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AACN CSC EXAM -CARDIAC SURGERY CERTIFICATION
EXAM WITH COMPLETE 300 QUESTIONS WITH CORRECT
ANSWERS AND RATIONALES JUST RELEASED THIS YEAR
1. A patient is scheduled for coronary artery bypass grafting (CABG) with cardiopulmonary
bypass. Which vessel is most commonly used as a conduit for the left anterior descending
(LAD) artery?
A) Saphenous vein
B) Radial artery
C) Left internal mammary artery (LIMA)
D) Right internal mammary artery (RIMA)
Answer: C (The left internal mammary artery (LIMA) is the preferred conduit for grafting the
LAD due to its long-term patency and resistance to atherosclerosis. The saphenous vein is used
for other vessels, and the radial artery is an alternative conduit.)
2. A patient is scheduled for a minimally invasive cardiac surgery (MICS) approach for mitral
valve repair. What is a primary advantage of this approach?
A) Longer hospital stay
B) Increased risk of infection
C) Reduced surgical trauma and faster recovery
D) Better visualization of the valve
Answer: C (Minimally invasive cardiac surgery offers advantages including reduced surgical
trauma, less pain, shorter hospital stays, and faster recovery compared to traditional
sternotomy.)
3. A patient undergoes a Cox maze procedure during cardiac surgery. What is the primary
indication for this procedure?
A) Coronary artery disease
B) Valvular heart disease
C) Atrial fibrillation
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D) Ventricular tachycardia
Answer: C (The Cox maze procedure is a surgical treatment for atrial fibrillation. It creates a
pattern of lesions in the atrial tissue to interrupt abnormal electrical pathways.)
4. A patient is scheduled for a transcatheter aortic valve replacement (TAVR). Which access
route is most commonly used?
A) Transapical
B) Transaortic
C) Transfemoral
D) Subclavian
Answer: C (The transfemoral approach is the most common access route for TAVR, as it is
minimally invasive and avoids the need for sternotomy. Other approaches include transapical,
transaortic, and subclavian.)
5. A patient undergoes open repair of a thoracic aortic aneurysm. Which complication is most
specific to this procedure?
A) Myocardial infarction
B) Stroke
C) Spinal cord ischemia
D) Renal failure
Answer: C (Spinal cord ischemia is a specific complication of thoracic aortic aneurysm repair due
to interruption of the blood supply to the spinal cord, particularly with involvement of the artery
of Adamkiewicz.)
6. A patient is scheduled for off-pump coronary artery bypass (OPCAB). What is the primary
advantage of this technique?
A) Better graft patency
B) Reduced risk of neurologic complications
C) Shorter operative time
D) Ability to perform more grafts
Answer: B (Off-pump CABG is performed without cardiopulmonary bypass, reducing the risk of
neurologic complications such as stroke and cognitive decline associated with the use of the
heart-lung machine.)
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7. A patient undergoes surgical aortic valve replacement with a mechanical valve. What is the
most important postoperative consideration?
A) Blood pressure control
B) Anticoagulation therapy
C) Pain management
D) Early ambulation
Answer: B (Patients with mechanical heart valves require lifelong anticoagulation with warfarin
to prevent thrombus formation and thromboembolic events. Anticoagulation management is a
critical postoperative consideration.)
8. A patient undergoes a pericardial window procedure. What is the primary indication for
this procedure?
A) Coronary artery disease
B) Pericardial effusion
C) Valvular disease
D) Atrial fibrillation
Answer: B (A pericardial window is performed to drain a pericardial effusion that is causing
symptoms or hemodynamic compromise. It creates a surgical opening in the pericardium to
allow fluid to drain into the pleural space.)
9. A patient undergoes surgical repair of a post-infarction ventricular septal defect (VSD).
What is the most critical postoperative monitoring parameter?
A) Heart rate
B) Blood pressure
C) Cardiac output and hemodynamics
D) Urine output
Answer: C (Patients with VSD repair require careful monitoring of cardiac output and
hemodynamics to assess for residual shunt or ventricular dysfunction. Hemodynamic monitoring
with a pulmonary artery catheter may be indicated.)
10. A patient undergoes endovascular repair of an abdominal aortic aneurysm (EVAR). What is
the most important post-procedure assessment?
A) Neurologic assessment
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B) Pulse assessment in the lower extremities
C) Wound assessment
D) Pain assessment
Answer: B (Pulse assessment in the lower extremities is critical after EVAR to detect occlusion or
embolization of the iliac or femoral arteries. Any change in pulses requires immediate
intervention.)
Domain 2: Cardiovascular Complications (Questions 34-99)
11. A patient who underwent CABG 6 hours ago develops sudden hypotension, elevated
central venous pressure (CVP), and muffled heart sounds. What is the most likely diagnosis?
A) Hypovolemia
B) Cardiac tamponade
C) Pulmonary embolism
D) Anaphylaxis
Answer: B (Beck's triad—hypotension, muffled heart sounds, and elevated CVP—is classic for
cardiac tamponade. This is a life-threatening complication that requires immediate
pericardiocentesis or surgical intervention.)
12. What is the most appropriate initial intervention for the patient in Question 11?
A) Administer intravenous fluids
B) Prepare for emergent pericardiocentesis
C) Increase vasopressor infusion
D) Obtain a stat chest X-ray
Answer: B (Cardiac tamponade requires immediate pericardiocentesis to relieve compression of
the heart. Delaying this intervention can lead to cardiac arrest.)
13. A patient develops atrial fibrillation on postoperative day 2 following CABG. What is the
first-line treatment for rate control?
A) Amiodarone
B) Beta-blocker (e.g., metoprolol)
C) Digoxin
4
SUCCESS!
AACN CSC EXAM -CARDIAC SURGERY CERTIFICATION
EXAM WITH COMPLETE 300 QUESTIONS WITH CORRECT
ANSWERS AND RATIONALES JUST RELEASED THIS YEAR
1. A patient is scheduled for coronary artery bypass grafting (CABG) with cardiopulmonary
bypass. Which vessel is most commonly used as a conduit for the left anterior descending
(LAD) artery?
A) Saphenous vein
B) Radial artery
C) Left internal mammary artery (LIMA)
D) Right internal mammary artery (RIMA)
Answer: C (The left internal mammary artery (LIMA) is the preferred conduit for grafting the
LAD due to its long-term patency and resistance to atherosclerosis. The saphenous vein is used
for other vessels, and the radial artery is an alternative conduit.)
2. A patient is scheduled for a minimally invasive cardiac surgery (MICS) approach for mitral
valve repair. What is a primary advantage of this approach?
A) Longer hospital stay
B) Increased risk of infection
C) Reduced surgical trauma and faster recovery
D) Better visualization of the valve
Answer: C (Minimally invasive cardiac surgery offers advantages including reduced surgical
trauma, less pain, shorter hospital stays, and faster recovery compared to traditional
sternotomy.)
3. A patient undergoes a Cox maze procedure during cardiac surgery. What is the primary
indication for this procedure?
A) Coronary artery disease
B) Valvular heart disease
C) Atrial fibrillation
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D) Ventricular tachycardia
Answer: C (The Cox maze procedure is a surgical treatment for atrial fibrillation. It creates a
pattern of lesions in the atrial tissue to interrupt abnormal electrical pathways.)
4. A patient is scheduled for a transcatheter aortic valve replacement (TAVR). Which access
route is most commonly used?
A) Transapical
B) Transaortic
C) Transfemoral
D) Subclavian
Answer: C (The transfemoral approach is the most common access route for TAVR, as it is
minimally invasive and avoids the need for sternotomy. Other approaches include transapical,
transaortic, and subclavian.)
5. A patient undergoes open repair of a thoracic aortic aneurysm. Which complication is most
specific to this procedure?
A) Myocardial infarction
B) Stroke
C) Spinal cord ischemia
D) Renal failure
Answer: C (Spinal cord ischemia is a specific complication of thoracic aortic aneurysm repair due
to interruption of the blood supply to the spinal cord, particularly with involvement of the artery
of Adamkiewicz.)
6. A patient is scheduled for off-pump coronary artery bypass (OPCAB). What is the primary
advantage of this technique?
A) Better graft patency
B) Reduced risk of neurologic complications
C) Shorter operative time
D) Ability to perform more grafts
Answer: B (Off-pump CABG is performed without cardiopulmonary bypass, reducing the risk of
neurologic complications such as stroke and cognitive decline associated with the use of the
heart-lung machine.)
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7. A patient undergoes surgical aortic valve replacement with a mechanical valve. What is the
most important postoperative consideration?
A) Blood pressure control
B) Anticoagulation therapy
C) Pain management
D) Early ambulation
Answer: B (Patients with mechanical heart valves require lifelong anticoagulation with warfarin
to prevent thrombus formation and thromboembolic events. Anticoagulation management is a
critical postoperative consideration.)
8. A patient undergoes a pericardial window procedure. What is the primary indication for
this procedure?
A) Coronary artery disease
B) Pericardial effusion
C) Valvular disease
D) Atrial fibrillation
Answer: B (A pericardial window is performed to drain a pericardial effusion that is causing
symptoms or hemodynamic compromise. It creates a surgical opening in the pericardium to
allow fluid to drain into the pleural space.)
9. A patient undergoes surgical repair of a post-infarction ventricular septal defect (VSD).
What is the most critical postoperative monitoring parameter?
A) Heart rate
B) Blood pressure
C) Cardiac output and hemodynamics
D) Urine output
Answer: C (Patients with VSD repair require careful monitoring of cardiac output and
hemodynamics to assess for residual shunt or ventricular dysfunction. Hemodynamic monitoring
with a pulmonary artery catheter may be indicated.)
10. A patient undergoes endovascular repair of an abdominal aortic aneurysm (EVAR). What is
the most important post-procedure assessment?
A) Neurologic assessment
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B) Pulse assessment in the lower extremities
C) Wound assessment
D) Pain assessment
Answer: B (Pulse assessment in the lower extremities is critical after EVAR to detect occlusion or
embolization of the iliac or femoral arteries. Any change in pulses requires immediate
intervention.)
Domain 2: Cardiovascular Complications (Questions 34-99)
11. A patient who underwent CABG 6 hours ago develops sudden hypotension, elevated
central venous pressure (CVP), and muffled heart sounds. What is the most likely diagnosis?
A) Hypovolemia
B) Cardiac tamponade
C) Pulmonary embolism
D) Anaphylaxis
Answer: B (Beck's triad—hypotension, muffled heart sounds, and elevated CVP—is classic for
cardiac tamponade. This is a life-threatening complication that requires immediate
pericardiocentesis or surgical intervention.)
12. What is the most appropriate initial intervention for the patient in Question 11?
A) Administer intravenous fluids
B) Prepare for emergent pericardiocentesis
C) Increase vasopressor infusion
D) Obtain a stat chest X-ray
Answer: B (Cardiac tamponade requires immediate pericardiocentesis to relieve compression of
the heart. Delaying this intervention can lead to cardiac arrest.)
13. A patient develops atrial fibrillation on postoperative day 2 following CABG. What is the
first-line treatment for rate control?
A) Amiodarone
B) Beta-blocker (e.g., metoprolol)
C) Digoxin
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