AACN CSC EXAM 2026 – COMPLETE TEST BANK CARDIAC SURGERY
CERTIFICATION 300 REAL QUESTIONS & VERIFIED ANSWERS
(GRADED A+)
SECTION 1: PREOPERATIVE ASSESSMENT & RISK STRATIFICATION
(Questions 1–40)
1. Which of the following is the most important preoperative assessment finding
that increases the risk of postoperative complications in a patient scheduled
for cardiac surgery?
A) Age over 65 years
B) Body mass index of 28
C) Left ventricular ejection fraction of 25%
D) History of smoking 20 years ago
Answer: C
Rationale: A severely reduced LVEF (<30%) significantly increases the risk of
perioperative morbidity and mortality. Poor ventricular function limits the
heart's ability to tolerate the stress of surgery and cardiopulmonary bypass.
2. A patient scheduled for coronary artery bypass grafting (CABG) has a serum
creatinine of 2.8 mg/dL. This finding indicates:
A) Normal renal function
B) Mild renal impairment
C) Moderate to severe renal impairment
D) No clinical significance
Answer: C
Rationale: A serum creatinine of 2.8 mg/dL indicates significant renal
impairment. This increases the risk of contrast‑induced nephropathy, acute
kidney injury post‑CPB, and affects medication dosing and fluid management.
3. A patient with severe aortic stenosis is scheduled for valve replacement.
Which finding would most increase the risk of perioperative mortality?
A) Ejection fraction 55%
1
,B) Mean aortic valve gradient 40 mmHg
C) Pulmonary artery systolic pressure 65 mmHg
D) Mild mitral regurgitation
Answer: C
Rationale: Pulmonary hypertension (PASP >60 mmHg) is a powerful predictor of
poor outcomes after valve surgery due to right ventricular dysfunction and
post‑operative failure.
4. Which scoring system is specifically validated for risk prediction in
cardiac surgery?
A) CHA₂DS₂‑VASc
B) EuroSCORE II
C) SOFA
D) RCRI
Answer: B
Rationale: EuroSCORE II and STS (Society of Thoracic Surgeons) score are
cardiac surgery–specific risk models. CHA₂DS₂‑VASc is for stroke risk in atrial
fibrillation.
5. The STS (Society of Thoracic Surgeons) risk score predicts:
A) Stroke risk in atrial fibrillation
B) Operative mortality and morbidity for cardiac surgery
C) Risk of contrast‑induced nephropathy
D) Need for postoperative mechanical circulatory support
Answer: B
Rationale: The STS risk score is a validated tool for predicting operative
mortality and morbidity for specific cardiac surgical procedures.
6. Preoperative frailty in a 78‑year‑old patient scheduled for CABG is best
assessed by:
A) Serum albumin level
B) Gait speed and grip strength
C) NYHA functional class
2
,D) Ejection fraction
Answer: B
Rationale: Frailty is a physical construct; slow gait and weak grip correlate
with increased mortality, prolonged ventilation, and discharge to facility.
7. A patient with diabetes and CKD stage 3b is scheduled for CABG. Which
medication should be held on the morning of surgery?
A) Metformin
B) Insulin glargine
C) Aspirin
D) Beta‑blocker
Answer: A
Rationale: Metformin should be held 24‑48 hours before surgery due to the risk
of lactic acidosis, especially in patients with renal impairment undergoing
cardiac surgery.
8. Which of the following patients is at highest risk for developing acute
kidney injury after cardiac surgery?
A) Baseline eGFR 45 mL/min with diabetes mellitus
B) Age 55 years
C) Mild hypertension controlled with lisinopril
D) Hemoglobin 13 g/dL
Answer: A
Rationale: Preoperative renal dysfunction (eGFR <60) combined with diabetes is a
major risk factor for AKI after cardiac surgery.
9. What is the recommended time frame for stopping clopidogrel before elective
CABG?
A) 24 hours
B) 3 days
C) 5‑7 days
D) 14 days
Answer: C
3
, Rationale: Clopidogrel should be discontinued for 5‑7 days prior to CABG to
reduce bleeding risk, unless the patient is at high thrombotic risk.
10. A patient with a history of heparin‑induced thrombocytopenia (HIT) is
scheduled for cardiac surgery. Which anticoagulant is most appropriate for
cardiopulmonary bypass?
A) Unfractionated heparin
B) Low molecular weight heparin
C) Bivalirudin
D) Warfarin
Answer: C
Rationale: Bivalirudin is a direct thrombin inhibitor used as an alternative to
heparin in patients with HIT undergoing cardiac surgery.
11. The presence of carotid bruit in a patient scheduled for CABG warrants:
A) No further evaluation
B) Carotid ultrasound
C) Immediate carotid endarterectomy before CABG
D) Aspirin and statin only
Answer: B
Rationale: Carotid bruit suggests significant stenosis; ultrasound is indicated
to assess risk of perioperative stroke.
12. Which preoperative laboratory value is most concerning in a patient
undergoing cardiac surgery?
A) Hemoglobin 10.5 g/dL
B) Platelet count 180,000/µL
C) INR 1.5
D) Serum sodium 135 mEq/L
Answer: C
Rationale: INR >1.4 indicates coagulopathy; an INR of 1.5 increases bleeding
risk, especially if not corrected with vitamin K or FFP.
4
CERTIFICATION 300 REAL QUESTIONS & VERIFIED ANSWERS
(GRADED A+)
SECTION 1: PREOPERATIVE ASSESSMENT & RISK STRATIFICATION
(Questions 1–40)
1. Which of the following is the most important preoperative assessment finding
that increases the risk of postoperative complications in a patient scheduled
for cardiac surgery?
A) Age over 65 years
B) Body mass index of 28
C) Left ventricular ejection fraction of 25%
D) History of smoking 20 years ago
Answer: C
Rationale: A severely reduced LVEF (<30%) significantly increases the risk of
perioperative morbidity and mortality. Poor ventricular function limits the
heart's ability to tolerate the stress of surgery and cardiopulmonary bypass.
2. A patient scheduled for coronary artery bypass grafting (CABG) has a serum
creatinine of 2.8 mg/dL. This finding indicates:
A) Normal renal function
B) Mild renal impairment
C) Moderate to severe renal impairment
D) No clinical significance
Answer: C
Rationale: A serum creatinine of 2.8 mg/dL indicates significant renal
impairment. This increases the risk of contrast‑induced nephropathy, acute
kidney injury post‑CPB, and affects medication dosing and fluid management.
3. A patient with severe aortic stenosis is scheduled for valve replacement.
Which finding would most increase the risk of perioperative mortality?
A) Ejection fraction 55%
1
,B) Mean aortic valve gradient 40 mmHg
C) Pulmonary artery systolic pressure 65 mmHg
D) Mild mitral regurgitation
Answer: C
Rationale: Pulmonary hypertension (PASP >60 mmHg) is a powerful predictor of
poor outcomes after valve surgery due to right ventricular dysfunction and
post‑operative failure.
4. Which scoring system is specifically validated for risk prediction in
cardiac surgery?
A) CHA₂DS₂‑VASc
B) EuroSCORE II
C) SOFA
D) RCRI
Answer: B
Rationale: EuroSCORE II and STS (Society of Thoracic Surgeons) score are
cardiac surgery–specific risk models. CHA₂DS₂‑VASc is for stroke risk in atrial
fibrillation.
5. The STS (Society of Thoracic Surgeons) risk score predicts:
A) Stroke risk in atrial fibrillation
B) Operative mortality and morbidity for cardiac surgery
C) Risk of contrast‑induced nephropathy
D) Need for postoperative mechanical circulatory support
Answer: B
Rationale: The STS risk score is a validated tool for predicting operative
mortality and morbidity for specific cardiac surgical procedures.
6. Preoperative frailty in a 78‑year‑old patient scheduled for CABG is best
assessed by:
A) Serum albumin level
B) Gait speed and grip strength
C) NYHA functional class
2
,D) Ejection fraction
Answer: B
Rationale: Frailty is a physical construct; slow gait and weak grip correlate
with increased mortality, prolonged ventilation, and discharge to facility.
7. A patient with diabetes and CKD stage 3b is scheduled for CABG. Which
medication should be held on the morning of surgery?
A) Metformin
B) Insulin glargine
C) Aspirin
D) Beta‑blocker
Answer: A
Rationale: Metformin should be held 24‑48 hours before surgery due to the risk
of lactic acidosis, especially in patients with renal impairment undergoing
cardiac surgery.
8. Which of the following patients is at highest risk for developing acute
kidney injury after cardiac surgery?
A) Baseline eGFR 45 mL/min with diabetes mellitus
B) Age 55 years
C) Mild hypertension controlled with lisinopril
D) Hemoglobin 13 g/dL
Answer: A
Rationale: Preoperative renal dysfunction (eGFR <60) combined with diabetes is a
major risk factor for AKI after cardiac surgery.
9. What is the recommended time frame for stopping clopidogrel before elective
CABG?
A) 24 hours
B) 3 days
C) 5‑7 days
D) 14 days
Answer: C
3
, Rationale: Clopidogrel should be discontinued for 5‑7 days prior to CABG to
reduce bleeding risk, unless the patient is at high thrombotic risk.
10. A patient with a history of heparin‑induced thrombocytopenia (HIT) is
scheduled for cardiac surgery. Which anticoagulant is most appropriate for
cardiopulmonary bypass?
A) Unfractionated heparin
B) Low molecular weight heparin
C) Bivalirudin
D) Warfarin
Answer: C
Rationale: Bivalirudin is a direct thrombin inhibitor used as an alternative to
heparin in patients with HIT undergoing cardiac surgery.
11. The presence of carotid bruit in a patient scheduled for CABG warrants:
A) No further evaluation
B) Carotid ultrasound
C) Immediate carotid endarterectomy before CABG
D) Aspirin and statin only
Answer: B
Rationale: Carotid bruit suggests significant stenosis; ultrasound is indicated
to assess risk of perioperative stroke.
12. Which preoperative laboratory value is most concerning in a patient
undergoing cardiac surgery?
A) Hemoglobin 10.5 g/dL
B) Platelet count 180,000/µL
C) INR 1.5
D) Serum sodium 135 mEq/L
Answer: C
Rationale: INR >1.4 indicates coagulopathy; an INR of 1.5 increases bleeding
risk, especially if not corrected with vitamin K or FFP.
4
