CSC EXAM-CARDIAC SURGERY CERTIFICATION
|ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
Following surgical repair of a thoracic aneurysm with an endoluminal graft, the patient is
unable to move his lower extremities. The nurse should first
A. Activate stroke team and prepare to do an urgent (STAT) computed tomography (CT) scan
B. Prepare to return to surgery for exploration of femoral artery occlusion
C. Call surgeon to obtain a neurology consultation in the morning
D. Prepare for lumbar drain insertion to remove cerebrospinal fluid (CSF)
CORRECT ANSWER
D
Spinal cord ischemia is a complication from thoracic aneurysm repair for both open and
endoluminal repair. Spinal cord ischemia results from increased cerebral spinal pressure
that compresses the spinal nerves. Untreated spinal cord ischemia can lead to
paraplegia. It is important to recognize the signs of spinal cord ischemia (loss of lower
extremity movement) promptly. Immediate insertion of a spinal drain can reverse the
spinal cord ischemia and prevent paraplegia. Bilateral leg paralysis is not typically an
initial symptom of stroke (A). Signs of femoral artery occlusion (B) are the 5 Ps:
pulselessness, pallor, pain, paresthesias, and paralysis. These symptoms would be
unilateral, not bilateral. Immediate insertion of a spinal drain is needed; waiting until
morning for the consultation (C) would be inappropriate.
1
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,Question 2
A postoperative patient who had undergone coronary artery bypass graft and ventricular
aneurysm repair has a 15-beat run of ventricular tachycardia. The most likely cause of the
dysrhythmia is
A. Irritability of the ventricle from the aneurysm repair
B. Spasm of the right coronary artery graft
C. Potassium 4.8 meq/dl and magnesium 2.1 meq/L
D. Did not restart administration of the angiotensinconverting enzyme (ACE) inhibitor (taken
preoperatively)
CORRECT ANSWER
A
Patients with left ventricular aneurysm typically have depressed left ventricular (LV)
function. Depressed LV function may lead to increased ventricular arrhythmias. LV
aneurysm repair is indicated to improve symptoms of angina, heart failure, systemic
thromboembolism, or malignant arrhythmias. In the immediate postoperative phase, the
repaired ventricle continues to be depressed and has the added trauma of surgery on the
left ventricle. Both of these increase the irritability of the LV, leading to ventricular
arrhythmias. Spasm (B) or occlusion of the RCA leads to bradyarrhythmias, not
ventricular arrhythmias. The potassium and magnesium levels in (C) are normal. Low
potassium and magnesium levels increase the risk for ventricular arrhythmias. ACE
inhibitors (D) do not have any antiarrhythmic effect.
Question 3
The nurse admits a patient after aortic valve replacement and notes the following settings
of the temporary pacemaker: DDD rate, 80/min; atrial MA, 10; ventricular MA, 4. The
underlying rhythm is complete heart block with ventricular escape rhythm rate 30/min.
The most likely cause of the complete heart block is
2
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,A. Spasm of the right coronary artery (RCA) graft
B. Damage of the atrioventricular (AV) node during repair of the aortic valve
C. Low potassium and magnesium levels
D. Toxic effects of β-blocker
CORRECT ANSWER
B
The AV node and the bundle of His are near the aortic valve. During aortic valve
replacement, hemorrhage, edema, suturing, or debridement near the AV node and the
bundle of His may cause heart blocks. Typically the epicardial pacing is only needed for a
few days until the edema resolves. If complete heart block persists after a few days, a
permanent pacemaker may be required. The RCA supplies oxygen to the sinoatrial (SA)
and AV nodes and spasm of the RCA graft (A) may cause bradycardia and/or heart blocks.
This patient did not have bypass surgery, so RCA spasm would not be a postoperative
complication. Low potassium and magnesium levels (C) increase the risk for ventricular
arrhythmias, not AV conduction defects. If toxic effects of β-blockers (D) were present,
the complete heart block would have been the underlying rhythm preoperatively.
Question 4
A postoperative coronary artery bypass graft and aortic valve replacement patient has
been in a normal sinus rhythm for 4 hours. The monitor is now showing P waves at a rate
of 73 beats per minute with no ventricular response. The best action would be to
A. Administer atropine 0.5 mg intravenous bolus (IV push)
B. Connect transcutaneous pacing pads to patient
C. Connect epicardial pacing wires to a temporary pacemaker
D. Administer epinephrine 1 mg IV push and start epinephrine infusion
CORRECT ANSWER
3
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, C
The AV node and the bundle of His are near the aortic valve. During aortic valve
replacement, hemorrhage, edema, suturing, or debridement near the AV node and the
bundle of His may cause heart blocks. Pacing is needed to treat the conduction defect
caused by the surgery. Atropine (A) and epinephrine (D) will not work because the
conduction problem is with the AV node and/or the bundle of His. Transcutaneous
(external) pacing (B) would be the next best option if epicardial wires were not present.
The heart rate should be greater than 45/min and less than 80/min.
Question 5
One hour after extubation, a diabetic coronary artery bypass surgery patient is becoming
slightly lethargic. Arterial blood gas (ABG) analysis yielded the following results: ph, 7.33;
pao2, 80 mm Hg; paco2, 50 mm Hg; sao2, 95%; HCO3, 28 meq/L; base excess, 0.5. The
nurse should first
A. Obtain a blood glucose level
B. Obtain a 12-lead ECG
C. Treat metabolic acidosis
D. Stimulate patient to breathe
CORRECT ANSWER
D
After extubation, cardiac surgery patients should be assessed for adequate ventilation.
Pain medications, atelectasis, and immobility may lead to hypoventilation.
Hypoventilation is a cause of respiratory acidosis. High carbon dioxide levels cause
lethargy. The patient is in the early phase of respiratory acidosis. Stimulation and
encouragement of incentive spirometry should prevent further hypoventilation and
reintubation. A, B, and C are actions or interventions for metabolic acidosis.
4
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|ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
Following surgical repair of a thoracic aneurysm with an endoluminal graft, the patient is
unable to move his lower extremities. The nurse should first
A. Activate stroke team and prepare to do an urgent (STAT) computed tomography (CT) scan
B. Prepare to return to surgery for exploration of femoral artery occlusion
C. Call surgeon to obtain a neurology consultation in the morning
D. Prepare for lumbar drain insertion to remove cerebrospinal fluid (CSF)
CORRECT ANSWER
D
Spinal cord ischemia is a complication from thoracic aneurysm repair for both open and
endoluminal repair. Spinal cord ischemia results from increased cerebral spinal pressure
that compresses the spinal nerves. Untreated spinal cord ischemia can lead to
paraplegia. It is important to recognize the signs of spinal cord ischemia (loss of lower
extremity movement) promptly. Immediate insertion of a spinal drain can reverse the
spinal cord ischemia and prevent paraplegia. Bilateral leg paralysis is not typically an
initial symptom of stroke (A). Signs of femoral artery occlusion (B) are the 5 Ps:
pulselessness, pallor, pain, paresthesias, and paralysis. These symptoms would be
unilateral, not bilateral. Immediate insertion of a spinal drain is needed; waiting until
morning for the consultation (C) would be inappropriate.
1
@https://www.stuvia.com/user/thestudyvault
,Question 2
A postoperative patient who had undergone coronary artery bypass graft and ventricular
aneurysm repair has a 15-beat run of ventricular tachycardia. The most likely cause of the
dysrhythmia is
A. Irritability of the ventricle from the aneurysm repair
B. Spasm of the right coronary artery graft
C. Potassium 4.8 meq/dl and magnesium 2.1 meq/L
D. Did not restart administration of the angiotensinconverting enzyme (ACE) inhibitor (taken
preoperatively)
CORRECT ANSWER
A
Patients with left ventricular aneurysm typically have depressed left ventricular (LV)
function. Depressed LV function may lead to increased ventricular arrhythmias. LV
aneurysm repair is indicated to improve symptoms of angina, heart failure, systemic
thromboembolism, or malignant arrhythmias. In the immediate postoperative phase, the
repaired ventricle continues to be depressed and has the added trauma of surgery on the
left ventricle. Both of these increase the irritability of the LV, leading to ventricular
arrhythmias. Spasm (B) or occlusion of the RCA leads to bradyarrhythmias, not
ventricular arrhythmias. The potassium and magnesium levels in (C) are normal. Low
potassium and magnesium levels increase the risk for ventricular arrhythmias. ACE
inhibitors (D) do not have any antiarrhythmic effect.
Question 3
The nurse admits a patient after aortic valve replacement and notes the following settings
of the temporary pacemaker: DDD rate, 80/min; atrial MA, 10; ventricular MA, 4. The
underlying rhythm is complete heart block with ventricular escape rhythm rate 30/min.
The most likely cause of the complete heart block is
2
@https://www.stuvia.com/user/thestudyvault
,A. Spasm of the right coronary artery (RCA) graft
B. Damage of the atrioventricular (AV) node during repair of the aortic valve
C. Low potassium and magnesium levels
D. Toxic effects of β-blocker
CORRECT ANSWER
B
The AV node and the bundle of His are near the aortic valve. During aortic valve
replacement, hemorrhage, edema, suturing, or debridement near the AV node and the
bundle of His may cause heart blocks. Typically the epicardial pacing is only needed for a
few days until the edema resolves. If complete heart block persists after a few days, a
permanent pacemaker may be required. The RCA supplies oxygen to the sinoatrial (SA)
and AV nodes and spasm of the RCA graft (A) may cause bradycardia and/or heart blocks.
This patient did not have bypass surgery, so RCA spasm would not be a postoperative
complication. Low potassium and magnesium levels (C) increase the risk for ventricular
arrhythmias, not AV conduction defects. If toxic effects of β-blockers (D) were present,
the complete heart block would have been the underlying rhythm preoperatively.
Question 4
A postoperative coronary artery bypass graft and aortic valve replacement patient has
been in a normal sinus rhythm for 4 hours. The monitor is now showing P waves at a rate
of 73 beats per minute with no ventricular response. The best action would be to
A. Administer atropine 0.5 mg intravenous bolus (IV push)
B. Connect transcutaneous pacing pads to patient
C. Connect epicardial pacing wires to a temporary pacemaker
D. Administer epinephrine 1 mg IV push and start epinephrine infusion
CORRECT ANSWER
3
@https://www.stuvia.com/user/thestudyvault
, C
The AV node and the bundle of His are near the aortic valve. During aortic valve
replacement, hemorrhage, edema, suturing, or debridement near the AV node and the
bundle of His may cause heart blocks. Pacing is needed to treat the conduction defect
caused by the surgery. Atropine (A) and epinephrine (D) will not work because the
conduction problem is with the AV node and/or the bundle of His. Transcutaneous
(external) pacing (B) would be the next best option if epicardial wires were not present.
The heart rate should be greater than 45/min and less than 80/min.
Question 5
One hour after extubation, a diabetic coronary artery bypass surgery patient is becoming
slightly lethargic. Arterial blood gas (ABG) analysis yielded the following results: ph, 7.33;
pao2, 80 mm Hg; paco2, 50 mm Hg; sao2, 95%; HCO3, 28 meq/L; base excess, 0.5. The
nurse should first
A. Obtain a blood glucose level
B. Obtain a 12-lead ECG
C. Treat metabolic acidosis
D. Stimulate patient to breathe
CORRECT ANSWER
D
After extubation, cardiac surgery patients should be assessed for adequate ventilation.
Pain medications, atelectasis, and immobility may lead to hypoventilation.
Hypoventilation is a cause of respiratory acidosis. High carbon dioxide levels cause
lethargy. The patient is in the early phase of respiratory acidosis. Stimulation and
encouragement of incentive spirometry should prevent further hypoventilation and
reintubation. A, B, and C are actions or interventions for metabolic acidosis.
4
@https://www.stuvia.com/user/thestudyvault
