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CMC Test Plan 2026: Domain Breakdown and Study Plan

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The CMC test plan for exams on and after November 19, 2026 puts 44% of the 75 scored questions on therapeutic interventions, with cardiovascular conditions and non-cardiovascular conditions at 21% each and monitoring and diagnostics at 14%. About 33 of your scored questions will ask what to give, place, adjust or stop, so interventions are where to start.

This post breaks down each domain with its item count and the topics it covers, then turns the weights into a study plan. Eligibility, fees and test-day rules are in the full CMC exam guide, linked at the end.

CMC exam format

  • 90 multiple-choice questions: 75 scored and 15 unscored pretest questions mixed in.
  • 2 hours, so about 80 seconds per question.
  • Your score is a raw count: the number of the 75 scored questions you answer correctly.
  • Only clinical judgment is tested. Unlike the CCRN and PCCN, there is no Professional Caring and Ethical Practice section.
  • Passing score: 50 of 75 for exams through November 18, 2026. AACN set a new standard for the revised exam and had not posted it as of late October 2026.

The new plan comes from a 2025 study of practice: a survey of cardiac medicine nurses with 670 usable responses rating 40 tasks and 106 knowledge statements. A task force used the ratings to choose the content and set the weights below.

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CMC test plan 2026: the four domains

AACN CMC test plan for exams on and after November 19, 2026. Item counts are shares of the 75 scored items, rounded. The older plan sums to 101% from rounding.
DomainShareAbout this many scored itemsPlan before Nov 19, 2026
Therapeutic Interventions44%3339%
Cardiovascular Conditions21%1623%
Non-cardiovascular Conditions21%1623%
Monitoring and Diagnostics14%10 to 1116%

Therapeutic interventions alone outweigh the two conditions domains combined (44% against 42%). Per study hour, that domain is worth about three times what monitoring and diagnostics is worth.

What each domain covers

Therapeutic Interventions (44%)

Drugs, devices and procedures. The drug list now names heart failure classes (ACE inhibitors, ARBs, ARNI, MRAs, SGLT2 inhibitors and beta-blockers), calcium channel blockers, lipid-lowering drugs, pulmonary vasodilators, and sedation and analgesia. Devices include temporary pacing, ICDs and CRT, intra-aortic balloon pumps and temporary and durable ventricular assist devices. Cath lab care, chest tubes, oxygen devices, cardiac rehab and renal replacement therapy (CRRT, SCUF and hemodialysis) are here too.

Cardiovascular Conditions (21%)

The cardiac diagnoses: acute coronary syndromes including spontaneous coronary artery dissection, heart failure, dysrhythmias, dyslipidemia and cardiac arrest, which is new on this plan. Questions usually describe a patient and ask what is happening or what to do first.

Non-cardiovascular Conditions (21%)

The other problems cardiac patients bring with them: respiratory failure and ARDS, pleural effusion, kidney injury, substance use, palliative and end-of-life care, and, new on this plan, delirium and fluid and acid-base imbalances. Adrenal disorders were dropped.

Monitoring and Diagnostics (14%)

ECG monitoring, hemodynamics, venous blood gases (SvO2 and ScvO2), labs and imaging, now including cardiac MRI and CT. Expect questions on what a result means and what it changes, not on how the test is run.

Turning the weights into a study plan

Start with a timed 90-question baseline mock. Then weight your hours by both the domain share and your miss rate in that domain. A domain worth 44% where you miss 30% costs more points than a 14% domain where you miss 50%.

A starting split by weight; move hours toward the domains your baseline shows are weakest.
DomainHours in a 60-hour planFocus
Therapeutic Interventions26Drug tables by class: action, what to monitor, when to hold. Device alarms and complications.
Cardiovascular Conditions13ACS, heart failure and rhythms as patient stories: recognize, then act.
Non-cardiovascular Conditions13Delirium screening, acid-base, AKI and respiratory failure in a cardiac patient.
Monitoring and Diagnostics8QT, hemodynamic numbers and what each abnormal result should trigger.
  1. Weeks 1 to 3: therapeutic interventions, drugs first, then devices. Build one page per drug class.
  2. Weeks 4 and 5: cardiovascular and non-cardiovascular conditions, alternating days.
  3. Week 6: monitoring and diagnostics, then a second timed mock.
  4. Weeks 7 and 8: mixed sets only, because the real exam does not group questions by domain, plus a final mock a few days out.

Sample questions from the two biggest gains

The first question tests antiarrhythmic monitoring under therapeutic interventions. The second tests delirium screening, a new topic in non-cardiovascular conditions.

Question 1 · Therapeutic Interventions

Dofetilide 500 mcg twice daily is started in the hospital for persistent AF. Two hours after the first dose, the QTc has risen from 430 to 520 ms. Which action is MOST appropriate?

  1. Discharge the patient home with an event monitor
  2. Give IV magnesium and continue the same dose
  3. Give the second dose as scheduled and recheck tomorrow
  4. Notify the provider for a dose reduction per protocol
Show the answer and rationale

Answer: D

  • A. Dofetilide must be started in the hospital with at least 3 days of monitoring.
  • B. Magnesium does not make continued full dosing safe when the QTc exceeds the threshold.
  • C. Continuing the full dose risks torsades de pointes.
  • D. Correct. A QTc above 500 ms or a rise of more than 15% after the first dose requires a dose reduction.

Dofetilide is started in the hospital with continuous ECG monitoring for at least 3 days (at least five doses). The dose is based on creatinine clearance, and the QTc is measured 2–3 hours after each dose. If the QTc rises more than 15% or exceeds 500 ms (550 ms with ventricular conduction delay) after the first dose, the dose is reduced; if it exceeds these limits after the second dose, dofetilide is stopped. Potassium and magnesium are kept normal, and interacting drugs such as verapamil, cimetidine, and trimethoprim are avoided.

Sources: Saunders Nursing Drug Handbook 2023; Jacobson, CV Nursing Practice, 3rd ed.; ACC/AHA/ACCP/HRS AF Guideline (2023)

Question 2 · Non-Cardiovascular Conditions

The nurse performs a CAM-ICU on a patient whose family reports that the patient is “not acting like themselves” since yesterday. Findings: RASS 0; 5 errors on the letters attention test; 1 incorrect answer out of 4 yes/no questions; and the two-step command is followed correctly. Which interpretation is MOST accurate?

  1. Positive, because inattention is present
  2. Unable to assess because the patient’s RASS is 0
  3. Negative; Features 3 and 4 are both absent
  4. Positive, because Features 1, 2, and 4 are present
Show the answer and rationale

Answer: C

  • A. Inattention alone is not enough. Feature 3 or Feature 4 must also be positive.
  • B. CAM-ICU can be performed at a RASS of −3 or higher.
  • C. Correct. Features 1 and 2 are present, but RASS is 0 (Feature 3 negative) and there is only 1 disorganized-thinking error (Feature 4 negative).
  • D. Feature 4 requires more than 1 total error. This patient made only 1.

CAM-ICU is positive when Feature 1 (acute change or fluctuating course) AND Feature 2 (inattention, more than 2 errors on the letters test) are present, PLUS either Feature 3 (altered level of consciousness, RASS other than 0) OR Feature 4 (disorganized thinking, more than 1 total error on the questions and command). This patient is negative at this assessment. Because delirium fluctuates, the nurse should reassess each shift and with changes in condition, and should continue delirium prevention measures.

Sources: AACN Essentials of Critical Care, 5th ed.; AACN Core Curriculum, 8th ed.; Urden, Critical Care Nursing, 10th ed.

Walk-through for the dofetilide question: the drug is started in hospital precisely because the QT can stretch after the first doses. The label checks the QTc 2 to 3 hours after the first dose and lowers the dose if it has risen more than 15% or passed 500 ms. A rise from 430 to 520 ms meets both triggers. Giving the next dose unchanged, adding magnesium and carrying on, or sending the patient home all ignore the protocol. The nurse calls for the dose reduction.

Walk-through for the CAM-ICU question: a positive screen needs an acute change or fluctuating course and inattention, plus either an altered level of consciousness or disorganized thinking. This patient has the first two, but a RASS of 0 means no altered consciousness, and one wrong answer with a correct command is not disorganized thinking. The screen is negative today, and because delirium fluctuates, it is repeated.

Frequently asked questions

How many questions are on the CMC exam?

The CMC has 90 questions in 2 hours. 75 are scored and 15 are unscored pretest questions.

What is the largest domain on the CMC test plan?

Therapeutic Interventions, at 44% of scored questions (about 33 of 75) for exams on and after November 19, 2026.

What is the passing score for the CMC?

AACN lists 50 of 75 scored questions for exams through November 18, 2026. A committee set a new passing standard for the revised exam; check the AACN cut score page before you test.

Who can take the CMC exam?

RNs with a current, nationally accredited clinical nursing specialty certification such as the CCRN or PCCN and 1,750 hours in 2 years (875 cardiac) or 2,000 hours in 5 years (1,000 cardiac) with acutely or critically ill adults. The credential is shown attached to the specialty, as in CCRN-CMC.

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Sources

  1. AACN Newsroom. Revised CMC and CSC Exams Launch Nov. 19, 2026. August 19, 2026. Link
  2. AACN. 2025 National Practice Analysis of Cardiac Medicine Nurses. Link
  3. AACN. CMC and CSC Frequently Asked Questions. Link
  4. AACN. Certification Exam Statistics and Cut Scores. Link
  5. AACN. CMC (Adult) Certification Practice Exam and Questions (content areas). Link
  6. Pfizer. Tikosyn (dofetilide) capsules prescribing information: Dosage and Administration. DailyMed. Link
  7. Krewulak KD, Rosgen BK, Ely EW, Stelfox HT, Fiest KM. The CAM-ICU-7 and ICDSC as measures of delirium severity in critically ill adult patients. PLoS One. 2020;15(11):e0242378. Link