The cardiac medicine subspecialty is for nurses who already hold a specialty credential and care for acutely ill adult cardiac patients: coronary care, telemetry, heart failure units, the cath lab and electrophysiology. The exam is short, 75 scored questions, all of them clinical judgment, and a revised test plan governs forms taken from November 19, 2026.
A patient with chest pain, ST depression and a troponin rise and fall has no obstructive disease on coronary angiography. The cause is not yet known. To identify it, the nurse should anticipate
Answer and why, all 4 options
When troponin rises with ischemic symptoms but the coronaries are not obstructed (MINOCA), cardiac MRI separates myocarditis, stress cardiomyopathy and embolic or small infarcts by their edema and enhancement patterns.
A treadmill test looks for flow-limiting stenosis, which angiography has already excluded, and it cannot explain the troponin rise.
A calcium score measures plaque burden and adds nothing once angiography has defined the anatomy.
Repeating the angiogram shows the same anatomy. The diagnosis lies in the myocardium, not the epicardial arteries.
Item 1050367
The cardiac medicine exam in twelve lines
From the August 2026 exam handbook, the test plan for exams on or after November 19, 2026, and the board's statistics page, read November 11, 2026.
CMC (Cardiac Medicine Certification), an adult subspecialty credentialCMC is written only after a current specialty credential, joined by a dash, as in PCCN-CMC.
50 of 75 scored questions (67%), in effect since June 1, 2022AACN’s score committee set the passing standard for the November 19, 2026 exam; check the cut-score table if you test on the new plan.AACN may post a new cut score for the Nov 19, 2026 exam (read Nov 11, 2026)
An unencumbered, current RN or APRN license in the US; a current ABSNC- or NCCA-accredited clinical specialty certification in direct adult care; and 1,750 hours with acutely or critically ill adults in 2 years (875 in the last year and 875 with cardiac patients) or 2,000 hours in 5 years (144 in the last year, 1,000 with cardiac patients)AACN’s examples of accepted specialty certifications include CCRN, PCCN, CEN, CMSRN, CNOR, CPAN and ACNPC-AG.
Revised test plan, used from November 19, 2026 and built on AACN’s 2025 study of practiceExams taken through November 18, 2026 follow the previous plan.
The subspecialty is never a first credential. You apply once you hold a current accredited clinical specialty certification and have logged hours with cardiac patients. CCRN and PCCN are the usual bases, but the list of accepted specialties is wider, from CEN to CMSRN (eligibility in full).
What it adds is depth on one patient group. The CCRN (Adult) exam spreads its questions over every adult ICU system and keeps 20% of them for professional caring and ethics; here every scored question is about the cardiac patient: device troubleshooting, hemodynamic numbers, drug holds, complications after a procedure. How the subspecialty is written after your name, and why it stands or falls with the specialty, is on cardiac nursing certifications.
Four sections on the November 2026 plan
Forms from November 19, 2026 onward follow the revised plan, where procedures and drugs together carry 44% of it (procedures and devices and pharmacology each have a page); forms through November 18 keep the older split, with 39% on interventions.
Both plans line by line are on exam facts; the study guide turns the additions into a checklist.
4 cardiac medicine questions to start
Therapeutic Interventions: pharmacology
After midazolam 5 mg IV (no opioid) for a TEE, a patient responds only to painful stimuli. RR is 7/min and SpO₂ 89% on 4 L/min despite stimulation and a jaw thrust. The patient takes no benzodiazepines at home. The nurse should anticipate
Answer and why, all 4 options
Physostigmine reverses central anticholinergic toxicity. It does not antagonize benzodiazepines and can cause bradycardia and bronchospasm.
Naloxone reverses opioids, and no opioid was given. Reaching for it reflexively treats every post-sedation apnea as opioid-driven.
Sugammadex encapsulates rocuronium or vecuronium. No neuromuscular blocker was given, so it does nothing for benzodiazepine sedation.
Midazolam alone caused the oversedation, and stimulation plus a jaw thrust have not fixed the hypoventilation. Flumazenil reverses the benzodiazepine, and the seizure risk is low because the patient does not take benzodiazepines at home.
Item 1105464
Therapeutic Interventions: procedures and devices
A conscious patient wearing a wearable cardioverter-defibrillator has had three alarm episodes today, each during vigorous arm activity, and feels well. The bedside monitor shows sinus rhythm with motion artifact. The nurse should FIRST
Answer and why, all 4 options
Only the conscious wearer should press the response buttons. Teaching a bystander to press them could block a shock during a real arrest.
Changing the detection rate does not fix artifact. It also risks missing a real ventricular arrhythmia, and the problem here is signal noise, not rate.
Repeated alarms only during vigorous arm movement, with sinus rhythm and motion artifact on the monitor, suggest electrode noise from a loose or poorly fitted garment. Checking fit and electrode contact deals with the cause of the false alarms.
Taking the vest off during activity leaves the patient unprotected at the times arrhythmias are most likely, which defeats the purpose of the device.
Item 2033115
Cardiovascular Conditions · 21%
A patient with HFrEF taking carvedilol has HR 72, BP 98/72 mm Hg, cool extremities, new confusion, crackles at both bases and distended neck veins. The nurse should classify the hemodynamic profile as
Answer and why, all 4 options
Warm and wet fits the congestion but ignores the cool skin, narrow pulse pressure and confusion. Those findings mean perfusion is inadequate.
Cool extremities, new confusion and a narrow pulse pressure show poor perfusion, which is the cold profile. Crackles and distended neck veins show congestion, which is the wet profile. Cold and wet usually needs inotropic support plus decongestion.
Warm and dry is the compensated profile. Here both perfusion and congestion are abnormal.
Cold and dry would mean low output without congestion. Crackles and distended neck veins show the patient is volume overloaded.
Item 2033175
Your score: – fills in as you answer; nothing is saved.Doubt a key? Note the item number — how corrections work →
Money, the pass line and the three-year cycle
Fee:$240, or $150 with AACN membership, as of November 2026. Whether joining pays is worked through on cost.
Pass line:50 of 75 scored questions on forms through November 18, 2026. A score committee set the standard for the revised exam, so check the cut-score table if you test later (passing score).
Pass rate:71.31% for first-time candidates in 2025, down from 82.80% in 2023 (the trend).
Retakes:at most 4 attempts in any rolling 12 months, each at the retest price.
Renewal: every 3 years, by cardiac practice hours plus CERPs, or by retesting (renewal).
CMC practice testPractice questions on the revised plan, each option explained
CMC exam factsOld and new test plans, booking, scoring, pass rates, retakes, renewal
CMC costMember and non-member fees, retest, renewal, whether dues pay back
CMC eligibilitySpecialty certification, license and two cardiac hour routes
CMC study guideDevices and drugs first, the lines the revised plan added, AACN's reading list
Asked before applying for the cardiac subspecialty
What does the CMC credential tell an employer?
That a nurse with a current specialty certification has passed the adult cardiac medicine exam and practices with acutely ill cardiac patients. Other fields use the letters for unrelated credentials in care management, consulting and municipal administration, so this site always writes "cardiac medicine" next to them.
Is the cardiac medicine exam harder than the CCRN?
First-time pass rates were close in 2025: 71.31% here and 72.02% for CCRN (Adult), both from the exam statistics page. The subspecialty is shorter and narrower but goes deeper on devices and drugs, and only nurses who already hold a specialty certification can sit it.
When can a cardiac nurse first qualify?
Two conditions have to be met together: a current specialty certification, and 1,750 hours in 2 years, 875 of them with cardiac patients (a five-year route also exists). A cardiac unit nurse who has just earned a CCRN may already have the hours; the details are on eligibility.
Does the revised test plan change the length or the price?
No. The study-of-practice page gives the revised exam 75 scored and 15 pretest questions (study of practice), the certification page still lists $240 and $150 (fees), and the time allowed, 2 hours, comes from the August 2026 handbook.