Change ahead : Revised CMC test plan from AACN’s 2025 study of practice · AACN
Cardiac procedures and devices, before and after
CMC · Section III · procedures and devices
Section III is the largest part of the revised exam, 44% shared between procedures and drugs, and the board publishes no split between the two. This page takes the procedures and devices; pharmacology has its own page.
Listed by area, as the plan groups them (test plan, p. 2):
Cardiac: right and left heart catheterization, PCI, pericardiocentesis, intra-aortic balloon pumps, temporary and durable VADs, structural procedures such as TAVR and TMVR.
Vascular: peripheral and carotid angiography and interventions, endovascular grafts and stents, catheter-directed thrombolysis.
Electrophysiology: temporary and permanent pacing, cardiac resynchronization, implantable and wearable defibrillators, ablation, cardioversion and defibrillation.
Respiratory: noninvasive and mechanical ventilation, pleural chest tubes and drains, oxygen delivery devices.
Renal and multisystem: renal replacement therapy, targeted temperature management, palliative and end-of-life care, cardiac rehabilitation.
18 questions on procedures and devices
0 of 18 attempted · 0 correct · 0 missed
Therapeutic Interventions: procedures and devices
During a treadmill stress test, a patient develops 3-mm horizontal ST depression in V3–V5 at a low workload and systolic BP falls 15 mm Hg. The nurse should anticipate
Answer and why, all 4 options
Repeating the test in 6 months leaves a high-risk ischemic finding untreated.
A calcium score measures plaque burden in patients without symptoms. It adds nothing after a strongly positive functional test.
Medical therapy alone fits a low-risk result. A drop in BP with exercise is a high-risk feature.
Marked horizontal ST depression at a low workload with a fall in systolic BP during exercise marks a high-risk result that suggests left main or multivessel disease. It calls for coronary angiography.
Item 1047777
Therapeutic Interventions: procedures and devices
A patient with metastatic lung cancer has worsening dyspnea. HR is 118 and BP 94/78 mm Hg. The ECG shows low QRS voltage, and the QRS amplitude alternates from beat to beat. The nurse should anticipate preparation for
Answer and why, all 4 options
Thoracentesis drains pleural fluid. Electrical alternans and low voltage point to the pericardium.
Electrical alternans with low voltage, tachycardia and a narrow pulse pressure in a patient with cancer point to a large effusion with tamponade. Pericardiocentesis relieves it.
An inotrope cannot overcome external compression of the heart. Filling, not contractility, is the problem.
Diuresis lowers preload, which the compressed heart depends on, and can cause collapse in tamponade.
Item 1048743
Therapeutic Interventions: procedures and devices
An 84-year-old patient with severe symptomatic aortic stenosis (mean gradient 48 mm Hg) and suitable femoral arteries is evaluated by the heart team. The nurse should anticipate
Answer and why, all 4 options
For a patient over 80 with severe symptomatic aortic stenosis and suitable femoral access, transfemoral TAVR is the guideline-preferred treatment.
Balloon valvuloplasty is a temporary bridge because restenosis is common. It is not final therapy.
No drug relieves fixed aortic obstruction, and nitrates can cause dangerous hypotension in severe AS.
Surgical replacement is favored in younger, lower-risk patients. At 84, TAVR is preferred when femoral access is suitable.
Item 1049390
Therapeutic Interventions: procedures and devices
A patient with an inferior STEMI is in cardiogenic shock. Angiography shows an occluded RCA plus 80% stenoses in the LAD and circumflex arteries. During primary PCI, the nurse should anticipate
Answer and why, all 4 options
Immediate multivessel PCI in shock raised 30-day death or dialysis in CULPRIT-SHOCK. It adds contrast and procedure time.
In cardiogenic shock with multivessel disease, PCI of the culprit lesion only, with staged treatment of other lesions if needed, lowers death and renal failure compared with immediate multivessel PCI, based on the CULPRIT-SHOCK trial.
Deferring reperfusion in shock is harmful. Opening the culprit artery is the definitive treatment.
Routine IABP before PCI did not improve survival in AMI shock in IABP-SHOCK II.
Item 1050353
Therapeutic Interventions: procedures and devices
During angiography, a 60% stenosis of the circumflex has an FFR of 0.88 in a patient with stable angina. The nurse should anticipate
Answer and why, all 4 options
An FFR above 0.80 means the stenosis is not limiting flow. Deferring PCI and continuing medical therapy is safe, as the FAME trials showed.
Adenosine dosing was adequate, and repeating the measurement looks for a different answer rather than acting on a clear one.
Surgery for a single nonsignificant lesion is not indicated.
Stenting a lesion that does not limit flow adds procedural and stent risk without benefit.
Item 1051250
Therapeutic Interventions: procedures and devices
A patient on peripheral VA-ECMO for cardiogenic shock has an arterial pulse pressure that has fallen to 3 mm Hg, PAOP 32 mm Hg, and pink frothy secretions. Echo shows a distended LV with an aortic valve that no longer opens. The nurse should anticipate
Answer and why, all 4 options
Sweep gas controls CO₂ removal by the oxygenator. It has no effect on LV pressure or distension.
A diuretic may ease lung water but does not unload a ventricle that cannot eject against ECMO flow, so relying on it alone leaves the cause in place.
Peripheral VA-ECMO returns blood retrogradely into the aorta and raises LV afterload. A weak ventricle that can no longer open the aortic valve distends, causing pulmonary edema and risking stasis thrombus. The LV must be unloaded, for example with a microaxial pump.
Higher ECMO flow raises retrograde aortic pressure further and makes the LV distension worse.
Item 1051534
Therapeutic Interventions: procedures and devices
A patient with cardiorenal syndrome on CRRT has a net fluid removal of 200 mL/h. Over the last hour, BP has fallen from 108/64 to 80/46 and HR has risen to 122. The nurse should FIRST
Answer and why, all 4 options
A higher blood flow raises clearance but does not treat volume depletion, and it can worsen instability.
Hypotension and tachycardia during CRRT suggest fluid is being removed faster than the vascular space can refill. Lowering the net ultrafiltration rate is the first fix.
A diuretic removes even more volume from a patient who is already hypotensive from fluid removal.
Intermittent hemodialysis removes fluid even faster and is worse tolerated in an unstable patient.
Item 1102465
Therapeutic Interventions: procedures and devices
A patient with a dual-chamber pacemaker placed 3 years ago for complete heart block has new exertional dyspnea. Interrogation shows RV pacing 98% of the time, and echo shows LVEF 35% (60% before implant). Coronary angiography is normal. The nurse should anticipate
Answer and why, all 4 options
Battery wear causes loss of capture or reaches the replacement indicator. It does not explain a dyssynchronous, weakened ventricle.
A lower rate does not reduce pacing in complete heart block, because the patient has no reliable intrinsic rhythm.
A fall in LVEF after years of near-constant RV pacing, with normal coronaries, is pacing-induced cardiomyopathy. Upgrading to biventricular pacing restores synchronous contraction.
Turning off the atrial lead removes AV synchrony and leaves the dyssynchrony from RV pacing in place.
Item 1103649
Therapeutic Interventions: procedures and devices
A patient has had three episodes of typical (counterclockwise) atrial flutter in 6 months despite rate control, each needing cardioversion. LVEF is normal. The patient asks about a long-term solution. The nurse should anticipate
Answer and why, all 4 options
Long-term amiodarone carries organ toxicity and is less effective than ablation for typical flutter.
AV node ablation with pacing controls the rate but leaves the flutter and creates lifelong pacemaker dependence.
Repeated cardioversion treats each episode without preventing recurrence.
Typical counterclockwise flutter depends on a circuit through the cavotricuspid isthmus. Ablating that isthmus cures most patients and is the preferred long-term option after recurrence.
Item 1103791
Therapeutic Interventions: procedures and devices
Four patients with heart failure are discussed for hospice referral. Which patient MOST clearly meets hospice eligibility?
Answer and why, all 4 options
NYHA class IV symptoms at rest, despite therapy, in a patient who declines advanced therapies such as LVAD or transplant meet hospice criteria for heart failure.
A patient who is improving with GDMT titration is still benefiting from disease-directed therapy.
A patient listed and awaiting LVAD surgery is pursuing advanced therapy, which conflicts with hospice.
A low LVEF alone does not make someone hospice-eligible. Class II symptoms with full-time work show good function.
Item 1104438
Therapeutic Interventions: procedures and devices
Four weeks after discharge for HFrEF, a patient is stable with NYHA class II symptoms on GDMT and asks whether exercise is safe. The nurse should
Answer and why, all 4 options
Restricting a stable patient to self-care leads to deconditioning.
Unsupervised high-intensity running is not the starting point. Exercise begins with a supervised, individualized prescription.
Supervised cardiac rehabilitation is recommended for stable HFrEF. It improves exercise capacity and quality of life and reduces hospitalizations.
Waiting for the LVEF to normalize withholds a proven therapy. Many patients never normalize, and rehab is safe in stable HFrEF.
Item 1104564
Therapeutic Interventions: procedures and devices
Two hours after transvenous lead extraction for an infected ICD system, which assessment finding requires the nurse's IMMEDIATE intervention?
Answer and why, all 4 options
A low-grade temperature of 37.7 °C is expected after removing an infected system and is not an emergency.
Moderate pocket tenderness is expected after extraction and can be treated with analgesia.
Some serosanguineous drainage from the pocket is expected early after the procedure.
New jugular venous distention after lead extraction suggests tamponade from a tear in the vein or heart wall. This is the most serious extraction complication and needs immediate action.
Item 1104596
Therapeutic Interventions: procedures and devices
A patient's pleural chest tube for a pneumothorax, which had an active air leak, is accidentally pulled out during repositioning. The nurse should FIRST
Answer and why, all 4 options
Reinserting a contaminated tube through the same opening is not a nursing action and risks infection.
A chest radiograph is needed, but covering the open site comes first so air does not enter the chest.
Sealing all 4 sides over a lung that is still leaking air traps the air and can cause a tension pneumothorax.
With an active air leak, covering the site with a dressing taped on 3 sides lets air escape on expiration while limiting air entry on inspiration. That reduces the risk of a tension pneumothorax until the tube is replaced.
Item 1104781
Therapeutic Interventions: procedures and devices
A patient in cardiogenic shock is on an IABP triggered from the arterial waveform. The pulse pressure has narrowed to 8 mm Hg, and the console alarms "trigger lost." The monitor shows sinus rhythm at 96 with clear R waves. The nurse should
Answer and why, all 4 options
More fill volume does not help the console sense the cardiac cycle.
With a narrow pulse pressure, the arterial waveform cannot trigger reliably. A clear ECG with distinct R waves is a better trigger source.
Internal triggering is asynchronous and is used only when there is no cardiac activity. It is unsafe in sinus rhythm.
Reducing the ratio decreases support but does not fix the trigger.
Item 2032571
Therapeutic Interventions: procedures and devices
A patient with an ICD felt lightheaded, briefly lost consciousness, and then received a single shock. The patient is now alert in sinus rhythm with BP 118/72. The nurse should anticipate
Answer and why, all 4 options
Temporary pacing is for symptomatic bradycardia. The patient is in sinus rhythm after a tachyarrhythmia shock.
A magnet suspends tachycardia therapies. It is used for repeated inappropriate shocks, not after one appropriate shock in a stable patient.
Syncope followed by one shock suggests an appropriate shock for VT or VF, and the patient is now stable. The next steps are device interrogation to confirm the rhythm and therapy, plus potassium and magnesium as reversible triggers.
An amiodarone infusion may follow if interrogation shows recurrent VT. Starting it before knowing what the device treated skips the diagnosis.
Item 2032689
Therapeutic Interventions: procedures and devices
Six hours after catheter ablation for SVT, the monitor shows short, self-terminating runs of the same SVT. The patient reports palpitations, and BP is 124/76. The nurse should
Answer and why, all 4 options
An amiodarone load is excessive for stable, self-limited SVT.
Short, self-limited runs of the same SVT in a stable patient soon after ablation may mean the pathway was not fully eliminated. The nurse keeps monitoring and reports it so the team can decide on next steps.
A repeat ablation is not done urgently for brief, self-terminating runs in a stable patient.
Adenosine treats a sustained run. These runs end on their own, so a dose for each one adds side effects without benefit.
Item 2032707
Therapeutic Interventions: procedures and devices
Two days after an inferior MI, a patient is in cardiogenic shock. Echo shows a hyperdynamic left ventricle with a flail posterior mitral leaflet. The nurse should anticipate
Answer and why, all 4 options
A flail mitral leaflet with shock two days after an inferior MI means papillary muscle rupture. IABP lowers afterload and regurgitant flow as a bridge to urgent surgery, which is the definitive repair.
Beta-blockade lowers contractility in a patient in cardiogenic shock and can cause collapse.
Waiting 24 hours to re-image delays urgent surgery for a lethal mechanical complication.
A fluid bolus raises left atrial pressure and pulmonary edema in acute severe MR.
Item 2033017
Therapeutic Interventions: procedures and devices
During temperature control at 33 °C after cardiac arrest, a patient develops visible shivering. BP is 150/90 mm Hg and HR 110. The nurse should FIRST
Answer and why, all 4 options
A lower target makes the body work harder to make heat and worsens shivering.
A neuromuscular blocker is the last step for shivering that persists. It also masks seizures.
Stopping the device lets the temperature drift and fever develop, which loses the protective effect.
Shivering raises metabolic demand and fights the cooling device. Among these options, deepening the ordered sedation and analgesia is the first escalation, after or alongside simple measures such as skin counterwarming.
Item 2033018
Your score: – fills in as you answer; nothing is saved.Doubt a key? Note the item number — how corrections work →
Device and procedure details that decide answers
Balloon pump timing. Inflation belongs at the dicrotic notch and deflation just before the next systole. Deflating late leaves the balloon up as the ventricle ejects and raises afterload; inflating early closes the aortic valve before ejection ends.
Balloon position. A weaker left radial pulse suggests the balloon has moved up toward the left subclavian artery; falling urine output suggests it has slipped down over the renal arteries.
A magnet on the wrong device. Over an ICD, a magnet suspends shocks and antitachycardia pacing but leaves bradycardia pacing alone; over a pacemaker it switches to asynchronous pacing.
Capture against sensing. A pacing spike with no complex after it is failure to capture; spikes where the patient's own beats should have inhibited them are failure to sense.
Bleeding you cannot see. After femoral access, back or flank pain with falling pressure points to a retroperitoneal bleed even with a clean site; a pulsatile mass with a bruit is a pseudoaneurysm.
A pulse check on a continuous-flow LVAD. Many patients have no palpable pulse; pressure is taken by Doppler and read together with the pump's flow and power.
A new focal deficit after TAVR or catheterization: a stroke, covered on SCRN hyperacute care.
Open-heart surgery and the first 48 hours after it: the CSC subspecialty, not covered here yet. Percutaneous procedures and their aftercare stay on this page.
The revised plan names temporary and durable ventricular assist devices and lists managing temporary mechanical circulatory support among its testable nursing actions. It does not name brands.
Do I need cath lab experience?
No. The plan tests care before and after a procedure, and the hours requirement asks for time with adult cardiac patients, not time in a lab.