AACN CSC (Adult Cardiac Surgery Certification) Advanced Practice Exam
Questions and Answers |Fall 2026/2027 Update | 100% Correct Latest
(Graded A+)
QUESTION 1
A post–cardiac bypass patient with MAP < 55 mm Hg and SVR < 700 dyn·s/cm⁵ most likely
requires:
A. Beta-blocker bolus
B. Vasopressor support such as norepinephrine
C. Increased propofol infusion
D. Diuretic administration
CORRECT ANSWER: B. Vasopressor support such as norepinephrine**
RATIONALE: Low MAP with reduced SVR suggests vasodilatory shock from inflammatory
response or vasoplegia after bypass; norepinephrine restores vascular tone and perfusion
pressure.
QUESTION 2
A sudden drop in chest tube drainage with hypotension after cardiac surgery most likely
indicates:
A. Cardiac tamponade
B. Hypovolemia
C. Pneumothorax
D. Line infection
CORRECT ANSWER: A. Cardiac tamponade**
RATIONALE: Abrupt cessation of drainage with rising CVP and falling arterial pressure signals
pericardial blood accumulation compressing the heart.
QUESTION 3
Which pulmonary artery catheter value best reflects left ventricular preload?
A. Central venous pressure
B. Pulmonary artery occlusion pressure (PAOP)
,C. Cardiac output
D. Systemic vascular resistance
CORRECT ANSWER: B. Pulmonary artery occlusion pressure (PAOP)**
RATIONALE: PAOP approximates left ventricular end-diastolic pressure in patients with normal
pulmonary compliance.
QUESTION 4
A patient with PAOP 25 mm Hg, crackles, and decreased oxygenation has:
A. Right-sided failure
B. Cardiogenic pulmonary edema
C. Pulmonary embolism
D. Hypovolemia
CORRECT ANSWER: B. Cardiogenic pulmonary edema**
RATIONALE: Elevated left-sided filling pressure causes fluid transudation into alveoli producing
congestion and hypoxemia.
QUESTION 5
After CABG, ST-segment elevation in leads II, III, aVF most likely indicates:
A. LAD graft occlusion
B. RCA or right graft occlusion causing inferior ischemia
C. Anterior wall ischemia
D. Diffuse pericarditis
CORRECT ANSWER: B. RCA or right graft occlusion causing inferior ischemia**
RATIONALE: Inferior leads correspond to RCA distribution; graft compromise must be urgently
evaluated.
QUESTION 6
Which electrolyte imbalance potentiates digoxin toxicity after cardiac surgery?
A. Hypernatremia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia
,CORRECT ANSWER: B. Hypokalemia**
RATIONALE: Low potassium enhances digoxin binding to Na⁺/K⁺-ATPase, increasing arrhythmia
risk.
QUESTION 7
A dopamine infusion increases MAP from 60 → 75 mm Hg with HR 130 bpm and rising lactate.
Best next step:
A. Continue dopamine
B. Reduce stimulation and sedate
C. Switch to norepinephrine
D. Add beta-blocker
CORRECT ANSWER: C. Switch to norepinephrine**
RATIONALE: Tachyarrhythmia and persistent hypoperfusion indicate excessive β-effect;
norepinephrine yields stronger α-mediated vasoconstriction with fewer chronotropic effects.
QUESTION 8
Post-valve replacement, new-onset systolic murmur and abrupt hypotension suggest:
A. Tamponade
B. Prosthetic valve dysfunction or dehiscence
C. Right heart failure
D. Atelectasis
CORRECT ANSWER: B. Prosthetic valve dysfunction or dehiscence**
RATIONALE: Mechanical instability or thrombus can acutely impair forward flow—requires
urgent echocardiographic evaluation.
QUESTION 9
Which assessment finding best differentiates cardiogenic shock from hypovolemic shock?
A. Low urine output
B. Tachycardia
C. Elevated PAOP
D. Low MAP
, CORRECT ANSWER: C. Elevated PAOP**
RATIONALE: Both show hypotension and oliguria, but cardiogenic shock features high filling
pressures due to pump failure.
QUESTION 10
When titrating a nitroprusside infusion, the nurse must monitor for:
A. Cyanide toxicity and thiocyanate accumulation
B. Nephrotoxicity
C. Bronchospasm
D. Ototoxicity
CORRECT ANSWER: A. Cyanide toxicity and thiocyanate accumulation**
RATIONALE: Nitroprusside metabolizes to cyanide; prolonged or high-dose infusions need
monitoring of acid-base balance and mental status.
QUESTION 11
During rewarming after hypothermic bypass, a major concern is:
A. Metabolic alkalosis
B. Vasodilation and hypotension from peripheral pooling
C. Hyperglycemia correction
D. Ventricular fibrillation
CORRECT ANSWER: B. Vasodilation and hypotension from peripheral pooling**
RATIONALE: Peripheral vessels dilate as temperature rises, reducing preload and MAP; careful
rewarming and vasopressors may be needed.
QUESTION 12
The optimal mean arterial pressure for adequate coronary perfusion in postoperative cardiac
patients is generally:
A. 40–50 mm Hg
B. 60–70 mm Hg
C. > 90 mm Hg
D. 100 mm Hg
Questions and Answers |Fall 2026/2027 Update | 100% Correct Latest
(Graded A+)
QUESTION 1
A post–cardiac bypass patient with MAP < 55 mm Hg and SVR < 700 dyn·s/cm⁵ most likely
requires:
A. Beta-blocker bolus
B. Vasopressor support such as norepinephrine
C. Increased propofol infusion
D. Diuretic administration
CORRECT ANSWER: B. Vasopressor support such as norepinephrine**
RATIONALE: Low MAP with reduced SVR suggests vasodilatory shock from inflammatory
response or vasoplegia after bypass; norepinephrine restores vascular tone and perfusion
pressure.
QUESTION 2
A sudden drop in chest tube drainage with hypotension after cardiac surgery most likely
indicates:
A. Cardiac tamponade
B. Hypovolemia
C. Pneumothorax
D. Line infection
CORRECT ANSWER: A. Cardiac tamponade**
RATIONALE: Abrupt cessation of drainage with rising CVP and falling arterial pressure signals
pericardial blood accumulation compressing the heart.
QUESTION 3
Which pulmonary artery catheter value best reflects left ventricular preload?
A. Central venous pressure
B. Pulmonary artery occlusion pressure (PAOP)
,C. Cardiac output
D. Systemic vascular resistance
CORRECT ANSWER: B. Pulmonary artery occlusion pressure (PAOP)**
RATIONALE: PAOP approximates left ventricular end-diastolic pressure in patients with normal
pulmonary compliance.
QUESTION 4
A patient with PAOP 25 mm Hg, crackles, and decreased oxygenation has:
A. Right-sided failure
B. Cardiogenic pulmonary edema
C. Pulmonary embolism
D. Hypovolemia
CORRECT ANSWER: B. Cardiogenic pulmonary edema**
RATIONALE: Elevated left-sided filling pressure causes fluid transudation into alveoli producing
congestion and hypoxemia.
QUESTION 5
After CABG, ST-segment elevation in leads II, III, aVF most likely indicates:
A. LAD graft occlusion
B. RCA or right graft occlusion causing inferior ischemia
C. Anterior wall ischemia
D. Diffuse pericarditis
CORRECT ANSWER: B. RCA or right graft occlusion causing inferior ischemia**
RATIONALE: Inferior leads correspond to RCA distribution; graft compromise must be urgently
evaluated.
QUESTION 6
Which electrolyte imbalance potentiates digoxin toxicity after cardiac surgery?
A. Hypernatremia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia
,CORRECT ANSWER: B. Hypokalemia**
RATIONALE: Low potassium enhances digoxin binding to Na⁺/K⁺-ATPase, increasing arrhythmia
risk.
QUESTION 7
A dopamine infusion increases MAP from 60 → 75 mm Hg with HR 130 bpm and rising lactate.
Best next step:
A. Continue dopamine
B. Reduce stimulation and sedate
C. Switch to norepinephrine
D. Add beta-blocker
CORRECT ANSWER: C. Switch to norepinephrine**
RATIONALE: Tachyarrhythmia and persistent hypoperfusion indicate excessive β-effect;
norepinephrine yields stronger α-mediated vasoconstriction with fewer chronotropic effects.
QUESTION 8
Post-valve replacement, new-onset systolic murmur and abrupt hypotension suggest:
A. Tamponade
B. Prosthetic valve dysfunction or dehiscence
C. Right heart failure
D. Atelectasis
CORRECT ANSWER: B. Prosthetic valve dysfunction or dehiscence**
RATIONALE: Mechanical instability or thrombus can acutely impair forward flow—requires
urgent echocardiographic evaluation.
QUESTION 9
Which assessment finding best differentiates cardiogenic shock from hypovolemic shock?
A. Low urine output
B. Tachycardia
C. Elevated PAOP
D. Low MAP
, CORRECT ANSWER: C. Elevated PAOP**
RATIONALE: Both show hypotension and oliguria, but cardiogenic shock features high filling
pressures due to pump failure.
QUESTION 10
When titrating a nitroprusside infusion, the nurse must monitor for:
A. Cyanide toxicity and thiocyanate accumulation
B. Nephrotoxicity
C. Bronchospasm
D. Ototoxicity
CORRECT ANSWER: A. Cyanide toxicity and thiocyanate accumulation**
RATIONALE: Nitroprusside metabolizes to cyanide; prolonged or high-dose infusions need
monitoring of acid-base balance and mental status.
QUESTION 11
During rewarming after hypothermic bypass, a major concern is:
A. Metabolic alkalosis
B. Vasodilation and hypotension from peripheral pooling
C. Hyperglycemia correction
D. Ventricular fibrillation
CORRECT ANSWER: B. Vasodilation and hypotension from peripheral pooling**
RATIONALE: Peripheral vessels dilate as temperature rises, reducing preload and MAP; careful
rewarming and vasopressors may be needed.
QUESTION 12
The optimal mean arterial pressure for adequate coronary perfusion in postoperative cardiac
patients is generally:
A. 40–50 mm Hg
B. 60–70 mm Hg
C. > 90 mm Hg
D. 100 mm Hg
