100 CSC (CardiaC Surgery CertifiCation) LateSt
aLL-in-one CSC review + 100 PraCtiCe QueStionS
with detaiLed anSwer exPLanation for the aaCn
CardiaC Surgery CertifiCation exam (ContainS 6
fuLL-Length PraCtiCe teStS) – SoftCover aLready
graded a+
Domain 1: Procedures (11% of exam)
Question 1: A patient is 6 hours post-coronary artery bypass graft (CABG) surgery. Which of the
following actions is the priority when managing a patient's mediastinal chest tube drainage?
A. Document drainage of 50 mL/hr as normal
B. Notify the surgeon for drainage of 200 mL/hr
C. Clamp the chest tube to assess for air leaks
D. Strip the chest tube to maintain patency
Answer: B
Rationale: A sudden increase in mediastinal chest tube drainage to 150-200 mL/hr or more is
concerning for postoperative hemorrhage. This could indicate a bleeding vessel or coagulopathy
and requires immediate notification of the surgeon for possible return to the operating room.
Question 2: The nurse is caring for a patient who had a coronary artery bypass graft (CABG)
using the left internal mammary artery (LIMA). Which postoperative assessment finding is most
important to report?
A. Pain at the harvest site
B. ST-segment changes on the ECG
C. Temperature of 99.2°F
D. Drainage of 40 mL/hr from the mediastinal tube
1
, Answer: B
Rationale: ST-segment changes may indicate ischemia in the territory supplied by the grafted
LIMA. The LIMA is the most commonly used arterial graft, and its patency is critical. Any ECG
changes suggesting ischemia require immediate notification of the provider.
Question 3: A patient is scheduled for a minimally invasive mitral valve repair. What should the
nurse anticipate regarding this procedure?
A. A full sternotomy incision
B. A shorter recovery period compared to traditional surgery
C. The patient will require a longer cardiopulmonary bypass time
D. The patient will need a temporary pacemaker postoperatively
Answer: B
Rationale: Minimally invasive cardiac surgery (MICS) involves smaller incisions and typically
results in less pain, shorter hospital stays, and faster recovery compared to traditional
sternotomy. These procedures may be performed through thoracotomies or robotic-assisted
approaches.
Question 4: A patient who underwent aortic valve replacement with a bioprosthetic valve asks
about long-term management. The nurse should teach the patient:
A. "You will need lifelong anticoagulation therapy"
B. "This valve may need to be replaced in 10-15 years"
C. "You will never need another valve surgery"
D. "This valve will last your entire lifetime"
Answer: B
Rationale: Bioprosthetic (tissue) valves have a limited lifespan and may degenerate over 10-15
years. Patients should be educated about the signs and symptoms of valve degeneration and
the need for routine follow-up echocardiograms.
Question 5: A patient post-CABG surgery has a new onset of atrial fibrillation. The nurse
understands this arrhythmia is most likely due to:
A. Electrolyte imbalance
B. Manipulation of the heart and pericardial irritation
C. Hypovolemia
D. Medication side effect
Answer: B
Rationale: Postoperative atrial fibrillation is a common complication following cardiac surgery,
occurring in 20-40% of patients. It is thought to result from manipulation of the heart,
pericardial inflammation, and increased sympathetic tone.
2
, Question 6: The nurse is preparing a patient for off-pump coronary artery bypass (OPCAB)
surgery. What is the primary advantage of this approach?
A. Reduced risk of stroke
B. Decreased need for postoperative mechanical ventilation
C. Avoidance of cardiopulmonary bypass-related complications
D. Shorter surgery time
Answer: C
Rationale: OPCAB surgery is performed on a beating heart without cardiopulmonary bypass.
The primary advantage is avoiding complications associated with bypass, including systemic
inflammatory response, coagulopathy, and potential neurological injury from microemboli.
Question 7: A patient who had a left ventricular assist device (LVAD) implanted as a bridge to
transplant should be taught:
A. To avoid taking daily weights
B. That the device is a permanent solution
C. To monitor for signs of right-sided heart failure
D. That no special restrictions are needed
Answer: C
Rationale: LVADs unload the left ventricle, which can lead to increased right ventricular volume
and pressure. Right-sided heart failure is a common complication post-LVAD implantation due to
volume overload and septal shift .
Question 8: A patient is 24 hours post-cardiac surgery with a median sternotomy incision.
Which finding would the nurse expect to see?
A. Incision is well-approximated with staples
B. Moderate sanguineous drainage on the dressing
C. Patient reports severe incisional pain
D. All of the above
Answer: D
Rationale: A well-approximated sternotomy incision with staples, moderate sanguineous
drainage, and severe incisional pain are all expected findings in the immediate postoperative
period. The nurse should monitor these findings for expected progression.
Question 9: A patient is being evaluated for a heart transplant. Which finding would be a
contraindication?
A. Severe pulmonary hypertension
B. End-stage heart failure
3
aLL-in-one CSC review + 100 PraCtiCe QueStionS
with detaiLed anSwer exPLanation for the aaCn
CardiaC Surgery CertifiCation exam (ContainS 6
fuLL-Length PraCtiCe teStS) – SoftCover aLready
graded a+
Domain 1: Procedures (11% of exam)
Question 1: A patient is 6 hours post-coronary artery bypass graft (CABG) surgery. Which of the
following actions is the priority when managing a patient's mediastinal chest tube drainage?
A. Document drainage of 50 mL/hr as normal
B. Notify the surgeon for drainage of 200 mL/hr
C. Clamp the chest tube to assess for air leaks
D. Strip the chest tube to maintain patency
Answer: B
Rationale: A sudden increase in mediastinal chest tube drainage to 150-200 mL/hr or more is
concerning for postoperative hemorrhage. This could indicate a bleeding vessel or coagulopathy
and requires immediate notification of the surgeon for possible return to the operating room.
Question 2: The nurse is caring for a patient who had a coronary artery bypass graft (CABG)
using the left internal mammary artery (LIMA). Which postoperative assessment finding is most
important to report?
A. Pain at the harvest site
B. ST-segment changes on the ECG
C. Temperature of 99.2°F
D. Drainage of 40 mL/hr from the mediastinal tube
1
, Answer: B
Rationale: ST-segment changes may indicate ischemia in the territory supplied by the grafted
LIMA. The LIMA is the most commonly used arterial graft, and its patency is critical. Any ECG
changes suggesting ischemia require immediate notification of the provider.
Question 3: A patient is scheduled for a minimally invasive mitral valve repair. What should the
nurse anticipate regarding this procedure?
A. A full sternotomy incision
B. A shorter recovery period compared to traditional surgery
C. The patient will require a longer cardiopulmonary bypass time
D. The patient will need a temporary pacemaker postoperatively
Answer: B
Rationale: Minimally invasive cardiac surgery (MICS) involves smaller incisions and typically
results in less pain, shorter hospital stays, and faster recovery compared to traditional
sternotomy. These procedures may be performed through thoracotomies or robotic-assisted
approaches.
Question 4: A patient who underwent aortic valve replacement with a bioprosthetic valve asks
about long-term management. The nurse should teach the patient:
A. "You will need lifelong anticoagulation therapy"
B. "This valve may need to be replaced in 10-15 years"
C. "You will never need another valve surgery"
D. "This valve will last your entire lifetime"
Answer: B
Rationale: Bioprosthetic (tissue) valves have a limited lifespan and may degenerate over 10-15
years. Patients should be educated about the signs and symptoms of valve degeneration and
the need for routine follow-up echocardiograms.
Question 5: A patient post-CABG surgery has a new onset of atrial fibrillation. The nurse
understands this arrhythmia is most likely due to:
A. Electrolyte imbalance
B. Manipulation of the heart and pericardial irritation
C. Hypovolemia
D. Medication side effect
Answer: B
Rationale: Postoperative atrial fibrillation is a common complication following cardiac surgery,
occurring in 20-40% of patients. It is thought to result from manipulation of the heart,
pericardial inflammation, and increased sympathetic tone.
2
, Question 6: The nurse is preparing a patient for off-pump coronary artery bypass (OPCAB)
surgery. What is the primary advantage of this approach?
A. Reduced risk of stroke
B. Decreased need for postoperative mechanical ventilation
C. Avoidance of cardiopulmonary bypass-related complications
D. Shorter surgery time
Answer: C
Rationale: OPCAB surgery is performed on a beating heart without cardiopulmonary bypass.
The primary advantage is avoiding complications associated with bypass, including systemic
inflammatory response, coagulopathy, and potential neurological injury from microemboli.
Question 7: A patient who had a left ventricular assist device (LVAD) implanted as a bridge to
transplant should be taught:
A. To avoid taking daily weights
B. That the device is a permanent solution
C. To monitor for signs of right-sided heart failure
D. That no special restrictions are needed
Answer: C
Rationale: LVADs unload the left ventricle, which can lead to increased right ventricular volume
and pressure. Right-sided heart failure is a common complication post-LVAD implantation due to
volume overload and septal shift .
Question 8: A patient is 24 hours post-cardiac surgery with a median sternotomy incision.
Which finding would the nurse expect to see?
A. Incision is well-approximated with staples
B. Moderate sanguineous drainage on the dressing
C. Patient reports severe incisional pain
D. All of the above
Answer: D
Rationale: A well-approximated sternotomy incision with staples, moderate sanguineous
drainage, and severe incisional pain are all expected findings in the immediate postoperative
period. The nurse should monitor these findings for expected progression.
Question 9: A patient is being evaluated for a heart transplant. Which finding would be a
contraindication?
A. Severe pulmonary hypertension
B. End-stage heart failure
3
