CSC EXAM 2026–2027 | (90 QUESTIONS AND CORRECT
ANSWERS) | ALREADY GRADED A+ | 100% VERIFIED
Nursing & Critical Care | American Association of Critical-Care Nurses (AACN)
Key Domains: Cardiovascular Assessment, Hemodynamic Monitoring, Perioperative Care, Postoperative
Complications, Cardiovascular Pharmacology, Mechanical Circulatory Support, and Patient/Family Education |
Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured CSC EXAM format for 2026–2027 provides the complete layout for generating high-quality exam-
style questions with correct answers and rationales. It emphasizes foundational cardiac surgery nursing
principles, evidence-based hemodynamic monitoring protocols, perioperative safety strategies, and critical care
interventions critical to professional nursing practice and successful AACN subspecialty certification.
The official, verified question count for the actual CSC (Cardiac Surgery Certification) Examination administered by
the AACN is exactly 90 multiple-choice questions (comprising 75 scored items and 15 unscored pretest items).
This document mirrors that authentic exam length and structure.
Answer Format
All correct answers appear in BOLD CYAN. Each question includes a concise rationale explaining safety/clinical
reasoning, protocol adherence, and why alternative options are less appropriate.
1. A patient is admitted 4 hours post-CABG. The pulmonary artery catheter readings show PCWP 24
mmHg, CI 1.8 L/min/m², and SVR 1800 dynes. Which hemodynamic profile is most consistent with
these findings?
A. Vasodilatory shock
B. Cardiogenic shock with elevated left ventricular preload
C. Hypovolemic shock
D. Right ventricular failure
Correct Answer: B. Cardiogenic shock with elevated left ventricular preload
Rationale: Elevated PCWP indicates increased left-sided filling pressures (LV failure/preload overload), low CI
confirms inadequate cardiac output, and high SVR is compensatory vasoconstriction. This is classic for cardiogenic
shock post-CPB. Hypovolemia would show low PCWP; vasodilatory shock shows low SVR; isolated RV failure
shows high CVP but relatively lower PCWP.
,2. During hemodynamic monitoring of a post-cardiac surgery patient, the nurse observes a sudden
equalization of diastolic pressures (CVP 18 mmHg, PAD 19 mmHg, PCWP 19 mmHg) with a falling
cardiac index. What is the priority nursing action?
A. Initiate high-dose inotropic support only
B. Notify the surgeon immediately and prepare for possible re-exploration
C. Administer a fluid challenge and reassess
D. Increase fluid administration to improve preload
Correct Answer: B. Notify the surgeon immediately and prepare for possible re-exploration
Rationale: Equalization of diastolic pressures is a hallmark of cardiac tamponade or pericardial compression.
Immediate notification of the surgical team is required for urgent evaluation (echo, re-sternotomy). Fluids may
temporarily help but do not address the underlying cause; inotropes alone are insufficient.
3. A post-mitral valve repair patient has a mixed venous oxygen saturation (SvO2) of 52%. Which
interpretation is most accurate?
A. Adequate oxygen delivery and tissue perfusion
B. Increased oxygen extraction due to low cardiac output or high oxygen demand
C. Normal post-operative finding unrelated to hemodynamics
D. Hyperdynamic state with excessive oxygen delivery
Correct Answer: B. Increased oxygen extraction due to low cardiac output or high oxygen demand
Rationale: SvO2 <60% (normal 60-80%) indicates increased oxygen extraction by tissues, typically from
decreased cardiac output, anemia, or increased metabolic demand. It signals inadequate oxygen delivery relative
to consumption and requires urgent intervention.
4. Which parameter is the most reliable indicator of adequate tissue perfusion in the immediate
postoperative period after cardiac surgery?
A. Heart rate of 95 bpm in sinus rhythm
B. Mean arterial pressure (MAP) of 68 mmHg
C. Urine output of 0.5 mL/kg/hr and warm extremities
D. Central venous pressure (CVP) of 10 mmHg
Correct Answer: C. Urine output of 0.5 mL/kg/hr and warm extremities
Rationale: Adequate urine output (>0.5 mL/kg/hr) and warm, well-perfused extremities are direct clinical
indicators of end-organ perfusion. MAP alone does not guarantee perfusion; CVP is a preload measure; HR is
nonspecific.
5. A patient on a pulmonary artery catheter has a cardiac index of 1.9 L/min/m², PCWP 22 mmHg, and
SVR 1600. The nurse should anticipate which pharmacologic intervention first?
, A. Vasopressin infusion to increase afterload
B. Volume expansion with crystalloid
C. Initiation of milrinone infusion
D. Nitroprusside for afterload reduction
Correct Answer: C. Initiation of milrinone infusion
Rationale: Low CI with elevated PCWP indicates poor contractility/pump failure. Milrinone provides inotropy and
afterload reduction (vasodilation) ideal for this profile. Volume is contraindicated with high PCWP; vasopressin
increases afterload inappropriately; nitroprusside alone does not provide inotropy.
6. What does an elevated pulmonary artery diastolic pressure (PAD) relative to PCWP suggest in a post-
cardiac surgery patient?
A. Left ventricular failure
B. Mitral stenosis
C. Pulmonary hypertension or increased pulmonary vascular resistance
D. Hypovolemia
Correct Answer: C. Pulmonary hypertension or increased pulmonary vascular resistance
Rationale: When PAD significantly exceeds PCWP, it points to elevated pulmonary vascular resistance (PVR) or
pulmonary hypertension. In LV failure PCWP rises first and PAD follows closely. Hypovolemia lowers all pressures.
7. The nurse is interpreting arterial blood gas results in a ventilated post-CABG patient: pH 7.28, PaCO2
52 mmHg, HCO3 24 mEq/L, PaO2 92 mmHg on FiO2 0.4. What is the primary acid-base disturbance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: C. Respiratory acidosis
Rationale: Elevated PaCO2 with normal HCO3 indicates acute respiratory acidosis (hypoventilation). This may
result from inadequate ventilation, sedation effects, or diaphragmatic dysfunction post-sternotomy. Metabolic
values are normal.
8. Following aortic valve replacement, continuous cardiac output monitoring shows a sudden drop in CI
from 2.8 to 1.6 L/min/m². Which assessment finding would most support the need for immediate
intervention?
A. Lactate level rising from 1.8 to 4.2 mmol/L
B. Urine output 35 mL over the last hour
ANSWERS) | ALREADY GRADED A+ | 100% VERIFIED
Nursing & Critical Care | American Association of Critical-Care Nurses (AACN)
Key Domains: Cardiovascular Assessment, Hemodynamic Monitoring, Perioperative Care, Postoperative
Complications, Cardiovascular Pharmacology, Mechanical Circulatory Support, and Patient/Family Education |
Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured CSC EXAM format for 2026–2027 provides the complete layout for generating high-quality exam-
style questions with correct answers and rationales. It emphasizes foundational cardiac surgery nursing
principles, evidence-based hemodynamic monitoring protocols, perioperative safety strategies, and critical care
interventions critical to professional nursing practice and successful AACN subspecialty certification.
The official, verified question count for the actual CSC (Cardiac Surgery Certification) Examination administered by
the AACN is exactly 90 multiple-choice questions (comprising 75 scored items and 15 unscored pretest items).
This document mirrors that authentic exam length and structure.
Answer Format
All correct answers appear in BOLD CYAN. Each question includes a concise rationale explaining safety/clinical
reasoning, protocol adherence, and why alternative options are less appropriate.
1. A patient is admitted 4 hours post-CABG. The pulmonary artery catheter readings show PCWP 24
mmHg, CI 1.8 L/min/m², and SVR 1800 dynes. Which hemodynamic profile is most consistent with
these findings?
A. Vasodilatory shock
B. Cardiogenic shock with elevated left ventricular preload
C. Hypovolemic shock
D. Right ventricular failure
Correct Answer: B. Cardiogenic shock with elevated left ventricular preload
Rationale: Elevated PCWP indicates increased left-sided filling pressures (LV failure/preload overload), low CI
confirms inadequate cardiac output, and high SVR is compensatory vasoconstriction. This is classic for cardiogenic
shock post-CPB. Hypovolemia would show low PCWP; vasodilatory shock shows low SVR; isolated RV failure
shows high CVP but relatively lower PCWP.
,2. During hemodynamic monitoring of a post-cardiac surgery patient, the nurse observes a sudden
equalization of diastolic pressures (CVP 18 mmHg, PAD 19 mmHg, PCWP 19 mmHg) with a falling
cardiac index. What is the priority nursing action?
A. Initiate high-dose inotropic support only
B. Notify the surgeon immediately and prepare for possible re-exploration
C. Administer a fluid challenge and reassess
D. Increase fluid administration to improve preload
Correct Answer: B. Notify the surgeon immediately and prepare for possible re-exploration
Rationale: Equalization of diastolic pressures is a hallmark of cardiac tamponade or pericardial compression.
Immediate notification of the surgical team is required for urgent evaluation (echo, re-sternotomy). Fluids may
temporarily help but do not address the underlying cause; inotropes alone are insufficient.
3. A post-mitral valve repair patient has a mixed venous oxygen saturation (SvO2) of 52%. Which
interpretation is most accurate?
A. Adequate oxygen delivery and tissue perfusion
B. Increased oxygen extraction due to low cardiac output or high oxygen demand
C. Normal post-operative finding unrelated to hemodynamics
D. Hyperdynamic state with excessive oxygen delivery
Correct Answer: B. Increased oxygen extraction due to low cardiac output or high oxygen demand
Rationale: SvO2 <60% (normal 60-80%) indicates increased oxygen extraction by tissues, typically from
decreased cardiac output, anemia, or increased metabolic demand. It signals inadequate oxygen delivery relative
to consumption and requires urgent intervention.
4. Which parameter is the most reliable indicator of adequate tissue perfusion in the immediate
postoperative period after cardiac surgery?
A. Heart rate of 95 bpm in sinus rhythm
B. Mean arterial pressure (MAP) of 68 mmHg
C. Urine output of 0.5 mL/kg/hr and warm extremities
D. Central venous pressure (CVP) of 10 mmHg
Correct Answer: C. Urine output of 0.5 mL/kg/hr and warm extremities
Rationale: Adequate urine output (>0.5 mL/kg/hr) and warm, well-perfused extremities are direct clinical
indicators of end-organ perfusion. MAP alone does not guarantee perfusion; CVP is a preload measure; HR is
nonspecific.
5. A patient on a pulmonary artery catheter has a cardiac index of 1.9 L/min/m², PCWP 22 mmHg, and
SVR 1600. The nurse should anticipate which pharmacologic intervention first?
, A. Vasopressin infusion to increase afterload
B. Volume expansion with crystalloid
C. Initiation of milrinone infusion
D. Nitroprusside for afterload reduction
Correct Answer: C. Initiation of milrinone infusion
Rationale: Low CI with elevated PCWP indicates poor contractility/pump failure. Milrinone provides inotropy and
afterload reduction (vasodilation) ideal for this profile. Volume is contraindicated with high PCWP; vasopressin
increases afterload inappropriately; nitroprusside alone does not provide inotropy.
6. What does an elevated pulmonary artery diastolic pressure (PAD) relative to PCWP suggest in a post-
cardiac surgery patient?
A. Left ventricular failure
B. Mitral stenosis
C. Pulmonary hypertension or increased pulmonary vascular resistance
D. Hypovolemia
Correct Answer: C. Pulmonary hypertension or increased pulmonary vascular resistance
Rationale: When PAD significantly exceeds PCWP, it points to elevated pulmonary vascular resistance (PVR) or
pulmonary hypertension. In LV failure PCWP rises first and PAD follows closely. Hypovolemia lowers all pressures.
7. The nurse is interpreting arterial blood gas results in a ventilated post-CABG patient: pH 7.28, PaCO2
52 mmHg, HCO3 24 mEq/L, PaO2 92 mmHg on FiO2 0.4. What is the primary acid-base disturbance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: C. Respiratory acidosis
Rationale: Elevated PaCO2 with normal HCO3 indicates acute respiratory acidosis (hypoventilation). This may
result from inadequate ventilation, sedation effects, or diaphragmatic dysfunction post-sternotomy. Metabolic
values are normal.
8. Following aortic valve replacement, continuous cardiac output monitoring shows a sudden drop in CI
from 2.8 to 1.6 L/min/m². Which assessment finding would most support the need for immediate
intervention?
A. Lactate level rising from 1.8 to 4.2 mmol/L
B. Urine output 35 mL over the last hour
