Cardiovascular

13% of the CCRN · blueprint Adult CCRN Test Plan (exams on and after 2025-11-12)

Short answer

Cardiovascular is 13% of the adult CCRN. It covers acute coronary syndrome, aortic aneurysm and dissection, cardiac infection and inflammatory disease, cardiac surgery and trauma, cardiac tamponade, cardiogenic shock, cardiomyopathy, dysrhythmias, heart failure, hypertensive crisis, conduction defects such as prolonged QT and WPW, structural and valvular disease, and vascular interventions including stents and endarterectomy.

Why it matters on this exam

Cardiovascular items are rarely pure recall. They give you a rhythm, a set of haemodynamic numbers and a trend, and ask what you do next.

Key concepts

Haemodynamics: preload, afterload, contractility; how CVP, PAOP, CO/CI and SVR move in cardiogenic, hypovolaemic, distributive and obstructive shock.
Cardiogenic shock: low CO/CI with high filling pressures and high SVR; support contractility and reduce afterload, do not flood with fluid.
Tamponade: equalisation of diastolic pressures, pulsus paradoxus, muffled tones, narrow pulse pressure — treatment is drainage, not diuresis.
ACS: ST elevation vs NSTEMI management, reperfusion timing, right ventricular infarct (preload dependent — nitrates are dangerous).
Dysrhythmias: stable vs unstable decision, synchronised cardioversion vs defibrillation, prolonged QT and the drugs that cause it.
Aortic dissection: reduce shear first (rate control before vasodilation), blood-pressure differential between arms.
Post-cardiac-surgery: mediastinal bleeding thresholds, tamponade after chest-tube obstruction, pacing wires, atrial fibrillation.

Common mistakes

Giving nitroglycerin in a right-ventricular infarct.
Treating hypotension in tamponade with diuresis because the CVP is high.

Worked example

Post-op day 0 CABG: chest-tube output stops abruptly, CVP rises, blood pressure falls, pulse pressure narrows. Obstructed drainage causing tamponade — escalate immediately; this is a surgical problem, not a fluid problem.

Original practice questions

CardiovascularDifficulty 3/5

A patient has a cardiac index of 1.6 L/min/m2, pulmonary artery occlusion pressure of 26 mmHg and systemic vascular resistance of 1,900 dynes/sec/cm-5. Which shock state do these numbers describe?

ACardiogenic shock, because the pump fails and filling pressures rise behind it
BDistributive shock, because vascular resistance is abnormal and output is inadequate
CObstructive shock caused by a tension pneumothorax reducing venous return
DHypovolaemic shock, because cardiac index is low and filling pressure has fallen

Show answer and rationale

Correct: A. Low cardiac index with a high PAOP and high SVR is the classic cardiogenic pattern: the pump fails, filling pressures rise behind it, and the body compensates by vasoconstricting. Hypovolaemia would show a low PAOP and distributive shock a low SVR.

D — Hypovolaemia lowers filling pressures; this PAOP is high.
B — Distributive shock is characterised by a low SVR, not 1,900.
C — Obstructive shock is possible with high filling pressure but would present with acute deterioration and other signs rather than these steady-state numbers.

CardiovascularDifficulty 3/5

A patient with an inferior STEMI and suspected right ventricular infarction becomes hypotensive. Which intervention is contraindicated?

ACautious intravenous fluid administration to support preload
BNitroglycerin infusion, because it drops the preload this ventricle depends on
CUrgent reperfusion therapy according to the institutional protocol
DContinuous monitoring for high-degree atrioventricular block

Show answer and rationale

Correct: B. A right ventricular infarct is preload dependent: the failing right ventricle needs filling pressure to deliver blood to the left side. Nitroglycerin drops preload and can cause profound hypotension. Fluids, reperfusion and block monitoring are all appropriate.

A — Fluids are the first-line support for a preload-dependent RV infarct.
C — Reperfusion remains the definitive treatment.
D — Inferior infarcts commonly involve the conduction system, so monitoring is appropriate.

CardiovascularDifficulty 3/5

Four hours after coronary artery bypass grafting, chest-tube drainage abruptly stops, central venous pressure rises, blood pressure falls and the pulse pressure narrows. What is the priority interpretation?

AVasoplegic syndrome after cardiopulmonary bypass requiring vasopressor titration
BHypovolaemia from ongoing surgical bleeding requiring rapid volume replacement
CCardiac tamponade from obstructed drainage, needing immediate surgical review
DAcute graft occlusion causing ischaemic left ventricular failure

Show answer and rationale

Correct: C. Abrupt cessation of drainage with rising filling pressure, falling blood pressure and a narrowing pulse pressure is tamponade until proven otherwise. Volume may temporise, but the clot must be relieved surgically.

B — Hypovolaemia lowers CVP rather than raising it.
D — Graft occlusion typically presents with ischaemic ECG changes and does not stop chest-tube output.
A — Vasoplegia presents with low systemic vascular resistance and warm extremities, not rising CVP.

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3 flashcards for Cardiovascular

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Primary references

CCRN Exam Handbook — Direct Care (July 2026) — AACN Certification Corporation · primary · retrieved 2026-09-22, verified 2026-09-22

Last reviewed: 2026-09-22Next review by: 2026-11-06Draft — pending editorial reviewHow we verify facts