CVICU CCRN/CSC Certification Exam — 300
Questions &Answers with rationales | latest
update
Topics Covered: Hemodynamics & Monitoring | Dysrhythmias & 12-Lead ECG |
Pharmacology (Drips, Pressors, Antiarrhythmics) | Mechanical Circulatory Support
(IABP, Impella, LVAD, VA-ECMO, VV-ECMO) | Heart Failure & Cardiogenic Shock |
Valvular Disease | Cardiac Transplant | Cardiac Surgery Post-op Care | Advanced Clinical
Integration
HEMODYNAMICS & MONITORING
1. A nurse is interpreting a pulmonary artery catheter (PAC). The following values are
obtained: CO 3.2 L/min, BSA 1.8 m², HR 110, BP 88/60. Which calculated value best
reflects the severity of this client's hemodynamic compromise?
A) MAP of 69 mmHg B) Cardiac index (CI) of 1.78 L/min/m² ✅ (Correct Answer) C) Heart
rate of 110 bpm D) Pulse pressure of 28 mmHg
Rationale: Cardiac Index (CI = CO/BSA) = 3.2/1.8 = 1.78 L/min/m². Normal CI is 2.2–4.0
L/min/m². A CI <2.2 indicates low cardiac output state. A CI <1.8 is consistent with
cardiogenic shock. CI is superior to raw CO because it accounts for body size, making it
the best indicator of hemodynamic adequacy per the CCRN/CSC framework.
2. A CVICU nurse is zeroing a pulmonary artery catheter. At which anatomical landmark
should the transducer be leveled?
A) Sternal notch B) Midaxillary line at the 4th intercostal space (phlebostatic axis) ✅ (Correct
Answer) C) Anterior axillary line at the 2nd intercostal space D) Midclavicular line at the 5th
intercostal space
Rationale: The phlebostatic axis (midaxillary line at the 4th ICS) corresponds to the level of
the right atrium and is the standard reference point for zeroing all hemodynamic
,transducers. Incorrect positioning causes erroneous readings: transducer too low falsely
elevates pressures; too high falsely lowers them.
3. A client has the following PAC readings: RAP 18 mmHg, PAOP 22 mmHg, PAP 48/28
mmHg, CO 2.8 L/min, SVR 1,800 dynes/sec/cm⁻⁵. Which hemodynamic profile is this
consistent with?
A) Distributive (septic) shock B) Hypovolemic shock C) Cardiogenic shock ✅ (Correct
Answer) D) Obstructive shock
Rationale: Cardiogenic shock is characterized by: elevated filling pressures (PAOP >18,
RAP elevated), low CO/CI, and high SVR (compensatory vasoconstriction). Distributive
shock features low SVR, high CO. Hypovolemic shock shows low filling pressures with low
CO. Obstructive shock (e.g., tamponade) shows equalization of pressures.
4. A nurse notes that the PAOP waveform shows giant V waves. Which condition should
the nurse associate this finding with?
A) Tricuspid regurgitation B) Aortic stenosis C) Mitral regurgitation ✅ (Correct Answer) D)
Pulmonary hypertension
Rationale: Giant V waves in the PAOP tracing result from acute mitral regurgitation
(MR). During systole, blood regurgitates backward through the incompetent mitral valve
into the left atrium, causing a dramatic rise in left atrial pressure that is transmitted back
to the PA catheter as a large V wave. This is also seen in severe MR from papillary muscle
rupture post-MI.
5. A PAC is being floated. The nurse observes the following waveform sequence: low-
amplitude pressure tracing → pressure increases with dicrotic notch → pressure drops
then rises with respiratory variation. Which sequence correctly identifies catheter position
progression?
A) RV → RA → PA → PAOP B) RA → RV → PA → PAOP ✅ (Correct Answer) C) RA →
PA → RV → PAOP D) PA → RA → RV → PAOP
Rationale: During PAC insertion: RA (low amplitude, a/c/v waves, ~2–8 mmHg mean) →
RV (high systolic, low diastolic, ~25/0–5 mmHg, no dicrotic notch) → PA (high systolic,
elevated diastolic with dicrotic notch, ~25/10 mmHg) → PAOP (low pressure, respiratory
variation, matches LAP, ~6–12 mmHg). Recognizing this sequence prevents complications.
,6. A client post-CABG has the following hemodynamics: CO 4.5 L/min, HR 88, BP 96/58,
SVR 680 dynes/sec/cm⁻⁵, PAOP 8 mmHg. Which condition does this hemodynamic profile
suggest?
A) Cardiogenic shock B) Cardiac tamponade C) Vasodilatory (distributive) shock ✅ (Correct
Answer) D) Volume overload
Rationale: Post-cardiac surgery vasoplegic syndrome (distributive/vasodilatory shock)
features low SVR (normal 800–1,200), normal-to-high CO, low PAOP (relative
hypovolemia), and hypotension despite adequate cardiac function. This results from
systemic inflammatory response to cardiopulmonary bypass (CPB). Vasopressors
(norepinephrine, vasopressin) are the treatment.
7. Which of the following is the correct formula for calculating Systemic Vascular
Resistance (SVR)?
A) SVR = (MAP – CVP) / CO × 80 B) SVR = (MAP – RAP) / CO × 80 ✅ (Correct Answer)
C) SVR = CO / BSA D) SVR = (PAOP – RAP) / CO × 80
Rationale: SVR = (MAP – RAP) / CO × 80 (normal: 800–1,200 dynes/sec/cm⁻⁵). The 80
converts from mmHg/L/min to dynes/sec/cm⁻⁵. RAP (right atrial pressure) represents the
downstream pressure. MAP is the driving pressure. SVR reflects left ventricular afterload.
PVR uses mean PAP and PAOP: PVR = (mean PAP – PAOP) / CO × 80.
8. A client's arterial line waveform shows a pulsus paradoxus of 18 mmHg. Which
condition is most likely?
A) Aortic regurgitation B) Hypertensive crisis C) Cardiac tamponade ✅ (Correct Answer) D)
IABP malfunction
Rationale: Pulsus paradoxus is an exaggerated (>10 mmHg) drop in systolic BP during
inspiration. In cardiac tamponade, pericardial fluid causes exaggerated ventricular
interdependence — during inspiration, RV filling increases (via increased venous return),
shifting the septum leftward and reducing LV filling, dropping systolic BP. It is also seen in
severe COPD and tension pneumothorax.
9. A CVICU nurse is caring for a client with a CVP of 22 mmHg and a PAOP of 24 mmHg.
Which of the following would be most consistent with cardiac tamponade?
, A) Wide pulse pressure and bounding pulses B) Equalization of diastolic pressures (RAP = RV
diastolic = PAOP) ✅ (Correct Answer) C) Low CVP with high PAOP D) Elevated CO with
low SVR
Rationale: Cardiac tamponade is pathognomonic for equalization of diastolic filling
pressures: RAP ≈ RV diastolic ≈ PAOP ≈ PAD (all within 4–5 mmHg of each other). This
occurs because pericardial fluid compresses all cardiac chambers equally. Beck's triad
(hypotension, JVD, muffled heart sounds) and pulsus paradoxus also help identify
tamponade.
10. A client's mixed venous oxygen saturation (SvO₂) via PAC drops from 72% to 54%.
Which interpretation is correct?
A) Increased oxygen delivery or decreased oxygen consumption B) Adequate cardiac reserve
with normal oxygen extraction C) Oxygen delivery is inadequate relative to metabolic demand
— cardiac output is likely falling ✅ (Correct Answer) D) The PAC is wedged and the reading
is inaccurate
Rationale: SvO₂ (normal 60–80%) reflects the balance between oxygen delivery (DO₂) and
consumption (VO₂). A falling SvO₂ (<60%) indicates that tissues are extracting more
oxygen because delivery is inadequate (low CO, low SaO₂, low Hgb) or consumption is
increased (fever, pain, sepsis). An SvO₂ <50% indicates critical oxygen imbalance.
11. Which of the following correctly describes a "damped" arterial line waveform and its
most common cause?
A) Exaggerated waveform with wide pulse pressure — caused by dysrhythmia B) Low-
amplitude, rounded waveform with absent dicrotic notch — caused by air bubble, clot, or kinked
tubing ✅ (Correct Answer) C) Narrow, spiked waveform — caused by excessive flushing D)
Bifid waveform — caused by aortic stenosis
Rationale: A damped arterial line waveform has a low amplitude, rounded appearance,
and absent or diminished dicrotic notch, resulting in falsely low systolic and falsely high
diastolic readings. Common causes: air bubble in the line, blood clot at the tip, kinked
catheter, or loose connection. The square wave test (fast flush) confirms damping —
waveform returns slowly rather than immediately.
12. A nurse is calculating the oxygen delivery index (DO₂I) for a CVICU client. Which
formula is correct?
Questions &Answers with rationales | latest
update
Topics Covered: Hemodynamics & Monitoring | Dysrhythmias & 12-Lead ECG |
Pharmacology (Drips, Pressors, Antiarrhythmics) | Mechanical Circulatory Support
(IABP, Impella, LVAD, VA-ECMO, VV-ECMO) | Heart Failure & Cardiogenic Shock |
Valvular Disease | Cardiac Transplant | Cardiac Surgery Post-op Care | Advanced Clinical
Integration
HEMODYNAMICS & MONITORING
1. A nurse is interpreting a pulmonary artery catheter (PAC). The following values are
obtained: CO 3.2 L/min, BSA 1.8 m², HR 110, BP 88/60. Which calculated value best
reflects the severity of this client's hemodynamic compromise?
A) MAP of 69 mmHg B) Cardiac index (CI) of 1.78 L/min/m² ✅ (Correct Answer) C) Heart
rate of 110 bpm D) Pulse pressure of 28 mmHg
Rationale: Cardiac Index (CI = CO/BSA) = 3.2/1.8 = 1.78 L/min/m². Normal CI is 2.2–4.0
L/min/m². A CI <2.2 indicates low cardiac output state. A CI <1.8 is consistent with
cardiogenic shock. CI is superior to raw CO because it accounts for body size, making it
the best indicator of hemodynamic adequacy per the CCRN/CSC framework.
2. A CVICU nurse is zeroing a pulmonary artery catheter. At which anatomical landmark
should the transducer be leveled?
A) Sternal notch B) Midaxillary line at the 4th intercostal space (phlebostatic axis) ✅ (Correct
Answer) C) Anterior axillary line at the 2nd intercostal space D) Midclavicular line at the 5th
intercostal space
Rationale: The phlebostatic axis (midaxillary line at the 4th ICS) corresponds to the level of
the right atrium and is the standard reference point for zeroing all hemodynamic
,transducers. Incorrect positioning causes erroneous readings: transducer too low falsely
elevates pressures; too high falsely lowers them.
3. A client has the following PAC readings: RAP 18 mmHg, PAOP 22 mmHg, PAP 48/28
mmHg, CO 2.8 L/min, SVR 1,800 dynes/sec/cm⁻⁵. Which hemodynamic profile is this
consistent with?
A) Distributive (septic) shock B) Hypovolemic shock C) Cardiogenic shock ✅ (Correct
Answer) D) Obstructive shock
Rationale: Cardiogenic shock is characterized by: elevated filling pressures (PAOP >18,
RAP elevated), low CO/CI, and high SVR (compensatory vasoconstriction). Distributive
shock features low SVR, high CO. Hypovolemic shock shows low filling pressures with low
CO. Obstructive shock (e.g., tamponade) shows equalization of pressures.
4. A nurse notes that the PAOP waveform shows giant V waves. Which condition should
the nurse associate this finding with?
A) Tricuspid regurgitation B) Aortic stenosis C) Mitral regurgitation ✅ (Correct Answer) D)
Pulmonary hypertension
Rationale: Giant V waves in the PAOP tracing result from acute mitral regurgitation
(MR). During systole, blood regurgitates backward through the incompetent mitral valve
into the left atrium, causing a dramatic rise in left atrial pressure that is transmitted back
to the PA catheter as a large V wave. This is also seen in severe MR from papillary muscle
rupture post-MI.
5. A PAC is being floated. The nurse observes the following waveform sequence: low-
amplitude pressure tracing → pressure increases with dicrotic notch → pressure drops
then rises with respiratory variation. Which sequence correctly identifies catheter position
progression?
A) RV → RA → PA → PAOP B) RA → RV → PA → PAOP ✅ (Correct Answer) C) RA →
PA → RV → PAOP D) PA → RA → RV → PAOP
Rationale: During PAC insertion: RA (low amplitude, a/c/v waves, ~2–8 mmHg mean) →
RV (high systolic, low diastolic, ~25/0–5 mmHg, no dicrotic notch) → PA (high systolic,
elevated diastolic with dicrotic notch, ~25/10 mmHg) → PAOP (low pressure, respiratory
variation, matches LAP, ~6–12 mmHg). Recognizing this sequence prevents complications.
,6. A client post-CABG has the following hemodynamics: CO 4.5 L/min, HR 88, BP 96/58,
SVR 680 dynes/sec/cm⁻⁵, PAOP 8 mmHg. Which condition does this hemodynamic profile
suggest?
A) Cardiogenic shock B) Cardiac tamponade C) Vasodilatory (distributive) shock ✅ (Correct
Answer) D) Volume overload
Rationale: Post-cardiac surgery vasoplegic syndrome (distributive/vasodilatory shock)
features low SVR (normal 800–1,200), normal-to-high CO, low PAOP (relative
hypovolemia), and hypotension despite adequate cardiac function. This results from
systemic inflammatory response to cardiopulmonary bypass (CPB). Vasopressors
(norepinephrine, vasopressin) are the treatment.
7. Which of the following is the correct formula for calculating Systemic Vascular
Resistance (SVR)?
A) SVR = (MAP – CVP) / CO × 80 B) SVR = (MAP – RAP) / CO × 80 ✅ (Correct Answer)
C) SVR = CO / BSA D) SVR = (PAOP – RAP) / CO × 80
Rationale: SVR = (MAP – RAP) / CO × 80 (normal: 800–1,200 dynes/sec/cm⁻⁵). The 80
converts from mmHg/L/min to dynes/sec/cm⁻⁵. RAP (right atrial pressure) represents the
downstream pressure. MAP is the driving pressure. SVR reflects left ventricular afterload.
PVR uses mean PAP and PAOP: PVR = (mean PAP – PAOP) / CO × 80.
8. A client's arterial line waveform shows a pulsus paradoxus of 18 mmHg. Which
condition is most likely?
A) Aortic regurgitation B) Hypertensive crisis C) Cardiac tamponade ✅ (Correct Answer) D)
IABP malfunction
Rationale: Pulsus paradoxus is an exaggerated (>10 mmHg) drop in systolic BP during
inspiration. In cardiac tamponade, pericardial fluid causes exaggerated ventricular
interdependence — during inspiration, RV filling increases (via increased venous return),
shifting the septum leftward and reducing LV filling, dropping systolic BP. It is also seen in
severe COPD and tension pneumothorax.
9. A CVICU nurse is caring for a client with a CVP of 22 mmHg and a PAOP of 24 mmHg.
Which of the following would be most consistent with cardiac tamponade?
, A) Wide pulse pressure and bounding pulses B) Equalization of diastolic pressures (RAP = RV
diastolic = PAOP) ✅ (Correct Answer) C) Low CVP with high PAOP D) Elevated CO with
low SVR
Rationale: Cardiac tamponade is pathognomonic for equalization of diastolic filling
pressures: RAP ≈ RV diastolic ≈ PAOP ≈ PAD (all within 4–5 mmHg of each other). This
occurs because pericardial fluid compresses all cardiac chambers equally. Beck's triad
(hypotension, JVD, muffled heart sounds) and pulsus paradoxus also help identify
tamponade.
10. A client's mixed venous oxygen saturation (SvO₂) via PAC drops from 72% to 54%.
Which interpretation is correct?
A) Increased oxygen delivery or decreased oxygen consumption B) Adequate cardiac reserve
with normal oxygen extraction C) Oxygen delivery is inadequate relative to metabolic demand
— cardiac output is likely falling ✅ (Correct Answer) D) The PAC is wedged and the reading
is inaccurate
Rationale: SvO₂ (normal 60–80%) reflects the balance between oxygen delivery (DO₂) and
consumption (VO₂). A falling SvO₂ (<60%) indicates that tissues are extracting more
oxygen because delivery is inadequate (low CO, low SaO₂, low Hgb) or consumption is
increased (fever, pain, sepsis). An SvO₂ <50% indicates critical oxygen imbalance.
11. Which of the following correctly describes a "damped" arterial line waveform and its
most common cause?
A) Exaggerated waveform with wide pulse pressure — caused by dysrhythmia B) Low-
amplitude, rounded waveform with absent dicrotic notch — caused by air bubble, clot, or kinked
tubing ✅ (Correct Answer) C) Narrow, spiked waveform — caused by excessive flushing D)
Bifid waveform — caused by aortic stenosis
Rationale: A damped arterial line waveform has a low amplitude, rounded appearance,
and absent or diminished dicrotic notch, resulting in falsely low systolic and falsely high
diastolic readings. Common causes: air bubble in the line, blood clot at the tip, kinked
catheter, or loose connection. The square wave test (fast flush) confirms damping —
waveform returns slowly rather than immediately.
12. A nurse is calculating the oxygen delivery index (DO₂I) for a CVICU client. Which
formula is correct?
