CSC Exam 2026/2027 – Complete Study
Guide | Practice Questions & Clinical
Rationales
Following surgical repair of a thoracic aneurysm with an endoluminal graft, the
patient is unable to move his lower extremities. The nurse should first
a. Activate stroke team and prepare to do an urgent (STAT) computed
tomography (CT) scan
b. Prepare to return to surgery for exploration of femoral artery occlusion
c. Call surgeon to obtain a neurology consultation in the morning
d. Prepare for lumbar drain insertion to remove cerebrospinal fluid (CSF) - correct
answer-D
Spinal cord ischemia is a complication from thoracic aneurysm repair for both
open and endoluminal repair. Spinal cord ischemia results from increased
cerebral spinal pressure that compresses the spinal nerves. Untreated spinal cord
ischemia can lead to paraplegia. It is important to recognize the signs of spinal
cord ischemia (loss of lower extremity movement) promptly. Immediate insertion
of a spinal drain can reverse the spinal cord ischemia and prevent paraplegia.
Bilateral leg paralysis is not typically an initial symptom of stroke (A). Signs of
femoral artery occlusion (B) are the 5 Ps: pulselessness, pallor, pain, paresthesias,
and paralysis. These symptoms would be unilateral, not bilateral. Immediate
,insertion of a spinal drain is needed; waiting until morning for the consultation (C)
would be inappropriate.
A postoperative patient who had undergone coronary artery bypass graft and
ventricular aneurysm repair has a 15-beat run of ventricular tachycardia. The
most likely cause of the dysrhythmia is
a. Irritability of the ventricle from the aneurysm repair
b. Spasm of the right coronary artery graft
c. Potassium 4.8 mEq/dL and magnesium 2.1 mEq/L
d. Did not restart administration of the angiotensinconverting enzyme (ACE)
inhibitor (taken preoperatively) - correct answer-A
Patients with left ventricular aneurysm typically have depressed left ventricular
(LV) function. Depressed LV function may lead to increased ventricular
arrhythmias. LV aneurysm repair is indicated to improve symptoms of angina,
heart failure, systemic thromboembolism, or malignant arrhythmias. In the
immediate postoperative phase, the repaired ventricle continues to be depressed
and has the added trauma of surgery on the left ventricle. Both of these increase
the irritability of the LV, leading to ventricular arrhythmias. Spasm (B) or occlusion
of the RCA leads to bradyarrhythmias, not ventricular arrhythmias. The potassium
and magnesium levels in (C) are normal. Low potassium and magnesium levels
increase the risk for ventricular arrhythmias. ACE inhibitors (D) do not have any
antiarrhythmic effect.
The nurse admits a patient after aortic valve replacement and notes the following
settings of the temporary pacemaker: DDD rate, 80/min; atrial MA, 10; ventricular
,MA, 4. The underlying rhythm is complete heart block with ventricular escape
rhythm rate 30/min. The most likely cause of the complete heart block is
a. Spasm of the right coronary artery (RCA) graft
b. Damage of the atrioventricular (AV) node during repair of the aortic valve
c. Low potassium and magnesium levels
d. Toxic effects of β-blocker - correct answer-B
The AV node and the bundle of His are near the aortic valve. During aortic valve
replacement, hemorrhage, edema, suturing, or debridement near the AV node
and the bundle of His may cause heart blocks. Typically the epicardial pacing is
only needed for a few days until the edema resolves. If complete heart block
persists after a few days, a permanent pacemaker may be required. The RCA
supplies oxygen to the sinoatrial (SA) and AV nodes and spasm of the RCA graft
(A) may cause bradycardia and/or heart blocks. This patient did not have bypass
surgery, so RCA spasm would not be a postoperative complication. Low potassium
and magnesium levels (C) increase the risk for ventricular arrhythmias, not AV
conduction defects. If toxic effects of β-blockers (D) were present, the complete
heart block would have been the underlying rhythm preoperatively.
A postoperative coronary artery bypass graft and aortic valve replacement patient
has been in a normal sinus rhythm for 4 hours. The monitor is now showing P
waves at a rate of 73 beats per minute with no ventricular response. The best
action would be to
a. Administer atropine 0.5 mg intravenous bolus (IV push)
b. Connect transcutaneous pacing pads to patient
c. Connect epicardial pacing wires to a temporary pacemaker
, d. Administer epinephrine 1 mg IV push and start epinephrine infusion - correct
answer-C
The AV node and the bundle of His are near the aortic valve. During aortic valve
replacement, hemorrhage, edema, suturing, or debridement near the AV node
and the bundle of His may cause heart blocks. Pacing is needed to treat the
conduction defect caused by the surgery. Atropine (A) and epinephrine (D) will
not work because the conduction problem is with the AV node and/or the bundle
of His. Transcutaneous (external) pacing (B) would be the next best option if
epicardial wires were not present. The heart rate should be greater than 45/min
and less than 80/min.
One hour after extubation, a diabetic coronary artery bypass surgery patient is
becoming slightly lethargic. Arterial blood gas (ABG) analysis yielded the following
results: pH, 7.33; PaO2, 80 mm Hg; PaCO2, 50 mm Hg; SaO2, 95%; HCO3, 28
mEq/L; base excess, 0.5. The nurse should first
a. Obtain a blood glucose level
b. Obtain a 12-lead ECG
c. Treat metabolic acidosis
d. Stimulate patient to breathe - correct answer-D
After extubation, cardiac surgery patients should be assessed for adequate
ventilation. Pain medications, atelectasis, and immobility may lead to
hypoventilation. Hypoventilation is a cause of respiratory acidosis. High carbon
dioxide levels cause lethargy. The patient is in the early phase of respiratory
acidosis. Stimulation and encouragement of incentive spirometry should prevent
further hypoventilation and reintubation. A, B, and C are actions or interventions
for metabolic acidosis.
Guide | Practice Questions & Clinical
Rationales
Following surgical repair of a thoracic aneurysm with an endoluminal graft, the
patient is unable to move his lower extremities. The nurse should first
a. Activate stroke team and prepare to do an urgent (STAT) computed
tomography (CT) scan
b. Prepare to return to surgery for exploration of femoral artery occlusion
c. Call surgeon to obtain a neurology consultation in the morning
d. Prepare for lumbar drain insertion to remove cerebrospinal fluid (CSF) - correct
answer-D
Spinal cord ischemia is a complication from thoracic aneurysm repair for both
open and endoluminal repair. Spinal cord ischemia results from increased
cerebral spinal pressure that compresses the spinal nerves. Untreated spinal cord
ischemia can lead to paraplegia. It is important to recognize the signs of spinal
cord ischemia (loss of lower extremity movement) promptly. Immediate insertion
of a spinal drain can reverse the spinal cord ischemia and prevent paraplegia.
Bilateral leg paralysis is not typically an initial symptom of stroke (A). Signs of
femoral artery occlusion (B) are the 5 Ps: pulselessness, pallor, pain, paresthesias,
and paralysis. These symptoms would be unilateral, not bilateral. Immediate
,insertion of a spinal drain is needed; waiting until morning for the consultation (C)
would be inappropriate.
A postoperative patient who had undergone coronary artery bypass graft and
ventricular aneurysm repair has a 15-beat run of ventricular tachycardia. The
most likely cause of the dysrhythmia is
a. Irritability of the ventricle from the aneurysm repair
b. Spasm of the right coronary artery graft
c. Potassium 4.8 mEq/dL and magnesium 2.1 mEq/L
d. Did not restart administration of the angiotensinconverting enzyme (ACE)
inhibitor (taken preoperatively) - correct answer-A
Patients with left ventricular aneurysm typically have depressed left ventricular
(LV) function. Depressed LV function may lead to increased ventricular
arrhythmias. LV aneurysm repair is indicated to improve symptoms of angina,
heart failure, systemic thromboembolism, or malignant arrhythmias. In the
immediate postoperative phase, the repaired ventricle continues to be depressed
and has the added trauma of surgery on the left ventricle. Both of these increase
the irritability of the LV, leading to ventricular arrhythmias. Spasm (B) or occlusion
of the RCA leads to bradyarrhythmias, not ventricular arrhythmias. The potassium
and magnesium levels in (C) are normal. Low potassium and magnesium levels
increase the risk for ventricular arrhythmias. ACE inhibitors (D) do not have any
antiarrhythmic effect.
The nurse admits a patient after aortic valve replacement and notes the following
settings of the temporary pacemaker: DDD rate, 80/min; atrial MA, 10; ventricular
,MA, 4. The underlying rhythm is complete heart block with ventricular escape
rhythm rate 30/min. The most likely cause of the complete heart block is
a. Spasm of the right coronary artery (RCA) graft
b. Damage of the atrioventricular (AV) node during repair of the aortic valve
c. Low potassium and magnesium levels
d. Toxic effects of β-blocker - correct answer-B
The AV node and the bundle of His are near the aortic valve. During aortic valve
replacement, hemorrhage, edema, suturing, or debridement near the AV node
and the bundle of His may cause heart blocks. Typically the epicardial pacing is
only needed for a few days until the edema resolves. If complete heart block
persists after a few days, a permanent pacemaker may be required. The RCA
supplies oxygen to the sinoatrial (SA) and AV nodes and spasm of the RCA graft
(A) may cause bradycardia and/or heart blocks. This patient did not have bypass
surgery, so RCA spasm would not be a postoperative complication. Low potassium
and magnesium levels (C) increase the risk for ventricular arrhythmias, not AV
conduction defects. If toxic effects of β-blockers (D) were present, the complete
heart block would have been the underlying rhythm preoperatively.
A postoperative coronary artery bypass graft and aortic valve replacement patient
has been in a normal sinus rhythm for 4 hours. The monitor is now showing P
waves at a rate of 73 beats per minute with no ventricular response. The best
action would be to
a. Administer atropine 0.5 mg intravenous bolus (IV push)
b. Connect transcutaneous pacing pads to patient
c. Connect epicardial pacing wires to a temporary pacemaker
, d. Administer epinephrine 1 mg IV push and start epinephrine infusion - correct
answer-C
The AV node and the bundle of His are near the aortic valve. During aortic valve
replacement, hemorrhage, edema, suturing, or debridement near the AV node
and the bundle of His may cause heart blocks. Pacing is needed to treat the
conduction defect caused by the surgery. Atropine (A) and epinephrine (D) will
not work because the conduction problem is with the AV node and/or the bundle
of His. Transcutaneous (external) pacing (B) would be the next best option if
epicardial wires were not present. The heart rate should be greater than 45/min
and less than 80/min.
One hour after extubation, a diabetic coronary artery bypass surgery patient is
becoming slightly lethargic. Arterial blood gas (ABG) analysis yielded the following
results: pH, 7.33; PaO2, 80 mm Hg; PaCO2, 50 mm Hg; SaO2, 95%; HCO3, 28
mEq/L; base excess, 0.5. The nurse should first
a. Obtain a blood glucose level
b. Obtain a 12-lead ECG
c. Treat metabolic acidosis
d. Stimulate patient to breathe - correct answer-D
After extubation, cardiac surgery patients should be assessed for adequate
ventilation. Pain medications, atelectasis, and immobility may lead to
hypoventilation. Hypoventilation is a cause of respiratory acidosis. High carbon
dioxide levels cause lethargy. The patient is in the early phase of respiratory
acidosis. Stimulation and encouragement of incentive spirometry should prevent
further hypoventilation and reintubation. A, B, and C are actions or interventions
for metabolic acidosis.
