AACN CSC FINAL EXAM WITH VERIFIED
RATIONALES PRACTICE QUESTIONS AND
ANSWERS 2026 WITH COMPLETE SOLUTIONS
,AACN CSC Practice Exam: 100 Questions with Answers & Rationales
1. A patient is being prepared for elective CABG surgery. Which medication should the nurse anticipate holding
preoperatively?
A. Metoprolol
B. Clopidogrel
C. Atorvastatin
D. Lisinopril
Answer: B. Clopidogrel
Rationale: Clopidogrel is an antiplatelet agent that inhibits platelet aggregation for the life of the platelet (7-10
days), significantly increasing the risk of perioperative bleeding. It is typically held 5-7 days prior to elective
cardiac surgery. Beta-blockers, statins, and ACE inhibitors are generally continued.
2. During a radial artery harvest, the surgeon requests a solution to prevent arterial spasm. The nurse
anticipates providing:
A. Nitroglycerin solution
B. Papaverine solution
C. Normal saline
D. Insulin solution
,Answer: B. Papaverine solution
Rationale: Papaverine is a vasodilator commonly used topically or injected into the harvested radial artery to
prevent vasospasm, which can lead to early graft failure. Nitroglycerin can be used, but papaverine is the
standard of care for the harvest bed.
3. A patient in the ICU is 4 hours post-CABG. Chest tube output suddenly drops from 100 mL/hr to 0 mL/hr. The
patient's CVP rises from 8 to 18 mmHg, and BP drops to 80/50. The most likely cause is:
A. Graft failure
B. Cardiac tamponade
C. Hypovolemia
D. Acute renal failure
Answer: B. Cardiac tamponade
Rationale: The classic triad of tamponade is a sudden cessation of chest tube output (due to clot blocking the
tube or overwhelming pressure), rising filling pressures (CVP), and hypotension (decreased cardiac output).
Graft failure typically presents with ST changes and arrhythmias, without the sudden cessation of output.
4. Which of the following is the most common cause of acute right ventricular failure following LVAD
implantation?
A. Pulmonary embolism
B. Leftward shift of the interventricular septum
, C. Right coronary artery spasm
D. Aortic valve stenosis
Answer: B. Leftward shift of the interventricular septum
Rationale: A newly implanted LVAD aggressively unloads the left ventricle. This causes the interventricular
septum to shift leftward, altering the geometry of the right ventricle and impairing its contractility, leading to RV
failure.
5. A patient is receiving IABP counterpulsation at 1:1. The nurse notes the augmentation pressure is lower than
the patient's systolic pressure. The priority action is to:
A. Increase the balloon volume
B. Check the timing of balloon inflation
C. Place the patient in Trendelenburg
D. Deflate the balloon immediately
Answer: B. Check the timing of balloon inflation
Rationale: A poorly timed balloon (inflating too late or deflating too early) results in poor diastolic augmentation.
Checking timing and adjusting to inflate at the dicrotic notch (aortic valve closure) is the priority.
6. A patient is 2 hours post-aortic valve replacement. The nurse notes a new onset of a wide-complex
tachycardia with a rate of 150. The patient is alert and has a BP of 110/70. The priority intervention is:
RATIONALES PRACTICE QUESTIONS AND
ANSWERS 2026 WITH COMPLETE SOLUTIONS
,AACN CSC Practice Exam: 100 Questions with Answers & Rationales
1. A patient is being prepared for elective CABG surgery. Which medication should the nurse anticipate holding
preoperatively?
A. Metoprolol
B. Clopidogrel
C. Atorvastatin
D. Lisinopril
Answer: B. Clopidogrel
Rationale: Clopidogrel is an antiplatelet agent that inhibits platelet aggregation for the life of the platelet (7-10
days), significantly increasing the risk of perioperative bleeding. It is typically held 5-7 days prior to elective
cardiac surgery. Beta-blockers, statins, and ACE inhibitors are generally continued.
2. During a radial artery harvest, the surgeon requests a solution to prevent arterial spasm. The nurse
anticipates providing:
A. Nitroglycerin solution
B. Papaverine solution
C. Normal saline
D. Insulin solution
,Answer: B. Papaverine solution
Rationale: Papaverine is a vasodilator commonly used topically or injected into the harvested radial artery to
prevent vasospasm, which can lead to early graft failure. Nitroglycerin can be used, but papaverine is the
standard of care for the harvest bed.
3. A patient in the ICU is 4 hours post-CABG. Chest tube output suddenly drops from 100 mL/hr to 0 mL/hr. The
patient's CVP rises from 8 to 18 mmHg, and BP drops to 80/50. The most likely cause is:
A. Graft failure
B. Cardiac tamponade
C. Hypovolemia
D. Acute renal failure
Answer: B. Cardiac tamponade
Rationale: The classic triad of tamponade is a sudden cessation of chest tube output (due to clot blocking the
tube or overwhelming pressure), rising filling pressures (CVP), and hypotension (decreased cardiac output).
Graft failure typically presents with ST changes and arrhythmias, without the sudden cessation of output.
4. Which of the following is the most common cause of acute right ventricular failure following LVAD
implantation?
A. Pulmonary embolism
B. Leftward shift of the interventricular septum
, C. Right coronary artery spasm
D. Aortic valve stenosis
Answer: B. Leftward shift of the interventricular septum
Rationale: A newly implanted LVAD aggressively unloads the left ventricle. This causes the interventricular
septum to shift leftward, altering the geometry of the right ventricle and impairing its contractility, leading to RV
failure.
5. A patient is receiving IABP counterpulsation at 1:1. The nurse notes the augmentation pressure is lower than
the patient's systolic pressure. The priority action is to:
A. Increase the balloon volume
B. Check the timing of balloon inflation
C. Place the patient in Trendelenburg
D. Deflate the balloon immediately
Answer: B. Check the timing of balloon inflation
Rationale: A poorly timed balloon (inflating too late or deflating too early) results in poor diastolic augmentation.
Checking timing and adjusting to inflate at the dicrotic notch (aortic valve closure) is the priority.
6. A patient is 2 hours post-aortic valve replacement. The nurse notes a new onset of a wide-complex
tachycardia with a rate of 150. The patient is alert and has a BP of 110/70. The priority intervention is:
