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Cardiac Surgery (Adult) Practice Test

AACN-CSC exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

- Cardiovascular
- Coronary artery bypass surgery (CABG) with cardiopulmonary bypass
- Coronary artery bypass surgery (CABG) without cardiopulmonary bypass
- Cox maze and modified maze procedure
- Minimally invasive cardiac surgery
- Pericardial window

- Repair of non-congenital heart defects
- left-ventricular aneurysm
- VSD post MI
- Surgical valve repair or replacement
- Transcatheter valve replacement
- TAVR
- Thoracic
- Endovascular repair of the aorta
- Open repair of thoracic aortic aneurysm or dissection

- Cardiovascular
- Cardiogenic shock
- Hypotension and hypertension
- Hypovolemia and hypervolemia
- Bleeding
- Myocardial infarction
- Myocardial stunning

- Open chest from the operating room
- Pericarditis
- Dysrhythmias
- Right heart failure
- Cardiac tamponade
- Vascular complications
- compartment syndrome
- retroperitoneal bleeding

- Respiratory
- Acute respiratory failure
- Acute respiratory distress syndrome (ARDS)
- Transfusion related acute lung injury (TRALI)
- Transfusion associated circulatory overload (TACO)
- Pleural space abnormalities
- pneumothorax
- Air-leak syndromes
- pneumopericardium
- pneumomediastinum
- Aspiration
- Atelectasis
- Pleural effusion
- Prolonged mechanical ventilation
- Pulmonary hypertension

- Endocrine
- Hyperglycemia and hypoglycemia
- Hematology / Immunology
- Protamine reactions
- Coagulopathies
- Anemia
- Heparin-induced thrombocytopenia (HIT)

- Neurology
- Postoperative impaired cognition
- Cerebrovascular accident (stroke)
- Lower limb deficits
- spinal cord ischemia
- paralysis
- Delirium

- Gastrointestinal
- Ischemic bowel
- Renal
- Acute kidney injury
- Electrolyte imbalances
- Multisystem
- Multisystem organ dysfunction syndrome (MODS)
- Chronic pain
- Acute pain
- Acid-base imbalances
- Malignant hyperthermia
- Behavioral / Psychosocial
- Preexisting behavioral health disorder
- anxiety
- PTSD
- Substance use and withdrawal

- Cardiovascular
- Fluid volume management specific to cardiac surgery
- Defibrillation and cardioversion
- Emergent resternotomy
- Cardiac surgery advanced life support (CALS)
- Temporary pacing
- Intra-aortic balloon pump
- Short-term ventricular assist devices (VADs)
- Extracorporeal membrane oxygenation (ECMO)
- Pericardial and mediastinal drain

- Pharmacology
- Platelet inhibitors
- Thrombolytics
- Anticoagulants
- Vasoactive agents
- Antidysrhythmics
- Inotropes
- Diuretics
- Beta-blockers
- Statins

- Pharmacologic agents for controlling bleeding
- desmopressin acetate
- factor VII
- antifibrinolytics
- Pulmonary vasodilators
- Sedation
- Neuromuscular blockade
- Respiratory
- Pleural chest tubes and drains
- Invasive and non-invasive mechanical ventilation
- Oxygen therapy delivery devices
- Post-extubation care

- Endocrine
- Glycemic control
- Hematology and Immunology
- Blood and blood products
- Neurology
- Lumbar drain
- Pain management
- Renal
- Renal replacement therapy
- hemodialysis
- CRRT

- Standards of Care
- Deep vein thrombosis (DVT) prophylaxis
- Early mobility protocols
- Gastrointestinal (GI) prophylaxis
- Surgical site protocols
- Recovery from anesthesia
- Rewarming from hypothermia
- Pneumonia prevention

- Cardiovascular
- Hemodynamic monitoring
- Echocardiography
- Electrocardiography (ECG)
- Laboratory testing
- Respiratory
- Arterial blood gas (ABG)
- Mixed venous gas
- Pulse oximetry
- Capnography
- Radiography
- Neurology
- Bispectral index monitoring (BIS)
- Cerebral oximetry monitoring
- Train-of-four (TOF)

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AACN-CSC
AACN Cardiac Surgery (Adult)
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Question: 690
In a patient scheduled for a minimally invasive CABG, the presence of chronic obstructive pulmonary
disease (COPD) raises concerns about:
A. higher likelihood of graft failure.
B. increased risk for postoperative arrhythmias.
C. difficulty in achieving adequate pain control.
D. prolonged intubation and mechanical ventilation.
Answer: D
Explanation: Patients with COPD are at higher risk for prolonged intubation and mechanical ventilation
due to compromised respiratory function, which must be managed carefully.
Question: 691
A patient with a history of ventricular tachycardia is monitored closely after cardiac surgery. Which
intervention is most important for preventing arrhythmias?
A. Maintaining electrolyte balance
B. Administering antiarrhythmic medications
C. Limiting physical activity
D. Monitoring blood glucose levels
Answer: A
Explanation: Electrolyte imbalances, particularly potassium and magnesium, can precipitate arrhythmias;
thus, maintaining balance is essential.
Question: 692
In the context of minimally invasive cardiac surgery, the surgeon may utilize which of the following
techniques to minimize trauma?
A. standard sternotomy with rib-spreading.
B. traditional median sternotomy for exposure.
C. thoracoscopic approaches for access.
D. extensive anterior thoracotomy for access.
Answer: C
Explanation: Thoracoscopic approaches are preferred in minimally invasive cardiac surgery as they
reduce trauma and Excellerate recovery times compared to traditional methods.
Question: 693
A patient is receiving hemodialysis for end-stage renal disease post-cardiac surgery. Which of the
following laboratory values most critically requires further intervention during the dialysis session?
A. Serum calcium level of 7.5 mg/dL
B. Serum bicarbonate level of 20 mEq/L
C. Serum sodium level of 130 mEq/L
D. Serum potassium level of 5.0 mEq/L
Answer: A
Explanation: A serum calcium level of 7.5 mg/dL indicates significant hypocalcemia, which may require
immediate intervention due to its potential to cause cardiac arrhythmias.
Question: 694
A patient shows signs of delirium after cardiac surgery, characterized by fluctuating attention and altered
mental status. Which class of medication is typically avoided in treating this condition?
A. Antidepressants
B. Antipsychotics
C. Benzodiazepines
D. Mood stabilizers
Answer: C
Explanation: Benzodiazepines are generally avoided in delirium management as they can exacerbate
confusion and sedation, whereas antipsychotics may be used judiciously to manage agitation.
Question: 695
A patient with a history of heart failure is recovering after aortic valve replacement. The nurse notes a
potassium level of 5.8 mEq/L. What is the priority nursing action?
A. Document the finding.
B. Administer a potassium-wasting diuretic.
C. Initiate cardiac monitoring.
D. Encourage dietary potassium restriction.
Answer: C
Explanation: A potassium level of 5.8 mEq/L indicates hyperkalemia, which can lead to serious cardiac
dysrhythmias. Cardiac monitoring is essential to assess for potential complications.
Question: 696
A patient with a latest history of aspiration pneumonia develops worsening respiratory symptoms and
hypoxemia. A chest X-ray reveals diffuse infiltrates. What is the likely diagnosis?
A. Transfusion-related acute lung injury (TRALI)
B. Acute respiratory distress syndrome (ARDS)
C. Pneumothorax
D. Transfusion-associated circulatory overload (TACO)
Answer: B
Explanation: Aspiration pneumonia can lead to ARDS due to the inflammatory response in the lungs,
resulting in diffuse infiltrates and hypoxemia.
Question: 697
During the postoperative monitoring of a cardiac surgery patient, which of the following vital sign
changes would most likely indicate the need for immediate intervention?
A. Heart rate increase to 100 bpm
B. Respiratory rate of 20 breaths per minute
C. Blood pressure drop to 90/60 mmHg
D. Temperature increase to 38.0�C
Answer: C
Explanation: A blood pressure drop to 90/60 mmHg indicates potential hypotension, which requires
immediate intervention to prevent inadequate perfusion and other complications.
Question: 698
Postoperatively, a patient develops a cardiac tamponade. The nurse assesses the following:
BP : 85/45
HR : 130
MAP : 52 mm Hg
CO : 2.0 L/min
CI : 1.3 L/min/m2
SVR : 1500 dynes/sec/cm-5
PAP : 28/14 mm Hg
The nurse should expect which intervention to be ordered?
A. fluid resuscitation.
B. pericardiocentesis.
C. administration of beta-blockers.
D. initiation of thrombolytics.
Answer: B
Explanation: Cardiac tamponade can lead to hemodynamic instability, as evidenced by the low blood
pressure and cardiac output. Pericardiocentesis is the most appropriate intervention to relieve the pressure
on the heart.
Question: 699
A patient with a history of heart failure and latest cardiac surgery develops acute hypoxemia. The
echocardiogram shows normal cardiac function. Which of the following is a potential diagnosis?
A. Pulmonary embolism
B. Pleural effusion
C. Transfusion-associated circulatory overload (TACO)
D. Acute respiratory distress syndrome (ARDS)
Answer: D
Explanation: Normal cardiac function with acute hypoxemia post-surgery suggests ARDS, which can
occur due to various factors, including inflammatory processes.
Question: 700
A patient has undergone a heart transplant and is now in the ICU. The nurse is monitoring for signs of
acute rejection. Which clinical manifestation should the nurse anticipate?
A. Sudden weight loss
B. Increased urine output
C. Hypotension
D. Bradycardia
Answer: C
Explanation: Hypotension can be a sign of acute rejection in heart transplant patients, indicating potential
hemodynamic instability.
Question: 701
A patient presents with signs of infection after cardiac surgery. Which laboratory result would most
strongly suggest a postoperative surgical site infection?
A. Normal C-reactive protein levels
B. Elevated white blood cell count with left shift
C. Elevated potassium levels
D. Decreased hemoglobin
Answer: B
Explanation: An elevated white blood cell count with a left shift indicates an increased number of
immature neutrophils, which is a strong indicator of infection.
Question: 702
A patient with a history of obstructive sleep apnea is being prepared for cardiac surgery. Which of the
following postoperative interventions is critical for preventing respiratory complications in this patient?
A. Continuous monitoring of blood glucose levels
B. Encouraging deep breathing exercises only
C. Administering narcotics for pain control
D. Use of CPAP (continuous positive airway pressure) therapy as needed
Answer: D
Explanation: Use of CPAP therapy is critical for patients with obstructive sleep apnea postoperatively to
prevent respiratory complications and ensure adequate oxygenation during recovery.
Question: 703
Following valve replacement surgery, a patient presents with the following parameters:
BP : 75/45
HR : 130
MAP : 50 mm Hg
CO : 2.3 L/min
CI : 1.5 L/min/m2
SVR : 1400 dynes/sec/cm-5
PAOP : 20 mm Hg
What is the most appropriate nursing action?
A. administer fluid bolus.
B. prepare for possible reoperation.
C. monitor for cardiac arrhythmias.
D. start dobutamine infusion.
Answer: D
Explanation: The patient is demonstrating low cardiac output and elevated PAOP, suggesting potential
heart failure. Starting dobutamine infusion is appropriate to support cardiac function.
Question: 704
Following a successful heart transplant, a patient develops new-onset hypertension. Which medication
class should the nurse anticipate being prescribed to manage this condition?
A. Beta-blockers.
B. ACE inhibitors.
C. Calcium channel blockers.
D. Diuretics.
Answer: B
Explanation: ACE inhibitors are commonly used to manage hypertension in post-transplant patients, as
they also provide renal protective effects.
Question: 705
Postoperatively, a patient develops sudden hypotension and tachycardia. The nurse notes a pulsating
abdominal mass on assessment. The most likely cause of these findings is
A. aortic dissection.
B. cardiac tamponade.
C. hemorrhagic shock.
D. renal failure.
Answer: A
Explanation: A pulsating abdominal mass with hypotension and tachycardia suggests an aortic dissection,
which requires immediate intervention.
Question: 706
A patient requiring defibrillation has recently undergone cardiac surgery. The team prepares the
defibrillator but notices the patient has a transvenous pacing wire in place. What is the most appropriate
action before delivering a shock?
A. Remove the pacing wire
B. Administer sedation
C. Increase the pacing rate temporarily
D. Ensure the defibrillator pads are placed correctly
Answer: D
Explanation: Ensuring that the defibrillator pads are placed correctly is essential to deliver an effective
shock while minimizing the risk of further complications, such as pacing wire interference.
Question: 707
A patient who had a CABG without CPB presents with new-onset atrial fibrillation. The nurse should
first assess:
A. the patient's pain level and sedation depth.
B. the surgical site for signs of hematoma.
C. fluid balance and urine output.
D. electrolyte levels; particularly potassium and magnesium.
Answer: D
Explanation: New-onset atrial fibrillation can be influenced by electrolyte imbalances, making it critical
to assess potassium and magnesium levels immediately.
Question: 708
During a post-operative assessment, a nurse notes that a patient's platelet count has dropped to 70,000/�L
following cardiac surgery. What is the most appropriate next step in management?
A. Prepare to administer platelets
B. Start high-dose steroid therapy
C. Monitor the patient for signs of bleeding
D. Increase fluid intake
Answer: C
Explanation: Monitoring for signs of bleeding is essential as the patient is at risk for thrombocytopenia-
related complications, and further intervention may depend on clinical findings.
Question: 709
A 60-year-old patient with a history of heart failure is being prepared for a temporary VAD placement
after cardiac surgery. What is the primary concern for the surgical team regarding this device?
A. Anticoagulation management
B. Patient�s renal function
C. Risk of infection
D. Device malfunction
Answer: A
Explanation: Anticoagulation management is a primary concern with temporary VADs, as proper
anticoagulation is critical to prevent thrombus formation within the device.
Question: 710
After undergoing a modified maze procedure, a patient develops signs of heart failure. The priority
nursing intervention should be
A. administering diuretics to manage fluid overload.
B. monitoring electrolytes to prevent dysrhythmias.
C. educating the patient on lifestyle modifications post-surgery.
D. initiating continuous cardiac monitoring for arrhythmias.
Answer: D
Explanation: Continuous cardiac monitoring is critical to detect any arrhythmias that may arise following
heart surgery, particularly after procedures that involve atrial tissue manipulation.
Question: 711
A patient presents with severe leg weakness following cardiac surgery. After ruling out stroke and spinal
cord injury, what should the medical team evaluate next?
A. Peripheral neuropathy
B. Electrolyte levels
C. Psychological evaluation
D. Cardiac function
Answer: A
Explanation: Peripheral neuropathy may present with weakness and sensory changes, especially in
patients with a history of diabetes or vascular issues; thus, it should be evaluated after ruling out more
urgent causes.
Question: 712
A patient exhibits signs of compartment syndrome in the leg after undergoing a vascular surgical
procedure. Which of the following clinical findings would most likely be present?
A. Severe pain on passive stretch
B. Increased capillary refill time
C. Warmth and erythema of the limb
D. Pulsatile mass in the affected area
Answer: A
Explanation: Severe pain on passive stretch is a classic sign of compartment syndrome, indicating
increased pressure within the muscle compartments.
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Cardiac Surgery (Adult) Practice Test

AACN-CSC exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

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