CSC Exam Study Guide for 2025/2026
90 Practice Questions with Verified Answers
and Evidence-Based Clinical Rationales
Study Guide for Cardiac Surgery Certification
June 2025
Comprehensive Preparation for the Cardiac Surgery Certification (CSC)
Exam
90 High-Yield Questions Aligned with AACN Blueprint, Including NGN-Inspired
Formats and Case Studies
Introduction
This study guide is designed to prepare nurses for the **Cardiac Surgery Certifi-
cation (CSC) Exam** 2025/2026, offered by the American Association of Critical-
Care Nurses (AACN). It includes 90 practice questions with verified answers and
detailed, evidence-based clinical rationales, fully aligned with the AACN CSC Exam
Blueprint. The guide features Next Generation NCLEX (NGN)-inspired clinical
judgment formats, including multiple-choice, select-all-that-apply, case studies,
and highlight questions, to enhance critical thinking skills. It covers key con-
tent areas: pre-op and post-op cardiac surgery care, hemodynamics and inva-
sive monitoring, temporary pacing and chest tube management, valve replace-
ment, coronary artery bypass grafting (CABG), extracorporeal membrane oxy-
genation (ECMO), ventricular assist devices (VADs), arrhythmias, pharmacology,
emergency response, multidisciplinary coordination, and patient/family educa-
tion. Ideal for critical care nurses in cardiovascular intensive care units (CVICU),
cardiothoracic intensive care units (CTICU), step-down, and surgical recovery,
including CCRN-certified nurses seeking specialization, this printable PDF (100+
pages) ensures high-yield preparation for initial certification or renewal.
Test Tips and Clinical Pearls
• Clinical Judgment Focus: NGN-style questions test prioritization and decision-
making; always consider ABCs (airway, breathing, circulation) first.
• Time Management: The CSC exam includes 90 questions (75 scored, 15
unscored) in 2 hours; allocate 1.3 minutes per question.
• Hemodynamic Mastery: Understand Swan-Ganz catheter readings and
1
, their implications for post-op management.
• Clinical Pearl: Always verify chest tube patency by checking for tidaling
and air leaks post-cardiac surgery.
• Pharmacology Tip: Know indications, side effects, and titration protocols
for vasoactive drugs (e.g., epinephrine, milrinone).
• Emergency Response Focus: Be prepared for questions on tamponade,
graft occlusion, and ECMO complications.
• Education Tip: Patient/family teaching questions may focus on discharge
planning and device care (e.g., VADs).
Practice Questions 1–90
QUESTION 1 A 65-year-old patient 6 hours post-CABG develops hypotension (BP
85/50 mmHg) and tachycardia (HR 120/min). Chest tube output is
300 mL in the last hour. Which intervention should the nurse pri-
oritize?
A. Administer IV fluids 500 mL bolus.
B. Notify the surgical team.
C. Increase norepinephrine infusion.
D. Obtain 12-lead ECG.
Answer: B. Notify the surgical team.
Rationale: Excessive chest tube output (>200 mL/hr) with hypoten-
sion and tachycardia suggests postoperative bleeding, requiring
urgent surgical evaluation for possible re-exploration. Fluids and
vasopressors are supportive, and ECG is secondary. Clinical Pearl:
Monitor for signs of cardiac tamponade (e.g., muffled heart sounds).
QUESTION 2 A 70-year-old patient post-aortic valve replacement is monitored
for complications. Which findings should the nurse report imme-
diately? (Select all that apply.)
A. Heart rate 110/min
B. BP 90/60 mmHg
C. SpO2 88
D. Urine output 20 mL/hr
E. Temperature 37.2°C
Answer: A, B, C, D
Rationale: Tachycardia, hypotension, hypoxemia, and oliguria in-
dicate potential hypoperfusion or bleeding, requiring immediate
2
, reporting. Normal temperature is not urgent. Clinical Pearl: As-
sess for paravalvular leak or valve dysfunction.
QUESTION 3 Case Study: A 58-year-old patient 2 days post-CABG develops sud-
den chest pain and dyspnea. Vital signs: BP 100/60 mmHg, HR
130/min, RR 28/min, SpO2 85
A. Pulmonary embolism
B. Graft occlusion
C. Cardiac tamponade
D. Pneumothorax
Answer: B. Graft occlusion
Rationale: ST-elevation, chest pain, and tachycardia suggest acute
graft occlusion or myocardial infarction, requiring urgent catheter-
ization. PE presents with tachycardia and hypoxemia but not ST-
elevation; tamponade shows muffled sounds; pneumothorax has
absent breath sounds. Clinical Pearl: Administer aspirin and no-
tify cardiology.
QUESTION 4 A 62-year-old patient post-CABG has the following hemodynamic
readings. Highlight items requiring immediate follow-up.
Hemodynamic Data:
- Cardiac output 3.2 L/min.
Pulmonary artery pressure 40/20 mmHg.
Central venous pressure 18 mmHg.
Systemic vascular resistance 1,600 dynes/sec/cm⁵.
Pulmonary capillary wedge pressure 22 mmHg.
Answer (Highlighted Text):
- Cardiac output 3.2 L/min.
- Central venous pressure 18 mmHg.
- Pulmonary capillary wedge pressure 22 mmHg.
Rationale: Low cardiac output, elevated CVP, and high PCWP in-
dicate left ventricular dysfunction or fluid overload, requiring in-
otropic support or diuresis. PAP and SVR are elevated but less ur-
gent. Clinical Pearl: Correlate with clinical signs (e.g., crackles).
QUESTION 5 A 55-year-old patient post-mitral valve repair has a temporary epi-
cardial pacemaker set to DDD mode. The ECG shows pacing spikes
without QRS complexes. Which action should the nurse take first?
A. Increase pacing output.
B. Check lead connections.
C. Administer IV atropine.
D. Notify electrophysiology.
Answer: B. Check lead connections.
3
, Rationale: Pacing spikes without QRS suggest capture failure, of-
ten due to loose connections in temporary pacemakers. Checking
leads is the first step before adjusting output or notifying special-
ists. Atropine is ineffective for pacing issues. Clinical Pearl: En-
sure skin contact for external pacing pads.
QUESTION 6 A 68-year-old patient post-CABG is prescribed milrinone. Which
monitoring parameters should the nurse prioritize? (Select all that
apply.)
A. BP
B. Heart rate
C. Platelet count
D. Serum potassium
E. Urine output
Answer: A, B, E
Rationale: Milrinone causes hypotension, tachycardia, and im-
proved cardiac output, requiring BP, HR, and urine output mon-
itoring. Platelets and potassium are unaffected. Clinical Pearl:
Titrate milrinone to maintain SBP >90 mmHg.
QUESTION 7 Case Study: A 60-year-old patient 4 hours post-CABG develops
jugular venous distension, muffled heart sounds, and BP 80/50
mmHg. Which intervention should the nurse prioritize?
A. Administer IV fluids.
B. Prepare for pericardiocentesis.
C. Increase vasopressor dose.
D. Order chest X-ray.
Answer: B. Prepare for pericardiocentesis.
Rationale: Beck’s triad (JVD, muffled sounds, hypotension) indi-
cates cardiac tamponade, requiring urgent pericardiocentesis. Flu-
ids and vasopressors are supportive; X-ray is diagnostic but de-
lays treatment. Clinical Pearl: Monitor for pulsus paradoxus (>10
mmHg BP drop on inspiration).
QUESTION 8 A 70-year-old patient post-aortic valve replacement has the follow-
ing labs. Highlight items requiring immediate follow-up.
Laboratory Results:
- Hemoglobin 7.2 g/dL.
Serum creatinine 2.5 mg/dL.
Serum potassium 5.8 mEq/L.
Platelet count 80,000/mm³.
INR 1.2.
4
90 Practice Questions with Verified Answers
and Evidence-Based Clinical Rationales
Study Guide for Cardiac Surgery Certification
June 2025
Comprehensive Preparation for the Cardiac Surgery Certification (CSC)
Exam
90 High-Yield Questions Aligned with AACN Blueprint, Including NGN-Inspired
Formats and Case Studies
Introduction
This study guide is designed to prepare nurses for the **Cardiac Surgery Certifi-
cation (CSC) Exam** 2025/2026, offered by the American Association of Critical-
Care Nurses (AACN). It includes 90 practice questions with verified answers and
detailed, evidence-based clinical rationales, fully aligned with the AACN CSC Exam
Blueprint. The guide features Next Generation NCLEX (NGN)-inspired clinical
judgment formats, including multiple-choice, select-all-that-apply, case studies,
and highlight questions, to enhance critical thinking skills. It covers key con-
tent areas: pre-op and post-op cardiac surgery care, hemodynamics and inva-
sive monitoring, temporary pacing and chest tube management, valve replace-
ment, coronary artery bypass grafting (CABG), extracorporeal membrane oxy-
genation (ECMO), ventricular assist devices (VADs), arrhythmias, pharmacology,
emergency response, multidisciplinary coordination, and patient/family educa-
tion. Ideal for critical care nurses in cardiovascular intensive care units (CVICU),
cardiothoracic intensive care units (CTICU), step-down, and surgical recovery,
including CCRN-certified nurses seeking specialization, this printable PDF (100+
pages) ensures high-yield preparation for initial certification or renewal.
Test Tips and Clinical Pearls
• Clinical Judgment Focus: NGN-style questions test prioritization and decision-
making; always consider ABCs (airway, breathing, circulation) first.
• Time Management: The CSC exam includes 90 questions (75 scored, 15
unscored) in 2 hours; allocate 1.3 minutes per question.
• Hemodynamic Mastery: Understand Swan-Ganz catheter readings and
1
, their implications for post-op management.
• Clinical Pearl: Always verify chest tube patency by checking for tidaling
and air leaks post-cardiac surgery.
• Pharmacology Tip: Know indications, side effects, and titration protocols
for vasoactive drugs (e.g., epinephrine, milrinone).
• Emergency Response Focus: Be prepared for questions on tamponade,
graft occlusion, and ECMO complications.
• Education Tip: Patient/family teaching questions may focus on discharge
planning and device care (e.g., VADs).
Practice Questions 1–90
QUESTION 1 A 65-year-old patient 6 hours post-CABG develops hypotension (BP
85/50 mmHg) and tachycardia (HR 120/min). Chest tube output is
300 mL in the last hour. Which intervention should the nurse pri-
oritize?
A. Administer IV fluids 500 mL bolus.
B. Notify the surgical team.
C. Increase norepinephrine infusion.
D. Obtain 12-lead ECG.
Answer: B. Notify the surgical team.
Rationale: Excessive chest tube output (>200 mL/hr) with hypoten-
sion and tachycardia suggests postoperative bleeding, requiring
urgent surgical evaluation for possible re-exploration. Fluids and
vasopressors are supportive, and ECG is secondary. Clinical Pearl:
Monitor for signs of cardiac tamponade (e.g., muffled heart sounds).
QUESTION 2 A 70-year-old patient post-aortic valve replacement is monitored
for complications. Which findings should the nurse report imme-
diately? (Select all that apply.)
A. Heart rate 110/min
B. BP 90/60 mmHg
C. SpO2 88
D. Urine output 20 mL/hr
E. Temperature 37.2°C
Answer: A, B, C, D
Rationale: Tachycardia, hypotension, hypoxemia, and oliguria in-
dicate potential hypoperfusion or bleeding, requiring immediate
2
, reporting. Normal temperature is not urgent. Clinical Pearl: As-
sess for paravalvular leak or valve dysfunction.
QUESTION 3 Case Study: A 58-year-old patient 2 days post-CABG develops sud-
den chest pain and dyspnea. Vital signs: BP 100/60 mmHg, HR
130/min, RR 28/min, SpO2 85
A. Pulmonary embolism
B. Graft occlusion
C. Cardiac tamponade
D. Pneumothorax
Answer: B. Graft occlusion
Rationale: ST-elevation, chest pain, and tachycardia suggest acute
graft occlusion or myocardial infarction, requiring urgent catheter-
ization. PE presents with tachycardia and hypoxemia but not ST-
elevation; tamponade shows muffled sounds; pneumothorax has
absent breath sounds. Clinical Pearl: Administer aspirin and no-
tify cardiology.
QUESTION 4 A 62-year-old patient post-CABG has the following hemodynamic
readings. Highlight items requiring immediate follow-up.
Hemodynamic Data:
- Cardiac output 3.2 L/min.
Pulmonary artery pressure 40/20 mmHg.
Central venous pressure 18 mmHg.
Systemic vascular resistance 1,600 dynes/sec/cm⁵.
Pulmonary capillary wedge pressure 22 mmHg.
Answer (Highlighted Text):
- Cardiac output 3.2 L/min.
- Central venous pressure 18 mmHg.
- Pulmonary capillary wedge pressure 22 mmHg.
Rationale: Low cardiac output, elevated CVP, and high PCWP in-
dicate left ventricular dysfunction or fluid overload, requiring in-
otropic support or diuresis. PAP and SVR are elevated but less ur-
gent. Clinical Pearl: Correlate with clinical signs (e.g., crackles).
QUESTION 5 A 55-year-old patient post-mitral valve repair has a temporary epi-
cardial pacemaker set to DDD mode. The ECG shows pacing spikes
without QRS complexes. Which action should the nurse take first?
A. Increase pacing output.
B. Check lead connections.
C. Administer IV atropine.
D. Notify electrophysiology.
Answer: B. Check lead connections.
3
, Rationale: Pacing spikes without QRS suggest capture failure, of-
ten due to loose connections in temporary pacemakers. Checking
leads is the first step before adjusting output or notifying special-
ists. Atropine is ineffective for pacing issues. Clinical Pearl: En-
sure skin contact for external pacing pads.
QUESTION 6 A 68-year-old patient post-CABG is prescribed milrinone. Which
monitoring parameters should the nurse prioritize? (Select all that
apply.)
A. BP
B. Heart rate
C. Platelet count
D. Serum potassium
E. Urine output
Answer: A, B, E
Rationale: Milrinone causes hypotension, tachycardia, and im-
proved cardiac output, requiring BP, HR, and urine output mon-
itoring. Platelets and potassium are unaffected. Clinical Pearl:
Titrate milrinone to maintain SBP >90 mmHg.
QUESTION 7 Case Study: A 60-year-old patient 4 hours post-CABG develops
jugular venous distension, muffled heart sounds, and BP 80/50
mmHg. Which intervention should the nurse prioritize?
A. Administer IV fluids.
B. Prepare for pericardiocentesis.
C. Increase vasopressor dose.
D. Order chest X-ray.
Answer: B. Prepare for pericardiocentesis.
Rationale: Beck’s triad (JVD, muffled sounds, hypotension) indi-
cates cardiac tamponade, requiring urgent pericardiocentesis. Flu-
ids and vasopressors are supportive; X-ray is diagnostic but de-
lays treatment. Clinical Pearl: Monitor for pulsus paradoxus (>10
mmHg BP drop on inspiration).
QUESTION 8 A 70-year-old patient post-aortic valve replacement has the follow-
ing labs. Highlight items requiring immediate follow-up.
Laboratory Results:
- Hemoglobin 7.2 g/dL.
Serum creatinine 2.5 mg/dL.
Serum potassium 5.8 mEq/L.
Platelet count 80,000/mm³.
INR 1.2.
4
