Cardiac Surgery (Adult) Practice Test

AACN-CSC test Format | Course Contents | Course Outline | test Syllabus | test 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 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:
1. higher likelihood of graft failure.
iculty in achieving adequate pain control. longed intubation and mechanical ventilation.
er: D
nation: Patients with COPD are at higher risk for prolonged intubation and mechanical ventil compromised respiratory function, which must be managed carefully.
ion: 691
ent with a history of ventricular tachycardia is monitored closely after cardiac surgery. Whic ention is most important for preventing arrhythmias?
intaining electrolyte balance ministering antiarrhythmic medications miting physical activity
nitoring blood glucose levels er: A
nation: Electrolyte imbalances, particularly potassium and magnesium, can precipitate arrhyt aintaining balance is essential.
ion: 692
increased risk for postoperative arrhythmias.
2. diff
3. pro Answ
Expla ation
due to
Quest
A pati h
interv
1. Ma
2. Ad
3. Li
4. Mo
Answ
Expla hmias;
thus, m
Quest
In the context of minimally invasive cardiac surgery, the surgeon may utilize which of the following techniques to minimize trauma?
1. standard sternotomy with rib-spreading.
2. traditional median sternotomy for exposure.
3. thoracoscopic approaches for access.
4. extensive anterior thoracotomy for access. Answer: C
Explanation: Thoracoscopic approaches are preferred in minimally invasive cardiac surgery as they reduce trauma and Improve 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?
1. Serum calcium level of 7.5 mg/dL
2. Serum bicarbonate level of 20 mEq/L
um potassium level of 5.0 mEq/L er: A
nation: A serum calcium level of 7.5 mg/dL indicates significant hypocalcemia, which may r diate intervention due to its potential to cause cardiac arrhythmias.
ion: 694
ent shows signs of delirium after cardiac surgery, characterized by fluctuating attention and altered status. Which class of medication is typically avoided in treating this condition?
tidepressants ipsychotics nzodiazepines od stabilizers
er: C
nation: Benzodiazepines are generally avoided in delirium management as they can exacerbat ion and sedation, whereas antipsychotics may be used judiciously to manage agitation.
ion: 695
ent with a history of heart failure is recovering after aortic valve replacement. The nurse not
Serum sodium level of 130 mEq/L
3. Ser Answ
Expla equire
imme
Quest
A pati mental
1. An
2. Ant
3. Be
4. Mo
Answ
Expla e
confus
Quest
A pati es a
potassium level of 5.8 mEq/L. What is the priority nursing action?
1. Document the finding.
2. Administer a potassium-wasting diuretic.
3. Initiate cardiac monitoring.
4. 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?
1. Transfusion-related acute lung injury (TRALI)
2. Acute respiratory distress syndrome (ARDS)
3. Pneumothorax
er: B
nation: Aspiration pneumonia can lead to ARDS due to the inflammatory response in the lun ng in diffuse infiltrates and hypoxemia.
ion: 697
the postoperative monitoring of a cardiac surgery patient, which of the following vital sign es would most likely indicate the need for immediate intervention?
art rate increase to 100 bpm
piratory rate of 20 breaths per minute od pressure drop to 90/60 mmHg mperature increase to 38.0�C
er: C
nation: A blood pressure drop to 90/60 mmHg indicates potential hypotension, which require diate intervention to prevent inadequate perfusion and other complications.
ion: 698
eratively, a patient develops a cardiac tamponade. The nurse assesses the following:
Transfusion-associated circulatory overload (TACO) Answ
Expla gs,
resulti
Quest
During chang
1. He
2. Res
3. Blo
4. Te
Answ
Expla s
imme Quest Postop
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?
1. fluid resuscitation.
2. pericardiocentesis.
3. administration of beta-blockers.
4. 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.
ion: 699
ent with a history of heart failure and latest cardiac surgery develops acute hypoxemia. The ardiogram shows normal cardiac function. Which of the following is a potential diagnosis?
monary embolism ural effusion
nsfusion-associated circulatory overload (TACO) ute respiratory distress syndrome (ARDS)
er: D
nation: Normal cardiac function with acute hypoxemia post-surgery suggests ARDS, which c ue to various factors, including inflammatory processes.
ion: 700
ent has undergone a heart transplant and is now in the ICU. The nurse is monitoring for sign ejection. Which clinical manifestation should the nurse anticipate?
dden weight loss reased urine output potension
dycardia
Quest
A pati echoc
1. Pul
2. Ple
3. Tra
4. Ac
Answ
Expla an
occur d
Quest
A pati s of
acute r
1. Su
2. Inc
3. Hy
4. Bra 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?
1. Normal C-reactive protein levels
2. Elevated white blood cell count with left shift
3. Elevated potassium levels
4. 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.
ent with a history of obstructive sleep apnea is being prepared for cardiac surgery. Which of ing postoperative interventions is critical for preventing respiratory complications in this pat
ntinuous monitoring of blood glucose levels couraging deep breathing exercises only ministering narcotics for pain control
of CPAP (continuous positive airway pressure) therapy as needed er: D
nation: Use of CPAP therapy is critical for patients with obstructive sleep apnea postoperativ respiratory complications and ensure adequate oxygenation during recovery.
ion: 703
wing valve replacement surgery, a patient presents with the following parameters: 5/45
30
50 mm Hg
.3 L/min
1.5 L/min/m2
1400 dynes/sec/cm-5
: 20 mm Hg
Question: 702
A pati the
follow ient?
1. Co
2. En
3. Ad
4. Use Answ
Expla ely to
prevent Quest Follo
BP : 7
HR : 1 MAP : CO : 2 CI : SVR : PAOP
What is the most appropriate nursing action?
1. administer fluid bolus.
2. prepare for possible reoperation.
3. monitor for cardiac arrhythmias.
4. start dobutamine infusion.
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?
1. Beta-blockers.
2. ACE inhibitors.
uretics. er: B
nation: ACE inhibitors are commonly used to manage hypertension in post-transplant patient so provide renal protective effects.
ion: 705
eratively, a patient develops sudden hypotension and tachycardia. The nurse notes a pulsatin inal mass on assessment. The most likely cause of these findings is
tic dissection. diac tamponade. morrhagic shock. al failure.
er: A
nation: A pulsating abdominal mass with hypotension and tachycardia suggests an aortic diss equires immediate intervention.
ion: 706
ent requiring defibrillation has recently undergone cardiac surgery. The team prepares the
Calcium channel blockers.
3. Di
Answ
Expla s, as
they al
Quest
Postop g
abdom
1. aor
2. car
3. he
4. ren Answ
Expla ection,
which r
Quest
A pati
defibrillator but notices the patient has a transvenous pacing wire in place. What is the most appropriate action before delivering a shock?
1. Remove the pacing wire
2. Administer sedation
3. Increase the pacing rate temporarily
4. Ensure the defibrillator pads are placed correctly
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:
1. the patient's pain level and sedation depth.
2. the surgical site for signs of hematoma.
ctrolyte levels; particularly potassium and magnesium. er: D
nation: New-onset atrial fibrillation can be influenced by electrolyte imbalances, making it cr ess potassium and magnesium levels immediately.
ion: 708
a post-operative assessment, a nurse notes that a patient's platelet count has dropped to 70, ing cardiac surgery. What is the most appropriate next step in management?
pare to administer platelets high-dose steroid therapy
nitor the patient for signs of bleeding rease fluid intake
er: C
nation: Monitoring for signs of bleeding is essential as the patient is at risk for thrombocytop complications, and further intervention may depend on clinical findings.
ion: 709
year-old patient with a history of heart failure is being prepared for a temporary VAD place
fluid balance and urine output.
3. ele Answ
Expla itical
to ass
Quest
During 000/�L
follow
1. Pre
2. Start
3. Mo
4. Inc Answ
Expla enia-
related
Quest
A 60- ment
after cardiac surgery. What is the primary concern for the surgical team regarding this device?
1. Anticoagulation management
2. Patient�s renal function
3. Risk of infection
4. 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
1. administering diuretics to manage fluid overload.
2. monitoring electrolytes to prevent dysrhythmias.
3. educating the patient on lifestyle modifications post-surgery.
er: D
nation: Continuous cardiac monitoring is critical to detect any arrhythmias that may arise foll urgery, particularly after procedures that involve atrial tissue manipulation.
ion: 711
ent presents with severe leg weakness following cardiac surgery. After ruling out stroke and njury, what should the medical team evaluate next?
ipheral neuropathy ctrolyte levels chological evaluation diac function
er: A
nation: Peripheral neuropathy may present with weakness and sensory changes, especially in with a history of diabetes or vascular issues; thus, it should be evaluated after ruling out m causes.
ion: 712
ent exhibits signs of compartment syndrome in the leg after undergoing a vascular surgical ure. Which of the following clinical findings would most likely be present?
initiating continuous cardiac monitoring for arrhythmias. Answ
Expla owing
heart s
Quest
A pati spinal
cord i
1. Per
2. Ele
3. Psy
4. Car Answ
Expla
patients ore
urgent
Quest
A pati proced
1. Severe pain on passive stretch
2. Increased capillary refill time
3. Warmth and erythema of the limb
4. 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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