ACCN CSC EXAM VERSION 1 2026/2027 WITH
ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED ANSWERS
|CURRENTLY TESTING QUESTIONS AND
SOLUTIONS|ALREADY GRADED A+|NEWEST
|JUST RELEASED!!|GUARANTEED PASS
The nurse caring for a patient undergoing an emergent re-sternotomy, SHOULD anticipate which
of the following outcomes?
A) A decrease in venous return and an increase in chest tube drainage.
B) An increase in tissue perfusion and a decrease in chest tube drainage.
C) An increased need for blood transfusions and a decrease in cardiac output.
D) A decrease in tissue perfusion and a decreased need for blood transfusions.
B) An increase in tissue perfusion and a decrease in chest tube drainage.
Resolution of the condition that necessitated the emergent open sternotomy would result in
the evacuation of blood from the pericardial space, allowing for an increase in venous return
and a subsequent increase in the ventricular filling.
Therefore, the nurse would anticipate an increase in tissue perfusion and a decrease in chest
tube drainage.
A patient is admitted to the unit following cardiac surgery performed with cardiopulmonary
bypass. The nurse notes a full rebreather mask in place with an estimated blood loss during
surgery of 500 ml after cell saver. The patient is currently lethargic with cool hands and feet.
Data are:
BP 103/68
HR 102
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,RR 14
T 98.1 degrees F (37.2 degrees C)
Sp02 90%
CO 3.6 L/min
Sv02 54%
10
Chest tube output 900 ml
What is the MOST LIKELY next step?
A) initiate dobutamine (Dobutrex) IV
B) transfuse one unit PRBCs
C) apply BIPAP with PEEP of 5 cm H20
D) administer labetalol (Trandate) IV bolus
B)transfuse one unit of PRBCs. Adequate SpO2 and low SvO2 with lethargy, cool/cold
extremities, tachycardia, lower CO, and adequate respiratory rate all indicate anemia rather
than a ventilation issue. BIPAP would increase circulating oxygen levels with additional PEEP
but does not address the other concerns. Dobutamine acts as a direct-acting inotrope that
could increase cardiac output but is likely to increase oxygen demand which is the current
primary concern. A beta-blocker would address the heart rate and may slightly decrease the
myocardial oxygen demand, but this heart rate is most likely a result of anemia rather than
the cause of oxygen consumption.
Following a failed PCI and subsequent CABG, a patient complains of sternal and back pain. Urine
output has decreased markedly. Vital signs are stable.
The nurse should obtain a/an
A) Hct level to rule out von Willebrand disease.
B) platelet count to rule out HIT.
C) PT level to rule out failure of the extrinsic clotting process.
D) activated clotting time level to rule out heparin rebound.
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,B) Platelet count to rule out HIT. HIT is diagnosed by thrombocytopenia and the presence of
antiplatelet antibodies. Activated clotting time elevation would indicate heparin rebound and
is not associated with sternal and back pain. Von Willebrand disease causes platelet
dysfunction that may lead to bleeding. Although a PT level assesses the extrinsic and common
clotting pathway, a failure would cause bleeding, not sternal and back pain.
Six hours following a mitral valve repair through a thoracotomy incision, the nurse notes the
right chest tube insertion site demonstrates crepitus superior to the insertion site. And bubbling
in the water-seal chamber stops when the chest tube is occluded inferior to the dressing. The
provider is notified and orders a STAT chest x-ray. The patient asks what is happening. The
nurse's BEST RESPONSE is
A) "The chest tube is not doing a good job and will likely have to be moved or replaced."
B) "There is some subcutaneous air under the skin on the right side of the patient's chest."
c) "Everything will be fine. The chest x-ray and doctor will be here soon."
D) "I am concerned about these areas on the chest and have notified the provider."
D) "I am concerned about these areas on the chest and have notified the provider.
The correct answer explains what the concern is about without providing unsubstantiated
hope, a medical diagnosis, or a course of action without full evidence.
The nurse is caring for a patient postoperatively who underwent cardiac surgery and notes the
patient is in pain and agitated. The nurse anticipates the provider will order fentanyl over
ketorolac (Tordal) due to fentanyl's
A) long active period
B) synergistic effect with morphine.
c) ability to provide analgesia and sedation.
D) metabolism by the kidneys.
c) ability to provide analgesia and sedation.
Fentanyl can provide analgesia and sedation by stimulating opiate receptors in the central
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, nervous system. Fentanyl has a short active period and can be given as a continuous dose or
in bolus doses. Fentanyl is metabolized by cytochrome P450 in the liver, ketorolac (Toradol) is
metabolized renally. Fentanyl should not be given with opioid agonists in non-ventilated
patients due to the risk of respiratory depression.
A patient had chest tubes removed 48 hours following CABG utilizing the left internal mammary
artery (LIMA). Chest X-ray shows a density in the left lower lobe. The patient refuses to use the
incentive spirometry due to incisional pain and complains of the inability to take a deep breath.
The patient is MOST LIKELY experiencing
A) pulmonary embolism.
B) pleural effusions.
c) pulmonary edema.
D) pneumonia.
B) Left pleural effusions are more common after the pleural cavity has been entered for LIMA
takedown.
The following hemodynamic profile is noted in a patient immediately upon arrival to the unit
following CABG:
BP 88/37
HR 130
MAP 54 mm Hg
CVP 10 mm Hg
PAP 50/25 mm Hg
CO 3.7/min
Cl 2.2 L/min/m2
SVR 994 dynes/sec/cm-5
SvO2 46%
The nurse should suspect the following
A) protamine reaction.
B) myocardial stunning.
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ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED ANSWERS
|CURRENTLY TESTING QUESTIONS AND
SOLUTIONS|ALREADY GRADED A+|NEWEST
|JUST RELEASED!!|GUARANTEED PASS
The nurse caring for a patient undergoing an emergent re-sternotomy, SHOULD anticipate which
of the following outcomes?
A) A decrease in venous return and an increase in chest tube drainage.
B) An increase in tissue perfusion and a decrease in chest tube drainage.
C) An increased need for blood transfusions and a decrease in cardiac output.
D) A decrease in tissue perfusion and a decreased need for blood transfusions.
B) An increase in tissue perfusion and a decrease in chest tube drainage.
Resolution of the condition that necessitated the emergent open sternotomy would result in
the evacuation of blood from the pericardial space, allowing for an increase in venous return
and a subsequent increase in the ventricular filling.
Therefore, the nurse would anticipate an increase in tissue perfusion and a decrease in chest
tube drainage.
A patient is admitted to the unit following cardiac surgery performed with cardiopulmonary
bypass. The nurse notes a full rebreather mask in place with an estimated blood loss during
surgery of 500 ml after cell saver. The patient is currently lethargic with cool hands and feet.
Data are:
BP 103/68
HR 102
1|Page
,RR 14
T 98.1 degrees F (37.2 degrees C)
Sp02 90%
CO 3.6 L/min
Sv02 54%
10
Chest tube output 900 ml
What is the MOST LIKELY next step?
A) initiate dobutamine (Dobutrex) IV
B) transfuse one unit PRBCs
C) apply BIPAP with PEEP of 5 cm H20
D) administer labetalol (Trandate) IV bolus
B)transfuse one unit of PRBCs. Adequate SpO2 and low SvO2 with lethargy, cool/cold
extremities, tachycardia, lower CO, and adequate respiratory rate all indicate anemia rather
than a ventilation issue. BIPAP would increase circulating oxygen levels with additional PEEP
but does not address the other concerns. Dobutamine acts as a direct-acting inotrope that
could increase cardiac output but is likely to increase oxygen demand which is the current
primary concern. A beta-blocker would address the heart rate and may slightly decrease the
myocardial oxygen demand, but this heart rate is most likely a result of anemia rather than
the cause of oxygen consumption.
Following a failed PCI and subsequent CABG, a patient complains of sternal and back pain. Urine
output has decreased markedly. Vital signs are stable.
The nurse should obtain a/an
A) Hct level to rule out von Willebrand disease.
B) platelet count to rule out HIT.
C) PT level to rule out failure of the extrinsic clotting process.
D) activated clotting time level to rule out heparin rebound.
2|Page
,B) Platelet count to rule out HIT. HIT is diagnosed by thrombocytopenia and the presence of
antiplatelet antibodies. Activated clotting time elevation would indicate heparin rebound and
is not associated with sternal and back pain. Von Willebrand disease causes platelet
dysfunction that may lead to bleeding. Although a PT level assesses the extrinsic and common
clotting pathway, a failure would cause bleeding, not sternal and back pain.
Six hours following a mitral valve repair through a thoracotomy incision, the nurse notes the
right chest tube insertion site demonstrates crepitus superior to the insertion site. And bubbling
in the water-seal chamber stops when the chest tube is occluded inferior to the dressing. The
provider is notified and orders a STAT chest x-ray. The patient asks what is happening. The
nurse's BEST RESPONSE is
A) "The chest tube is not doing a good job and will likely have to be moved or replaced."
B) "There is some subcutaneous air under the skin on the right side of the patient's chest."
c) "Everything will be fine. The chest x-ray and doctor will be here soon."
D) "I am concerned about these areas on the chest and have notified the provider."
D) "I am concerned about these areas on the chest and have notified the provider.
The correct answer explains what the concern is about without providing unsubstantiated
hope, a medical diagnosis, or a course of action without full evidence.
The nurse is caring for a patient postoperatively who underwent cardiac surgery and notes the
patient is in pain and agitated. The nurse anticipates the provider will order fentanyl over
ketorolac (Tordal) due to fentanyl's
A) long active period
B) synergistic effect with morphine.
c) ability to provide analgesia and sedation.
D) metabolism by the kidneys.
c) ability to provide analgesia and sedation.
Fentanyl can provide analgesia and sedation by stimulating opiate receptors in the central
3|Page
, nervous system. Fentanyl has a short active period and can be given as a continuous dose or
in bolus doses. Fentanyl is metabolized by cytochrome P450 in the liver, ketorolac (Toradol) is
metabolized renally. Fentanyl should not be given with opioid agonists in non-ventilated
patients due to the risk of respiratory depression.
A patient had chest tubes removed 48 hours following CABG utilizing the left internal mammary
artery (LIMA). Chest X-ray shows a density in the left lower lobe. The patient refuses to use the
incentive spirometry due to incisional pain and complains of the inability to take a deep breath.
The patient is MOST LIKELY experiencing
A) pulmonary embolism.
B) pleural effusions.
c) pulmonary edema.
D) pneumonia.
B) Left pleural effusions are more common after the pleural cavity has been entered for LIMA
takedown.
The following hemodynamic profile is noted in a patient immediately upon arrival to the unit
following CABG:
BP 88/37
HR 130
MAP 54 mm Hg
CVP 10 mm Hg
PAP 50/25 mm Hg
CO 3.7/min
Cl 2.2 L/min/m2
SVR 994 dynes/sec/cm-5
SvO2 46%
The nurse should suspect the following
A) protamine reaction.
B) myocardial stunning.
4|Page
