Cardiac Medicine Certification (CMC) Exam Review
Cardiac Medicine Certification is a subspecialty offered by the American Association of Critical Care Nurses. It offers the Registered Nurse certification and specialization to practice in any setting in which there will be patients requiring specialized cardiac care. This can include an ICU or CCU ward, an Interventional Cardiology practice, a heart failure ward, and others.
In order to take the Cardiac Medicine Certification exam, the applicant must be a licensed Registered Nurse or ARNP. The practitioner must also hold current certification as a critical care specialist. A minimum of 1,750 hours of providing direct patient care to cardiac patients must have been completed within the 2 years prior to application. At least 875 of those hours should have been completed within the past year.
The Cardiac Medicine Certification exam is offered year-round to Registered Nurses and ARNPs at multiple sites across the United States. The cost to take the CMC exam is $135 for members of the American Association of Critical Care Nurses (AACN) and $180 for non-members.
The CMC exam must be completed within 2 hours and it consists of 90 multiple-choice questions. Over one-half of the Cardiac Medicine Certification exam consists of questions testing the RN or ARNP's knowledge in specific cardiac or cardiac-related conditions, i.e., acute myocardial infarction, congestive heart failure, cardiac dysrhythmias. The balance of the CMC exam consists of questions regarding the nursing interventions used to treat these patients and the specific monitoring systems available to affectively assess patients with acute cardiac conditions.
The Cardiac Medicine Certification is valid for 3 years. The RN or ARNP who wishes to renew their certification must have spent at least 432 hours during the 3-year period providing direct patient care to patients with acute cardiac disease. In addition, at least 25 hours of continuing education hours pertaining to cardiac care must be completed or the RN or ARNP can retake the CMC examination.
CMC Practice Questions
1. A 72-year-old man with chronic systolic congestive heart failure is hospitalized due to worsening of his symptoms. He is initially stable, but on the second day of his hospitalization, he suddenly develops chest pain, worsening cough, and rapidly worsening shortness of breath. An electrocardiogram reveals an acute, left-sided, ST-segment elevation myocardial infarction. What is the most likely cause of his shortness of breath?
- Pulmonary embolism
- Pulmonary edema
- Reactive airway disease
2. A 47-year-old woman presents to the hospital with a blood pressure of 220/130 mm Hg. She is confused and restless on arrival and is unable to answer questions. Her family reports that she complained of a bad headache and nausea earlier in the day. Her husband notes that she stopped taking her blood pressure medications over the past few days because she did not feel like she needed them anymore. What is the most appropriate treatment approach?
- Slowly lower the patient's systolic blood pressure to 120 mm Hg with intravenous (IV) antihypertensive medication, and then switch to oral antihypertensive medication for maintenance.
- Slowly lower the patient's diastolic blood pressure to 85 mm Hg with oral antihypertensive medication, and then adjust the dose of antihypertensive medication to maintain blood pressure.
- Rapidly lower the patient's systolic blood pressure to 120 mm Hg with oral antihypertensive medication, and then adjust the dose of antihypertensive medication to maintain blood pressure.
- Rapidly lower the patient's diastolic blood pressure to 100 mm Hg with IV antihypertensive medication, and then gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medication.
3. A routine x-ray shows that a patient has an asymptomatic descending thoracic aortic aneurysm. The aneurysm has a diameter of 4 cm. What is the recommended initial management?
- Beta-blockers for aggressive blood pressure control and surveillance
- Surveillance only
- Surgical correction
- Aspirin, aggressive blood pressure control with a beta-blocker, an angiotensin-converting enzyme inhibitor, and surveillance
4. The nurse is caring for a 72-year-old man who was admitted to the hospital to rule out acute coronary syndrome. While the nurse is in the room talking to the patient, he suddenly clutches his chest and then falls back on his bed unresponsive. The nurse calls for help and begins cardiopulmonary resuscitation. A team arrives with the crash cart and attaches a monitor/defibrillator to the patient's chest. The monitor reveals asystole. What should the next immediate action be?
- Shock the patient.
- Resume chest compressions.
- Insert an advanced airway.
- Give 1 mg of epinephrine intravenously.
5. A 68-year-old woman presents with acute substernal chest pain and dyspnea. An electrocardiogram reveals deep T-wave inversion with QT-interval prolongation. Laboratory analysis reveals very mild elevation of troponin and cardiac enzymes. The patient had no history of cardiac disease. Shortly before her symptoms developed, she had been told that her daughter and grandchild had been killed in a car accident. Echocardiography showed left ventricular (LV) apical ballooning with dyskinesis of the apical one-half of the LV. Coronary angiography demonstrated only mild coronary atherosclerosis. When the patient was reevaluated weeks later, it was shown that she had recovered normal LV function. What did this patient most likely experience?
- Psychosomatic chest pain
- Stress-induced (takotsubo) cardiomyopathy
- A myocardial infarction
- Hypertrophic cardiomyopathy
1. C: The medical history of the patient described in the question is key to discovering the most likely cause of his shortness of breath. He already had a history of congestive heart failure, which likely developed into acute decompensated heart failure (ADHF) due to his ST-segment elevation myocardial infarction. The ADHF is a fairly common cause of acute respiratory distress and is associated with the rapid accumulation of fluid in the lungs (pulmonary edema). Although a pulmonary embolism, pneumonia, and reactive airway disease may all cause dyspnea, cough, and chest pain, they are less likely in this case due to the patient's history.
2. D: The patient described in the question is experiencing a hypertensive emergency with associated hypertensive encephalopathy. In this situation, a patient's diastolic blood pressure should be rapidly lowered to around 100 mm Hg with intravenous antihypertensive medication (with the maximum initial decrease 25% or less of the presenting value). This initial decrease in blood pressure should take place over 2-6 hours. Once the blood pressure is controlled, the patient should be switched to oral therapy, and the diastolic blood pressure should gradually be reduced to about 85 mm Hg over the next 2-3 months. While the severity of the symptoms calls for rapid lowering of the blood pressure, if the blood pressure is lowered too much over a short period of time, other complications, such as renal failure, could occur.
3. A: In an asymptomatic patient with a descending thoracic aortic aneurysm with a diameter of less than 6 cm, medical management is recommended. This includes aggressive blood pressure control with beta-blockers as part of the regimen, surveillance for signs and symptoms, and serial imaging to evaluate growth and structure. Surgery is indicated if the patient is symptomatic, if the descending aortic aneurysm is 6-7 cm or greater, if the aneurysm has an accelerated growth rate, or if there is evidence of dissection.
4. B: Asystole is not a rhythm that can be shocked into regularity. One of the most important parts of advanced cardiac life support is to minimize interruptions in chest compressions. A team member should ensure that the patient has good intravenous access; 1 mg of epinephrine can be given every 3-5 minutes, but chest compressions should continue while this is taking place. The patient may need to have an advanced airway placed, but once again, chest compressions should be continued while preparations are made.
5. B: Stress-induced (takotsubo) cardiomyopathy is characterized by transient systolic dysfunction of the apical segment of the left ventricle (LV), LV apical ballooning, electrocardiographic changes, mild elevation of troponin and cardiac enzymes, and absence of obstructive coronary artery disease. Symptoms may be similar to a myocardial infarction, but the fact that there is only very mild elevation in troponin and the patient's quick recovery should make you think about other options. The combination of characteristic findings described here and the preceding stressor indicates stress-induced cardiomyopathy. It is frequently triggered by an acute medical illness or an intense emotional or physical stress.
Last Updated: 04/18/2018