CSC -CARDIAC SURGERY CERTIFICATION |ACTUAL
QUESTIONS AND VERIFIED ANSWERS|BRAND NEW
2026-2027 UPDATE|GRADED A+
Question 1
You are caring for a patient with an intra-aortic balloon pump and note blood in the
tubing. Your initial action should be:
A. Stop the balloon pump and notify the physician.
B. Administer 100% oxygen to help displace the helium and notify the physician
C. Leave the IABP running and notify the physician.
D. Purge the IABP manually to clear the blood from the tubing.
CORRECT ANSWER
A. Blood in the IABP tubing indicates a balloon rupture which can cause gas embolus.
However, helium is thought to be easily absorbed in the presence of balloon rupture and
oxygen is not generally indicated. The appropriate action is to disconnect the balloon
from the console or turn it on standby so the movement of helium is stopped and notify
the physician. The nurse will need to prepare for IABP removal and replacement if
needed.
Question 2
When caring for a patient immediately post CABG the nurse recognizes that the most likely
cause of hypotension in the immediate post-operative period is
A. Decreased circulating volume requiring no intervention unless persistent > 12 hours.
B. LV failure requiring an inotrope as first line treatment for any hypotension.
C. Decreased circulating volume representing the need for increased fluid administration.
D. LV failure requiring an assist device.
CORRECT ANSWER
C. Hypotension in the immediate postoperative period is usually caused by low
circulating volume and responds to treatment with fluids. Volume is the first line
1
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, treatment for hypotension. If there is no immediate response to volume administration,
500 mg of IV calcium chloride is often given. Existing vasopressors, such as
norepinephrine, can also be adjusted. It is important for hypotension to be promptly
treated. Persistent hypotension can result in hypoperfusion and end organ damage.
LV failure is not the most common cause of hypotension in the immediate post-operative
period and therefore inotropic agents are not first line agents used in the treatment of
hypotension. Hypotension that does not respond to fluid administration may require an
inotrope.
Question 3
Preoperative clopidogrel should be held for how many days in the elective surgery patient:
A.It does not need to be held.
B. 1-2 days.
C. 5-7 days.
D. 30 days.
CORRECT ANSWER
C. Clopidogrel inhibits the P2Y12 receptor on the platelet for the lifetime of the platelet
(10 days). Inhibited platelets cannot participate in clotting, so the risk of bleeding
increases with antiplatelet drugs. Most clinical trials have identified an increased risk in
bleeding, transfusion, and re-exploration when clopidogrel is taken within 5 days of
surgery, and no increase in bleeding or transfusions when clopidogrel is stopped for > 5
days prior to surgery. Therefore, clopidogrel should be stopped for 5 to 7 days prior to
elective surgery. Emergent surgery can be done regardless of when the last dose of
clopidogrel was taken, but will be associated with increased bleeding and need for
platelet transfusions.
Question 4
The term OPCAB refers to:
A. combination open heart surgery and percutaneous procedure.
B. CABG surgery without the use of cardiopulmonary bypass (CPB).
2
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,C. the use of thoracotomy instead of sternotomy.
D. patients who are fast tracked to be discharged in less than 5 days.
CORRECT ANSWER
B. OPCAB refers to off-pump coronary artery bypass. Surgery is done without CPB but it
still involves a median sternotomy.
MIDCAB (minimally invasive direct coronary artery bypass) is performed on a beating
heart without CPB and without the use of a median sternotomy. MIDCAB is commonly
done through an anterior thoracotomy incision and is used to bypass the mid to distal
LAD with a left internal mammary artery (LIMA) graft. A ministernotomy can also be used
to gain access during MIDCAB.
Question 5
Which of the following patients is at highest risk for neurological complications after
CABG?
A. A 63-year- old patient with a BMI of 30 undergoing OPCAB
B. A 85-year-old patient with an atherosclerotic aorta undergoing CPB
C. A previously healthy 50-year-old woman undergoing CPB
D. A 67-year-old man having a MIDCAB to the LAD with no known history of hypertension
CORRECT ANSWER
B. Severe atherosclerosis of the aorta, advanced age, use of CPB, aortic cross-clamping,
diabetes, hypertension, female sex, and history of stroke place patients at high risk for
neurological complications following cardiac surgery. Other factors contributing to
neurological complications include alcohol abuse, heart failure, arrhythmias, and
hyperglycemia.
Question 6
The nurse caring for the post operative cardiac surgery patient recognizes the following as
potential contributors to post-operative vasodilation that can cause hypotension:
A. Cooling that occurs while on cardiopulmonary bypass, and use of vasodilators post op.
3
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, B. Use of norepinephrine or dopamine to support BP immediately post-op.
C. Inflammatory response due to CPB and use of norepinephrine to support BP
D. Rewarming that occurs after return to the ICU, and the inflammatory response to use of
cardiopulmonary bypass during surgery
CORRECT ANSWER
D. Intraoperative cooling results in vasoconstriction; rewarming after surgery causes
vasodilation and can contribute to hypotension if volume administration is inadequate
for the increased size of the vascular space caused by vasodilation. The use of CPB
stimulates an inflammatory response that results in vasodilation that contributes to
hypotension.
Norepinephrine and dopamine cause peripheral vasoconstriction, not vasodilation.
Question 7
A characteristic of a fast-track pathway after CABG would include:
A. anticipated discharge between post-op days 7 and 8.
B. a defined medication strategy to prevent postoperative atrial fibrillation.
C. liberal use of opioid medications to increase patient comfort during the ventilator
weaning
process.
D. extubation by the third post-op day
CORRECT ANSWER
C. Low-risk patients can be selected for fast tracking after CABG. These patients are
targeted for early extubation, early ambulation, and early discharge. Patients who are
fast tracked receive sedation and analgesia to allow for early extubation.
Pharmacological strategies to prevent atrial fibrillation and early phase I cardiac
rehabilitation are also key components of fast tracking.
Question 8
4
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QUESTIONS AND VERIFIED ANSWERS|BRAND NEW
2026-2027 UPDATE|GRADED A+
Question 1
You are caring for a patient with an intra-aortic balloon pump and note blood in the
tubing. Your initial action should be:
A. Stop the balloon pump and notify the physician.
B. Administer 100% oxygen to help displace the helium and notify the physician
C. Leave the IABP running and notify the physician.
D. Purge the IABP manually to clear the blood from the tubing.
CORRECT ANSWER
A. Blood in the IABP tubing indicates a balloon rupture which can cause gas embolus.
However, helium is thought to be easily absorbed in the presence of balloon rupture and
oxygen is not generally indicated. The appropriate action is to disconnect the balloon
from the console or turn it on standby so the movement of helium is stopped and notify
the physician. The nurse will need to prepare for IABP removal and replacement if
needed.
Question 2
When caring for a patient immediately post CABG the nurse recognizes that the most likely
cause of hypotension in the immediate post-operative period is
A. Decreased circulating volume requiring no intervention unless persistent > 12 hours.
B. LV failure requiring an inotrope as first line treatment for any hypotension.
C. Decreased circulating volume representing the need for increased fluid administration.
D. LV failure requiring an assist device.
CORRECT ANSWER
C. Hypotension in the immediate postoperative period is usually caused by low
circulating volume and responds to treatment with fluids. Volume is the first line
1
@https://www.stuvia.com/user/thestudyvault
, treatment for hypotension. If there is no immediate response to volume administration,
500 mg of IV calcium chloride is often given. Existing vasopressors, such as
norepinephrine, can also be adjusted. It is important for hypotension to be promptly
treated. Persistent hypotension can result in hypoperfusion and end organ damage.
LV failure is not the most common cause of hypotension in the immediate post-operative
period and therefore inotropic agents are not first line agents used in the treatment of
hypotension. Hypotension that does not respond to fluid administration may require an
inotrope.
Question 3
Preoperative clopidogrel should be held for how many days in the elective surgery patient:
A.It does not need to be held.
B. 1-2 days.
C. 5-7 days.
D. 30 days.
CORRECT ANSWER
C. Clopidogrel inhibits the P2Y12 receptor on the platelet for the lifetime of the platelet
(10 days). Inhibited platelets cannot participate in clotting, so the risk of bleeding
increases with antiplatelet drugs. Most clinical trials have identified an increased risk in
bleeding, transfusion, and re-exploration when clopidogrel is taken within 5 days of
surgery, and no increase in bleeding or transfusions when clopidogrel is stopped for > 5
days prior to surgery. Therefore, clopidogrel should be stopped for 5 to 7 days prior to
elective surgery. Emergent surgery can be done regardless of when the last dose of
clopidogrel was taken, but will be associated with increased bleeding and need for
platelet transfusions.
Question 4
The term OPCAB refers to:
A. combination open heart surgery and percutaneous procedure.
B. CABG surgery without the use of cardiopulmonary bypass (CPB).
2
@https://www.stuvia.com/user/thestudyvault
,C. the use of thoracotomy instead of sternotomy.
D. patients who are fast tracked to be discharged in less than 5 days.
CORRECT ANSWER
B. OPCAB refers to off-pump coronary artery bypass. Surgery is done without CPB but it
still involves a median sternotomy.
MIDCAB (minimally invasive direct coronary artery bypass) is performed on a beating
heart without CPB and without the use of a median sternotomy. MIDCAB is commonly
done through an anterior thoracotomy incision and is used to bypass the mid to distal
LAD with a left internal mammary artery (LIMA) graft. A ministernotomy can also be used
to gain access during MIDCAB.
Question 5
Which of the following patients is at highest risk for neurological complications after
CABG?
A. A 63-year- old patient with a BMI of 30 undergoing OPCAB
B. A 85-year-old patient with an atherosclerotic aorta undergoing CPB
C. A previously healthy 50-year-old woman undergoing CPB
D. A 67-year-old man having a MIDCAB to the LAD with no known history of hypertension
CORRECT ANSWER
B. Severe atherosclerosis of the aorta, advanced age, use of CPB, aortic cross-clamping,
diabetes, hypertension, female sex, and history of stroke place patients at high risk for
neurological complications following cardiac surgery. Other factors contributing to
neurological complications include alcohol abuse, heart failure, arrhythmias, and
hyperglycemia.
Question 6
The nurse caring for the post operative cardiac surgery patient recognizes the following as
potential contributors to post-operative vasodilation that can cause hypotension:
A. Cooling that occurs while on cardiopulmonary bypass, and use of vasodilators post op.
3
@https://www.stuvia.com/user/thestudyvault
, B. Use of norepinephrine or dopamine to support BP immediately post-op.
C. Inflammatory response due to CPB and use of norepinephrine to support BP
D. Rewarming that occurs after return to the ICU, and the inflammatory response to use of
cardiopulmonary bypass during surgery
CORRECT ANSWER
D. Intraoperative cooling results in vasoconstriction; rewarming after surgery causes
vasodilation and can contribute to hypotension if volume administration is inadequate
for the increased size of the vascular space caused by vasodilation. The use of CPB
stimulates an inflammatory response that results in vasodilation that contributes to
hypotension.
Norepinephrine and dopamine cause peripheral vasoconstriction, not vasodilation.
Question 7
A characteristic of a fast-track pathway after CABG would include:
A. anticipated discharge between post-op days 7 and 8.
B. a defined medication strategy to prevent postoperative atrial fibrillation.
C. liberal use of opioid medications to increase patient comfort during the ventilator
weaning
process.
D. extubation by the third post-op day
CORRECT ANSWER
C. Low-risk patients can be selected for fast tracking after CABG. These patients are
targeted for early extubation, early ambulation, and early discharge. Patients who are
fast tracked receive sedation and analgesia to allow for early extubation.
Pharmacological strategies to prevent atrial fibrillation and early phase I cardiac
rehabilitation are also key components of fast tracking.
Question 8
4
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