CMC and CSC Exam Changes Nov 19, 2026: What's New

CMC and CSC exam changes: what happens on November 19, 2026

AACN announced the revised exams in August 2026. Both rest on 2025 studies of practice: surveys of nurses practicing in cardiac medicine (CMC) and nurses caring for adult cardiac surgery patients (CSC). A national task force used the results to rewrite each test plan and set the weight of each domain.

A Score Evaluation Committee reviewed the difficulty of the new item pools to set new passing standards. Until AACN posts them, assume the new cut score may differ from the old one.

CMC changes: old and new domain weights

Therapeutic interventions now make up almost half the exam. That domain covers drugs, pacing, implanted devices, cath lab care, circulatory support and renal replacement therapy.

• New or expanded: cardiac arrest, spontaneous coronary artery dissection under ACS, temporary and durable ventricular assist devices, and heart failure drug classes such as ARNI, MRA and SGLT2 inhibitors.
• Also added: delirium, fluid and acid-base imbalances, chest tubes, oxygen devices, cardiac rehabilitation, and cardiac MRI and CT.
• Dropped: adrenal disorders.

CSC changes: old and new domain weights

Complications gained the most. Together with therapeutic interventions it is now 80% of the CSC: the exam is mostly about recognizing what is going wrong after surgery and what to do about it.

• New: vasoplegia, systolic anterior motion of the mitral valve, air embolus, graft complications and graft care, thrombus and embolus, paralytic ileus, SIRS, reversal agents and calcium channel blockers.
• Procedures now include TMVR and surgical left atrial appendage closure.
• Dropped: BIS, cerebral oximetry, train-of-four monitoring and lumbar drains.

Who is affected: testing before or after November 19

Your test date decides which plan applies, not the date you applied. If you sit the exam on or before November 18, 2026, you get the earlier plan. On November 19 or later, you get the new one.

• Testing before November 19: study to the old weights. Monitoring and diagnostics and, for the CSC, procedures are still worth a little more.
• Already approved but not yet scheduled: AACN's testing window is currently 180 days, so you could land on either side of the date. Decide your date first, then pick the plan to study.
• Retesting after November 19: your score report from the old exam still shows weak domains, but rebalance your time to the new weights.

How to adjust your study for the new plans

1. CMC: give therapeutic interventions close to half your remaining time. Build a drug table for heart failure therapy (what each class does, what to monitor, when to hold it) and review device care: pacing, ICDs, IABP and ventricular assist devices.
2. CSC: practice complication recognition as patterns: bleeding versus tamponade, vasoplegia versus hypovolemia, low output versus right ventricular failure. Then link each pattern to the intervention.
3. Both: cut time on the dropped topics, and add short reviews of the new ones.
4. Both: take a timed mock exam. With 90 questions in 120 minutes you have about 80 seconds per question.

Sample questions from the new focus areas

The first question tests heart failure drug therapy, which carries more weight on the new CMC. The second tests vasoplegia, a new CSC complication.

Walk-through for the heart failure question: look at the trend, not just the drug list. Potassium is 5.8 and creatinine rose by half in a week while the patient takes two drugs that raise potassium (the MRA and the ARNI). The spironolactone label says to lower the dose or stop it when hyperkalemia occurs, so increasing it or carrying on unchanged is wrong. Switching to another drug of the same class does not deal with the potassium already in the blood. Holding the MRA and rechecking labs fits the data.

Walk-through for the vasoplegia question: vasoplegia is low vascular resistance with a normal or high cardiac output after bypass. Factors often cited include long bypass runs, renal failure, recent ACE inhibitor use and, in some reports, a low ejection fraction. A short 45-minute run points the other way, and neither a preserved ejection fraction nor statin use is a cited risk. That leaves the ACE inhibitor taken the morning of surgery, which some studies link to vasoplegia, although the results are mixed.