Start Here · 5 min read
Exam Overview
An Overview of the Exam
The CMC (Adult) credential validates specialty knowledge in the care of acutely and critically ill adult cardiac patients. It is a subspecialty certification: it is earned on top of a current clinical nursing specialty certification and is displayed attached to that credential with a hyphen, for example CCRN-CMC or PCCN-CMC. The exam is developed and administered by the AACN Certification Corporation, and the entire exam measures Clinical Judgment, the clinical judgment component of the AACN Synergy Model for Patient Care.
Exam Format at a Glance
| Feature | Details |
|---|---|
| Credentialing body | AACN Certification Corporation |
| Total questions | 90 multiple-choice items |
| Scored items | 75 scored; 15 unscored pretest items (not identified) |
| Testing time | 2 hours |
| Question type | Single-best-answer multiple choice with four options |
| Content | 100% Clinical Judgment |
| Passing standard | Criterion-referenced cut score set by modified Angoff study; currently 50 of 75 scored items correct |
| Guessing | No penalty; only correct answers are counted |
| Delivery | Computer-based testing at PSI testing centers or live remote proctoring; paper-and-pencil at some events |
| Results | Computer-based: on screen at completion, detailed score report by email within 24 hours; paper-and-pencil: 6–8 weeks |
| Retakes | Up to four attempts in a rolling 12-month period, each at the retest fee |
| Fee | AACN Member | Nonmember |
|---|---|---|
| Initial exam | $150 | $240 |
| Retest | $125 | $170 |
| Renewal by exam | $125 | $170 |
Eligibility
All three requirements must be met before you apply: a license, an existing specialty certification, and recent cardiac clinical practice.
- A current, unencumbered U.S. RN or APRN license.
- A current, nationally accredited clinical nursing specialty certification (accredited by ABSNC or NCCA), such as CCRN or PCCN.
- Option 1 (two-year): 1,750 hours of direct care of acutely or critically ill adult patients in the previous two years, with 875 of those hours in the most recent year; 875 of the 1,750 hours must be in the care of acutely or critically ill adult cardiac patients.
- Option 2 (five-year): practice as an RN or APRN for at least five years with at least 2,000 hours of direct care of acutely or critically ill adult patients, 144 of them in the most recent year; 1,000 of the hours must be in the care of acutely or critically ill adult cardiac patients.
Inpatient Settings
Coronary care units, combined ICU/CCU, medical ICUs, telemetry, and progressive care units.
Procedural Settings
Interventional cardiology, the cardiac catheterization lab, and electrophysiology.
Outpatient and Home
Heart failure clinics and heart failure home care programs that manage acutely ill cardiac patients.
Check Your Test Plan
This guide follows the revised CMC test plan that AACN introduced in November, based on its latest national study of practice. The four content categories are unchanged; the weights shift toward Therapeutic Interventions, and newer therapies and devices are named in the outline. Before you schedule, confirm on aacn.org which CMC test plan applies on your test date.Test Plan
Every question on the CMC exam measures Clinical Judgment and maps to one of four categories. The categories cover the cardiac conditions themselves, the non-cardiac conditions that complicate cardiac care, the procedures, devices, and drugs used to treat these patients, and the monitoring and diagnostic data used to evaluate them.
CMC test plan categories
Cardiovascular Conditions — 21%ACS, heart failure, dysrhythmias, valvular, pericardial, and vascular disease
Non-Cardiovascular Conditions — 21%Respiratory, endocrine, hematologic, neurologic, renal, multisystem, behavioral
Therapeutic Interventions — 44%Procedures, devices, EP, pharmacology, respiratory and renal support
Monitoring and Diagnostics — 14%Hemodynamics, ECG, imaging, labs, respiratory monitoring
| Test Plan Category | Weight | Approx. scored items | Key Topics |
|---|---|---|---|
| I. Cardiovascular Conditions | 21% | 16 | ACS (STEMI, NSTEMI, unstable angina, SCAD), cardiac arrest, heart failure and pulmonary edema, cardiomyopathies, myocarditis, pericarditis, endocarditis, pericardial effusion and tamponade, dysrhythmias, syncope, valvular disorders, hypertensive urgency and emergency, aortic aneurysm and dissection, arterial occlusion, venous thrombosis, dyslipidemia, post-intervention vascular complications |
| II. Non-Cardiovascular Conditions | 21% | 16 | Pulmonary embolism, acute respiratory failure, ARDS, pleural disorders, pulmonary hypertension, sleep apnea; diabetes, metabolic syndrome, and thyroid disorders; anemia and coagulopathies (HIT, DIC); stroke and delirium; AKI, CKD, electrolytes; shock, MODS, non-cardiac chest pain; substance use and withdrawal |
| III. Therapeutic Interventions | 44% | 33 | Heart catheterization and PCI, pericardiocentesis, IABP, temporary and durable VADs, TAVR, TMVR, transcatheter edge-to-edge repair, LAA occlusion; peripheral and carotid interventions, endovascular grafts, catheter-directed thrombolysis; cardiovascular pharmacology; pacemakers, CRT, ICD, wearable defibrillator, ablation, cardioversion, defibrillation; NIV, mechanical ventilation, chest tubes, oxygen delivery, RRT; targeted temperature management, palliative and end-of-life care, cardiac rehabilitation |
| IV. Monitoring and Diagnostics | 14% | 10 | Hemodynamic monitoring, echocardiography, 12-lead ECG, laboratory testing, stress testing, remote cardiac monitoring, cardiac MRI and CT, ABGs and venous blood gases (SvO₂, ScvO₂), pulse oximetry, capnography, chest radiography |
Test plan categories (% of exam)
Exam Focus
Therapeutic Interventions alone accounts for nearly half (44%) of the scored items. Expect many questions to ask what the nurse does before, during, or after a procedure, device, or drug, and which finding signals a complication that requires immediate action.Scoring and Results
- The passing standard is criterion-referenced: it is set by a panel of content experts using a modified Angoff method, not by comparing you with other candidates.
- Only the 75 scored items count toward your result; the 15 pretest items are scattered throughout the exam and cannot be identified, so treat every question as scored.
- The score report shows your performance in each test plan category, which is the best guide to focused review if a retest is needed.
Renewal
| Requirement | Details |
|---|---|
| Cycle | 3 years |
| Clinical practice | 432 hours of direct care of acutely or critically ill adult cardiac patients during the cycle, 144 of them in the 12 months before renewal |
| Continuing education or exam | 25 Category A clinical judgment CERPs in cardiac topics, or pass the CMC exam |
| Underlying credential | Your clinical nursing specialty certification must remain current; the CMC cannot stand alone |
Confirm Current Details
Fees, eligibility hours, renewal requirements, and testing policies are set by AACN and can change. Verify them in the current CMC Exam Handbook before you register.Why CMC Certification Matters
Validated Cardiac Expertise
The credential demonstrates subspecialty knowledge in adult cardiac care, measured against a national standard.
Career Advancement
Many organizations recognize subspecialty certification in clinical ladders, charge, preceptor, and educator roles, and compensation.
Patient Outcomes
Certification reflects the clinical judgment needed to recognize ischemia, decompensation, dysrhythmias, and procedural complications early.
Organizational Standards
Certified nurses support cardiac program accreditation, chest pain and heart failure center standards, and professional practice recognition.
Finished reading?
Next, start the first chapter.