1
AACN CSC Exam NEWEST 2025/2026 Actual
Exam – Cardiac Surgery Certification | 100%
Verified | Graded A+ Detailed Rationales – Pass
Guaranteed – A+ Graded
[SECTION 1: Preoperative Cardiac Surgery Assessment & Preparation — Questions 1-50]
Q1: Which preoperative diagnostic test is the gold standard for assessing the severity of coronary
artery disease (CAD) and determining the need for surgical revascularization?
A. Transthoracic echocardiogram (TTE).
B. Coronary angiography.
C. Computed Tomography Angiography (CTA).
D. Cardiac Magnetic Resonance Imaging (MRI).
B. Coronary angiography. [CORRECT]
Correct Answer: B
Rationale: Coronary angiography is the invasive gold standard for visualizing the extent and
location of coronary artery occlusions. It provides the anatomical detail necessary to plan
coronary artery bypass grafting (CABG). TTE assesses structure and function but not coronary
anatomy directly. CTA is non-invasive but less definitive for surgical planning than angiography.
Cardiac MRI is used for structure, function, and tissue characterization but not primary CAD
assessment.
Q2: A patient scheduled for CABG is taking Clopidogrel (Plavix). According to standard
preoperative protocols, when should this medication be discontinued to minimize bleeding risk?
A. 24 hours prior to surgery.
B. 48 hours prior to surgery.
C. 5 to 7 days prior to surgery.
D. 2 weeks prior to surgery.
C. 5 to 7 days prior to surgery. [CORRECT]
,2
Correct Answer: C
Rationale: Clopidogrel irreversibly inhibits platelet aggregation, and platelet life span is
approximately 7-10 days. Discontinuing 5 to 7 days prior allows for the generation of new,
functional platelets, significantly reducing the risk of excessive bleeding during surgery. 24-48
hours is insufficient as the drug's effect lasts for the lifespan of the platelet. 2 weeks is
unnecessarily long and increases thrombotic risk.
Q3: A patient with a mechanical aortic valve is scheduled for non-cardiac surgery. How should
their anticoagulation management be handled?
A. Continue Warfarin without interruption.
B. Stop Warfarin 3 days prior and bridge with Heparin.
C. Stop Warfarin 1 day prior and start Aspirin.
D. Switch to Dabigatran 1 week prior.
B. Stop Warfarin 3 days prior and bridge with Heparin. [CORRECT]
Correct Answer: B
Rationale: Patients with mechanical valves are at high risk for thromboembolism, so "bridging"
therapy with a short-acting anticoagulant like Heparin (typically unfractionated or low molecular
weight) is standard when Warfarin is held for surgery. Warfarin is usually stopped 3-5 days pre-
op to allow the INR to normalize. Continuing Warfarin poses a high bleeding risk. Switching to
Dabigatran without bridging is often contraindicated in mechanical valve patients due to higher
stroke risk.
Q4: Which risk assessment tool is specifically validated to predict mortality after cardiac
surgery?
A. APACHE II score.
B. SOFA score.
C. EuroSCORE II.
D. Glasgow Coma Scale.
C. EuroSCORE II. [CORRECT]
,3
Correct Answer: C
Rationale: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a
widely validated risk model used to predict mortality in cardiac surgery patients. It incorporates
patient factors, cardiac factors, and operation details. APACHE II and SOFA are general ICU
severity scores, not specific to cardiac surgery outcomes. Glasgow Coma Scale measures level of
consciousness.
Q5: During preoperative teaching for a median sternotomy patient, which instruction regarding
sternal precautions is most accurate?
A. You may lift up to 25 pounds after 2 weeks.
B. Use your arms to push yourself up from a sitting position.
C. Avoid reaching behind your back and do not lift objects heavier than 5-10 pounds.
D. Cross your arms across your chest when coughing.
C. Avoid reaching behind your back and do not lift objects heavier than 5-10 pounds.
[CORRECT]
Correct Answer: C
Rationale: Sternal precautions typically include not lifting more than 5-10 pounds (or a gallon of
milk) for 6-12 weeks to prevent dehiscence. Reaching behind the back puts shear force on the
sternum and should be avoided. Lifting 25 pounds is prohibited during the initial recovery phase.
Pushing up with arms puts excessive stress on the sternum; patients should use a "log roll" or
brace with a pillow. Crossing arms restricts coughing effectiveness; hugging a pillow is better.
Q6: A patient with severe aortic stenosis presents for preoperative evaluation. Which finding is
most consistent with this diagnosis?
A. Diastolic murmur best heard at the apex.
B. Systolic ejection murmur radiating to the carotids.
C. Continuous machinery-like murmur.
D. Holosystolic murmur radiating to the axilla.
B. Systolic ejection murmur radiating to the carotids. [CORRECT]
, 4
Correct Answer: B
Rationale: Aortic stenosis causes a systolic ejection murmur (crescendo-decrescendo) that is best
heard at the right upper sternal border and radiates to the carotids due to turbulent flow across the
narrow valve. A describes aortic regurgitation (diastolic). C describes a patent ductus arteriosus.
D describes mitral regurgitation.
Q7: Which preoperative laboratory value is most critical to evaluate for a patient with suspected
renal insufficiency prior to cardiac surgery?
A. Serum Albumin.
B. Serum Creatinine and GFR.
C. White Blood Cell Count.
D. Platelet count.
B. Serum Creatinine and GFR. [CORRECT]
Correct Answer: B
Rationale: Serum Creatinine and Glomerular Filtration Rate (GFR) are the primary indicators of
renal function. Renal insufficiency increases the risk of acute kidney injury (AKI) post-CPB and
affects medication dosing and clearance. Albumin indicates nutritional status. WBC indicates
infection. Platelets indicate clotting ability.
Q8: A patient with a history of peripheral vascular disease (PVD) is scheduled for CABG using
the Left Internal Mammary Artery (LIMA). Why is the LIMA the preferred conduit?
A. It is a vein and easy to harvest.
B. It has excellent long-term patency rates compared to saphenous vein grafts.
C. It does not require anticoagulation.
D. It is resistant to atherosclerosis because it is an artery.
B. It has excellent long-term patency rates compared to saphenous vein grafts. [CORRECT]
Correct Answer: B
AACN CSC Exam NEWEST 2025/2026 Actual
Exam – Cardiac Surgery Certification | 100%
Verified | Graded A+ Detailed Rationales – Pass
Guaranteed – A+ Graded
[SECTION 1: Preoperative Cardiac Surgery Assessment & Preparation — Questions 1-50]
Q1: Which preoperative diagnostic test is the gold standard for assessing the severity of coronary
artery disease (CAD) and determining the need for surgical revascularization?
A. Transthoracic echocardiogram (TTE).
B. Coronary angiography.
C. Computed Tomography Angiography (CTA).
D. Cardiac Magnetic Resonance Imaging (MRI).
B. Coronary angiography. [CORRECT]
Correct Answer: B
Rationale: Coronary angiography is the invasive gold standard for visualizing the extent and
location of coronary artery occlusions. It provides the anatomical detail necessary to plan
coronary artery bypass grafting (CABG). TTE assesses structure and function but not coronary
anatomy directly. CTA is non-invasive but less definitive for surgical planning than angiography.
Cardiac MRI is used for structure, function, and tissue characterization but not primary CAD
assessment.
Q2: A patient scheduled for CABG is taking Clopidogrel (Plavix). According to standard
preoperative protocols, when should this medication be discontinued to minimize bleeding risk?
A. 24 hours prior to surgery.
B. 48 hours prior to surgery.
C. 5 to 7 days prior to surgery.
D. 2 weeks prior to surgery.
C. 5 to 7 days prior to surgery. [CORRECT]
,2
Correct Answer: C
Rationale: Clopidogrel irreversibly inhibits platelet aggregation, and platelet life span is
approximately 7-10 days. Discontinuing 5 to 7 days prior allows for the generation of new,
functional platelets, significantly reducing the risk of excessive bleeding during surgery. 24-48
hours is insufficient as the drug's effect lasts for the lifespan of the platelet. 2 weeks is
unnecessarily long and increases thrombotic risk.
Q3: A patient with a mechanical aortic valve is scheduled for non-cardiac surgery. How should
their anticoagulation management be handled?
A. Continue Warfarin without interruption.
B. Stop Warfarin 3 days prior and bridge with Heparin.
C. Stop Warfarin 1 day prior and start Aspirin.
D. Switch to Dabigatran 1 week prior.
B. Stop Warfarin 3 days prior and bridge with Heparin. [CORRECT]
Correct Answer: B
Rationale: Patients with mechanical valves are at high risk for thromboembolism, so "bridging"
therapy with a short-acting anticoagulant like Heparin (typically unfractionated or low molecular
weight) is standard when Warfarin is held for surgery. Warfarin is usually stopped 3-5 days pre-
op to allow the INR to normalize. Continuing Warfarin poses a high bleeding risk. Switching to
Dabigatran without bridging is often contraindicated in mechanical valve patients due to higher
stroke risk.
Q4: Which risk assessment tool is specifically validated to predict mortality after cardiac
surgery?
A. APACHE II score.
B. SOFA score.
C. EuroSCORE II.
D. Glasgow Coma Scale.
C. EuroSCORE II. [CORRECT]
,3
Correct Answer: C
Rationale: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a
widely validated risk model used to predict mortality in cardiac surgery patients. It incorporates
patient factors, cardiac factors, and operation details. APACHE II and SOFA are general ICU
severity scores, not specific to cardiac surgery outcomes. Glasgow Coma Scale measures level of
consciousness.
Q5: During preoperative teaching for a median sternotomy patient, which instruction regarding
sternal precautions is most accurate?
A. You may lift up to 25 pounds after 2 weeks.
B. Use your arms to push yourself up from a sitting position.
C. Avoid reaching behind your back and do not lift objects heavier than 5-10 pounds.
D. Cross your arms across your chest when coughing.
C. Avoid reaching behind your back and do not lift objects heavier than 5-10 pounds.
[CORRECT]
Correct Answer: C
Rationale: Sternal precautions typically include not lifting more than 5-10 pounds (or a gallon of
milk) for 6-12 weeks to prevent dehiscence. Reaching behind the back puts shear force on the
sternum and should be avoided. Lifting 25 pounds is prohibited during the initial recovery phase.
Pushing up with arms puts excessive stress on the sternum; patients should use a "log roll" or
brace with a pillow. Crossing arms restricts coughing effectiveness; hugging a pillow is better.
Q6: A patient with severe aortic stenosis presents for preoperative evaluation. Which finding is
most consistent with this diagnosis?
A. Diastolic murmur best heard at the apex.
B. Systolic ejection murmur radiating to the carotids.
C. Continuous machinery-like murmur.
D. Holosystolic murmur radiating to the axilla.
B. Systolic ejection murmur radiating to the carotids. [CORRECT]
, 4
Correct Answer: B
Rationale: Aortic stenosis causes a systolic ejection murmur (crescendo-decrescendo) that is best
heard at the right upper sternal border and radiates to the carotids due to turbulent flow across the
narrow valve. A describes aortic regurgitation (diastolic). C describes a patent ductus arteriosus.
D describes mitral regurgitation.
Q7: Which preoperative laboratory value is most critical to evaluate for a patient with suspected
renal insufficiency prior to cardiac surgery?
A. Serum Albumin.
B. Serum Creatinine and GFR.
C. White Blood Cell Count.
D. Platelet count.
B. Serum Creatinine and GFR. [CORRECT]
Correct Answer: B
Rationale: Serum Creatinine and Glomerular Filtration Rate (GFR) are the primary indicators of
renal function. Renal insufficiency increases the risk of acute kidney injury (AKI) post-CPB and
affects medication dosing and clearance. Albumin indicates nutritional status. WBC indicates
infection. Platelets indicate clotting ability.
Q8: A patient with a history of peripheral vascular disease (PVD) is scheduled for CABG using
the Left Internal Mammary Artery (LIMA). Why is the LIMA the preferred conduit?
A. It is a vein and easy to harvest.
B. It has excellent long-term patency rates compared to saphenous vein grafts.
C. It does not require anticoagulation.
D. It is resistant to atherosclerosis because it is an artery.
B. It has excellent long-term patency rates compared to saphenous vein grafts. [CORRECT]
Correct Answer: B
