CVICU Competency Exam
Hemodynamics and Post-Operative Management
Total Questions: 75
Time Allowed: As per institutional policy
Passing Score: As per institutional policy
Certification Alignment: AACN CCRN / CSC Blueprints
Exam Section Distribution
Section Questions Topic Focus
Hemodynamic Monitoring & 1-15 CVP, PAP, PCWP, Arterial
Waveform Interpretation Lines, CO/CI, SVR, SvO₂
Vasoactive & Inotropic 16-27 Norepinephrine, Epinephrine,
Medications Milrinone, Dobutamine,
Vasopressin
Mechanical Ventilation in 28-35 Settings, Weaning, PEEP,
Cardiac Patients Complications, Post-Op
Ventilation
Post-Cardiac Surgery 36-50 CABG, Valve Surgery, LVAD,
Recovery Transplant, Bleeding,
Tamponade
Arrhythmia Recognition & 51-60 AFib, VT/VF, Heart Blocks,
Management Pacing, Cardioversion,
Defibrillation
Acute Coronary Syndrome 61-68 STEMI, NSTEMI, Reperfusion,
Post-PCI Care, Complications
Mechanical Circulatory 69-75 IABP, Impella, ECMO –
Support Indications, Troubleshooting,
Weaning
,SECTION 1: Hemodynamic Monitoring & Waveform Interpretation
Q1: A patient in the CVICU has a pulmonary artery catheter. The waveform shows a gradual
upstroke, a peak systolic pressure of 25 mmHg, a dicrotic notch, and an end-diastolic pressure of
10 mmHg. This waveform is located in which cardiac/vascular structure?
A. Right atrium
B. Right ventricle
C. Pulmonary artery [CORRECT]
D. Pulmonary capillary wedge position
Correct Answer: C
Rationale: Correct because the pulmonary artery waveform has a gradual systolic upstroke
(vs. sharp RV upstroke), dicrotic notch (pulmonic valve closure), and diastolic decay.
Q2: A post-operative CABG patient has a cardiac index of 1.8 L/min/m², MAP of 55 mmHg, CVP
of 2 mmHg, and PCWP of 5 mmHg. The most appropriate initial intervention is:
A. Start norepinephrine infusion
B. Administer fluid bolus [CORRECT]
C. Start dobutamine infusion
D. Place patient in Trendelenburg position
Correct Answer: B
Rationale: Correct because low PCWP (5 mmHg) and low CVP (2 mmHg) indicate hypovolemia
as cause of low cardiac index and hypotension; fluid resuscitation is first-line.
Q3: An arterial line waveform appears overdamped. Which finding would confirm this?
A. Overshoot of the systolic peak with ringing artifact
B. Slurred upstroke, loss of dicrotic notch, and delayed systolic peak [CORRECT]
C. Normal square wave test
D. Systolic pressure artificially elevated
Correct Answer: B
Rationale: Correct because overdamped waveform shows slow upstroke, absent or rounded
dicrotic notch, and underestimation of systolic pressure; caused by air bubbles, clots, or
kinked tubing.
Q4: The CVP waveform shows a prominent v wave during inspiration. This finding is most
consistent with:
A. Hypovolemia
B. Right ventricular failure [CORRECT]
C. Tricuspid stenosis
, D. Pulmonary hypertension
Correct Answer: B
Rationale: Correct because elevated CVP with prominent v waves indicates right ventricular
failure or tricuspid regurgitation; v wave reflects atrial filling against a non-compliant right
ventricle.
Q5: A PA catheter is advanced from the pulmonary artery into the wedge position. The balloon
is deflated, but the waveform remains wedged. The nurse should first:
A. Continue to monitor the patient
B. Pull the catheter back 2-3 cm [CORRECT]
C. Flush the catheter with heparinized saline
D. Inflate the balloon further
Correct Answer: B
Rationale: Correct because an overwedged tracing indicates the catheter tip has migrated too
far distally; gentle withdrawal 2-3 cm restores PA waveform and prevents pulmonary artery
rupture.
Q6: A patient has an arterial line placed. The transducer is leveled at the phlebostatic axis (4th
intercostal space, mid-axillary line). If the transducer is moved 10 cm above the phlebostatic
axis, the measured pressure will:
A. Increase by approximately 7.5 mmHg
B. Decrease by approximately 7.5 mmHg [CORRECT]
C. Remain unchanged
D. Increase by approximately 10 mmHg
Correct Answer: B
Rationale: Correct because for every 1.36 cm the transducer is above the right atrium, the
pressure reading decreases by 1 mmHg; 10 cm above decreases pressure by approximately 7.5
mmHg.
Q7: During thermodilution cardiac output measurement, the injectate temperature is 10°C and
the curve shows a prolonged, low-amplitude decay. This is most consistent with:
A. Low cardiac output
B. Tricuspid regurgitation [CORRECT]
C. High cardiac output
D. Pulmonary artery hypertension
Correct Answer: B
Rationale: Correct because tricuspid regurgitation causes injectate to recirculate into the right
Hemodynamics and Post-Operative Management
Total Questions: 75
Time Allowed: As per institutional policy
Passing Score: As per institutional policy
Certification Alignment: AACN CCRN / CSC Blueprints
Exam Section Distribution
Section Questions Topic Focus
Hemodynamic Monitoring & 1-15 CVP, PAP, PCWP, Arterial
Waveform Interpretation Lines, CO/CI, SVR, SvO₂
Vasoactive & Inotropic 16-27 Norepinephrine, Epinephrine,
Medications Milrinone, Dobutamine,
Vasopressin
Mechanical Ventilation in 28-35 Settings, Weaning, PEEP,
Cardiac Patients Complications, Post-Op
Ventilation
Post-Cardiac Surgery 36-50 CABG, Valve Surgery, LVAD,
Recovery Transplant, Bleeding,
Tamponade
Arrhythmia Recognition & 51-60 AFib, VT/VF, Heart Blocks,
Management Pacing, Cardioversion,
Defibrillation
Acute Coronary Syndrome 61-68 STEMI, NSTEMI, Reperfusion,
Post-PCI Care, Complications
Mechanical Circulatory 69-75 IABP, Impella, ECMO –
Support Indications, Troubleshooting,
Weaning
,SECTION 1: Hemodynamic Monitoring & Waveform Interpretation
Q1: A patient in the CVICU has a pulmonary artery catheter. The waveform shows a gradual
upstroke, a peak systolic pressure of 25 mmHg, a dicrotic notch, and an end-diastolic pressure of
10 mmHg. This waveform is located in which cardiac/vascular structure?
A. Right atrium
B. Right ventricle
C. Pulmonary artery [CORRECT]
D. Pulmonary capillary wedge position
Correct Answer: C
Rationale: Correct because the pulmonary artery waveform has a gradual systolic upstroke
(vs. sharp RV upstroke), dicrotic notch (pulmonic valve closure), and diastolic decay.
Q2: A post-operative CABG patient has a cardiac index of 1.8 L/min/m², MAP of 55 mmHg, CVP
of 2 mmHg, and PCWP of 5 mmHg. The most appropriate initial intervention is:
A. Start norepinephrine infusion
B. Administer fluid bolus [CORRECT]
C. Start dobutamine infusion
D. Place patient in Trendelenburg position
Correct Answer: B
Rationale: Correct because low PCWP (5 mmHg) and low CVP (2 mmHg) indicate hypovolemia
as cause of low cardiac index and hypotension; fluid resuscitation is first-line.
Q3: An arterial line waveform appears overdamped. Which finding would confirm this?
A. Overshoot of the systolic peak with ringing artifact
B. Slurred upstroke, loss of dicrotic notch, and delayed systolic peak [CORRECT]
C. Normal square wave test
D. Systolic pressure artificially elevated
Correct Answer: B
Rationale: Correct because overdamped waveform shows slow upstroke, absent or rounded
dicrotic notch, and underestimation of systolic pressure; caused by air bubbles, clots, or
kinked tubing.
Q4: The CVP waveform shows a prominent v wave during inspiration. This finding is most
consistent with:
A. Hypovolemia
B. Right ventricular failure [CORRECT]
C. Tricuspid stenosis
, D. Pulmonary hypertension
Correct Answer: B
Rationale: Correct because elevated CVP with prominent v waves indicates right ventricular
failure or tricuspid regurgitation; v wave reflects atrial filling against a non-compliant right
ventricle.
Q5: A PA catheter is advanced from the pulmonary artery into the wedge position. The balloon
is deflated, but the waveform remains wedged. The nurse should first:
A. Continue to monitor the patient
B. Pull the catheter back 2-3 cm [CORRECT]
C. Flush the catheter with heparinized saline
D. Inflate the balloon further
Correct Answer: B
Rationale: Correct because an overwedged tracing indicates the catheter tip has migrated too
far distally; gentle withdrawal 2-3 cm restores PA waveform and prevents pulmonary artery
rupture.
Q6: A patient has an arterial line placed. The transducer is leveled at the phlebostatic axis (4th
intercostal space, mid-axillary line). If the transducer is moved 10 cm above the phlebostatic
axis, the measured pressure will:
A. Increase by approximately 7.5 mmHg
B. Decrease by approximately 7.5 mmHg [CORRECT]
C. Remain unchanged
D. Increase by approximately 10 mmHg
Correct Answer: B
Rationale: Correct because for every 1.36 cm the transducer is above the right atrium, the
pressure reading decreases by 1 mmHg; 10 cm above decreases pressure by approximately 7.5
mmHg.
Q7: During thermodilution cardiac output measurement, the injectate temperature is 10°C and
the curve shows a prolonged, low-amplitude decay. This is most consistent with:
A. Low cardiac output
B. Tricuspid regurgitation [CORRECT]
C. High cardiac output
D. Pulmonary artery hypertension
Correct Answer: B
Rationale: Correct because tricuspid regurgitation causes injectate to recirculate into the right
