Question 9 · Therapeutic Interventions
Lab Baseline 12 h
Fibrinogen 310 mg/dL 118 mg/dL
Hemoglobin 13.1 g/dL 12.4 g/dL
Platelets 228 × 10³/µL 201 × 10³/µL
aPTT 34 s 62 s
A patient with a submassive pulmonary embolism is receiving catheter-directed thrombolysis through bilateral pulmonary artery catheters. Twelve hours into the infusion, the patient reports a severe headache and has new right arm drift. Lab values are shown below. What is the nurse's PRIORITY action?
- A.Reduce the thrombolytic infusion rate by half and repeat the fibrinogen level in 2 hours
- B.Continue the infusions and obtain a stat CT pulmonary angiogram to assess clot burden
- C.Stop the thrombolytic and anticoagulant infusions and arrange an emergent head CT
- D.Administer the ordered acetaminophen and perform neurologic checks every hour
Show answer and explanation
Answer: C. Stop the thrombolytic and anticoagulant infusions and arrange an emergent head CT
A sudden severe headache with a focal deficit during thrombolysis, along with a sharply falling fibrinogen, indicates possible intracranial hemorrhage; all thrombolytic and anticoagulant infusions are stopped immediately and an emergent head CT is obtained. Reducing the rate or continuing the infusion risks extending the bleed. Treating the headache symptomatically delays recognition of a neurologic emergency.
Question 10 · Therapeutic Interventions
A patient's chest tube for a pneumothorax disconnects from the drainage tubing while the patient is being turned. The drainage system is intact and on the floor beside the bed. What is the nurse's FIRST action?
- A.Clamp the chest tube close to the chest wall for 4 hours
- B.Remove the tube and cover the site with petroleum gauze
- C.Submerge the end of the chest tube 2–3 cm in sterile water
- D.Wipe the connector with alcohol and wait for the provider
Show answer and explanation
Answer: C. Submerge the end of the chest tube 2–3 cm in sterile water
Placing the open end of the chest tube 2–3 cm under sterile water creates an immediate water seal that lets air escape but not re-enter, until a sterile system is reconnected. Prolonged clamping can cause a tension pneumothorax when an air leak is present. The nurse should not remove the tube, and waiting with an open tube allows air to enter the pleural space.

Parameter	Value
BP	78/50 mm Hg
HR	112/min, sinus
Peak LVOT gradient	70 mm Hg
LVEF	75%, hyperdynamic

Sample site	O₂ saturation
Right atrium	64%
Right ventricle	82%
Pulmonary artery	83%
Systemic artery	93%

Lab	Baseline	12 h
Fibrinogen	310 mg/dL	118 mg/dL
Hemoglobin	13.1 g/dL	12.4 g/dL
Platelets	228 × 10³/µL	201 × 10³/µL
aPTT	34 s	62 s

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