CCTC CERTIFICATION BUNDLE FINAL
PAPER 2026 COMPLETE QUESTIONS AND
ANSWERS GRADED A+
⩥ What causes a S3 (third heart sound)? Answer: blood flowing from
the atrium into a noncompliant ventricle
-normal in children and adults up to 35-40 y/o
-can suggest HF in older adults
⩥ What causes S4 (fourth heart sound)? Answer: created during atrial
systole as blood flowing into the right or left ventricle is met with
resistance. This resistance to blood flow is due to ventricular
hypertrophy caused by HTN, CAD, cardiomyopathies, aortic stenosis,
etc.
⩥ What is an Opening snap caused by? Answer: high pressure in left
atrium that abruptly displaces or "snaps" open a rigid valve leaflet.
⩥ Systolic click is caused from? Answer: the opening of a rigid and
calcified aortic or pulmonic valve during ventricular contraction
⩥ What causes a heart murmur? Answer: critically narrowed valve
a malfunctioning valve that allow regurgitant blood flow
,congenital defect of the ventricular wall
a defect b/t the aorta and the pulmonary artery
increased flow of blood through a normal structure
⩥ Blood flow through the heart Answer:
⩥ hemodynamic monitoring Answer: -the use of pressure monitoring
devices to directly measure cardiovascular function
-Treatment should be centered around oxygen delivery to tissues and
cells.
-Failure to recognize abnormal findings will lead to tissue death, organ
dysfunction and failure and eventual death.
⩥ where is Hemodynamic monitoring done? Answer: in the OR or ICU
⩥ What are the HCP looking at with hemodynamic monitoring? Answer:
Central venous pressure
pulmonary artery pressure
Arterial pressure
⩥ Components of Hemodynamic Monitoring: Answer: -a disposable
flush system, compose of IV NS solution (which may include heparin),
tubing, stopcocks, and a flush device
,-a pressure bag placed around the flush solution that is maintained at 300
mmHg of pressure. The pressurized flush system delivers 3-5 mL of
solution per hour through the catheter to prevent clotting and backflow
of blood into the pressure monitoring system
-a transducer to convert the pressure coming from the artery or heart
chamber into an electrical signal
-an amplifier or monitor, which increases the size of the electrical signal
for displaying on an oscilloscope
⩥ The phlebostatic Axis- Answer: The reference point for the atrium
when the patient is positioned supine.
⩥ The nurses role for hemodynamic monitoring: Answer: -ensure the
system is set up and maintained properly. Make sure it is patent and free
of air bubbles
-Checking the stopcock of the transducer is positioned at the level of the
atrium before the system is used to obtain pressure measurements. The
nurse uses a marker to identify this level on the chest wall
⩥ Complications from the use of hemodynamic monitoring systems:
Answer: penumothorax
infection
air embolism
⩥ 5 key elements of the central line bundle? Answer: -hand hygiene
, -maximal sterile barrier precautions during line insertion
-chlorhexidine skin antisepsis
-optimal catheter site selection with avoidance of using the femoral vein
for central venous access in adult pts
-daily review of line necessity, with prompt removal of unnecessary
lines
⩥ When should hand hygiene be performed in the care of a pt w/ a
central line? Answer: -before or after palpating the catheter insertion site
-w/ all dressing changes
-when hands are visibly soiled or contaminated
-before donning and after removing gloves
⩥ What are the maximal sterile barrier precautions used during central
line insertion? Answer: -primary provider: wears a cap, mask, sterile
gown, and sterile gloves. Cap should cover all hair, and the mask should
cover the nose and the mouth tightly. Nurses also wear a cap and a mask
-Patient: cover pt from head to toe with a sterile drape, with a small
opening for the site of insertion
⩥ Antiseptic used to prepare the pt's skin for central line insertion?
Answer: -chlorhexidine skin antisepsis
-alcohol chlorhexidine antiseptic applied using a back and forth scrub
for at least 30 sec; this should not be wiped or blotted dry
PAPER 2026 COMPLETE QUESTIONS AND
ANSWERS GRADED A+
⩥ What causes a S3 (third heart sound)? Answer: blood flowing from
the atrium into a noncompliant ventricle
-normal in children and adults up to 35-40 y/o
-can suggest HF in older adults
⩥ What causes S4 (fourth heart sound)? Answer: created during atrial
systole as blood flowing into the right or left ventricle is met with
resistance. This resistance to blood flow is due to ventricular
hypertrophy caused by HTN, CAD, cardiomyopathies, aortic stenosis,
etc.
⩥ What is an Opening snap caused by? Answer: high pressure in left
atrium that abruptly displaces or "snaps" open a rigid valve leaflet.
⩥ Systolic click is caused from? Answer: the opening of a rigid and
calcified aortic or pulmonic valve during ventricular contraction
⩥ What causes a heart murmur? Answer: critically narrowed valve
a malfunctioning valve that allow regurgitant blood flow
,congenital defect of the ventricular wall
a defect b/t the aorta and the pulmonary artery
increased flow of blood through a normal structure
⩥ Blood flow through the heart Answer:
⩥ hemodynamic monitoring Answer: -the use of pressure monitoring
devices to directly measure cardiovascular function
-Treatment should be centered around oxygen delivery to tissues and
cells.
-Failure to recognize abnormal findings will lead to tissue death, organ
dysfunction and failure and eventual death.
⩥ where is Hemodynamic monitoring done? Answer: in the OR or ICU
⩥ What are the HCP looking at with hemodynamic monitoring? Answer:
Central venous pressure
pulmonary artery pressure
Arterial pressure
⩥ Components of Hemodynamic Monitoring: Answer: -a disposable
flush system, compose of IV NS solution (which may include heparin),
tubing, stopcocks, and a flush device
,-a pressure bag placed around the flush solution that is maintained at 300
mmHg of pressure. The pressurized flush system delivers 3-5 mL of
solution per hour through the catheter to prevent clotting and backflow
of blood into the pressure monitoring system
-a transducer to convert the pressure coming from the artery or heart
chamber into an electrical signal
-an amplifier or monitor, which increases the size of the electrical signal
for displaying on an oscilloscope
⩥ The phlebostatic Axis- Answer: The reference point for the atrium
when the patient is positioned supine.
⩥ The nurses role for hemodynamic monitoring: Answer: -ensure the
system is set up and maintained properly. Make sure it is patent and free
of air bubbles
-Checking the stopcock of the transducer is positioned at the level of the
atrium before the system is used to obtain pressure measurements. The
nurse uses a marker to identify this level on the chest wall
⩥ Complications from the use of hemodynamic monitoring systems:
Answer: penumothorax
infection
air embolism
⩥ 5 key elements of the central line bundle? Answer: -hand hygiene
, -maximal sterile barrier precautions during line insertion
-chlorhexidine skin antisepsis
-optimal catheter site selection with avoidance of using the femoral vein
for central venous access in adult pts
-daily review of line necessity, with prompt removal of unnecessary
lines
⩥ When should hand hygiene be performed in the care of a pt w/ a
central line? Answer: -before or after palpating the catheter insertion site
-w/ all dressing changes
-when hands are visibly soiled or contaminated
-before donning and after removing gloves
⩥ What are the maximal sterile barrier precautions used during central
line insertion? Answer: -primary provider: wears a cap, mask, sterile
gown, and sterile gloves. Cap should cover all hair, and the mask should
cover the nose and the mouth tightly. Nurses also wear a cap and a mask
-Patient: cover pt from head to toe with a sterile drape, with a small
opening for the site of insertion
⩥ Antiseptic used to prepare the pt's skin for central line insertion?
Answer: -chlorhexidine skin antisepsis
-alcohol chlorhexidine antiseptic applied using a back and forth scrub
for at least 30 sec; this should not be wiped or blotted dry
