AACN CSC Cardiac Surgery Essentials for Critical Care Nursing,
Exam Questions and Answers |Fall 2026/2027 Update | 100%
Correct Latest (Graded A+)
You are caring for a patient with an intra-aortic balloon pump and note blood in the tubing.
Your initial action should be:
A. Stop the balloon pump and notify the physician.
B. Administer 100% oxygen to help displace the helium and notify the
physician C. Leave the IABP running and notify the physician.
D. Purge the IABP manually to clear the blood from the tubing. - A. Blood in the IABP tubing
indicates a balloon rupture which can cause gas embolus. However, helium is thought to be
easily absorbed in the presence of balloon rupture and oxygen is not generally indicated. The
appropriate action is to disconnect the balloon from the console or turn it on standby so the
movement of helium is stopped and notify the physician. The nurse will need to prepare for
IABP removal and replacement if needed.
When caring for a patient immediately post CABG the nurse recognizes that the most
likely cause of hypotension in the immediate post-operative period is
A. Decreased circulating volume requiring no intervention unless persistent > 12 hours.
B. LV failure requiring an inotrope as first line treatment for any hypotension.
C. Decreased circulating volume representing the need for increased fluid administration.
D. LV failure requiring an assist device. - C. Hypotension in the immediate postoperative period
is usually caused by low circulating volume and responds to treatment with fluids. Volume is the
first line treatment for hypotension. If there is no immediate response to volume administration,
500 mg of IV calcium chloride is often given. Existing vasopressors, such as norepinephrine,
can also be adjusted. It is important for hypotension to be promptly treated. Persistent
hypotension can result in hypoperfusion and end organ damage.
LV failure is not the most common cause of hypotension in the immediate post-operative period
and therefore inotropic agents are not first line agents used in the treatment of hypotension.
Hypotension that does not respond to fluid administration may require an inotrope.
Preoperative clopidogrel should be held for how many days in the elective surgery patient:
A.It does not need to be held.
B. 1-2 days.
C. 5-7 days.
D. 30 days. - C. Clopidogrel inhibits the P2Y12 receptor on the platelet for the lifetime of the
platelet (10 days). Inhibited platelets cannot participate in clotting, so the risk of bleeding
increases with antiplatelet drugs. Most clinical trials have identified an increased risk in
bleeding, transfusion, and re-exploration when clopidogrel is taken within 5 days of surgery, and
no increase in bleeding or transfusions when clopidogrel is stopped for > 5 days prior to surgery.
Therefore, clopidogrel should be stopped for 5 to 7 days prior to elective surgery. Emergent
,surgery can be done regardless of when the last dose of clopidogrel was taken, but will be
associated with increased bleeding and need for platelet transfusions.
The term OPCAB refers to:
A. combination open heart surgery and percutaneous procedure.
B. CABG surgery without the use of cardiopulmonary bypass (CPB).
C. the use of thoracotomy instead of sternotomy.
D. patients who are fast tracked to be discharged in less than 5 days. - B. OPCAB refers to
off-pump coronary artery bypass. Surgery is done without CPB but it still involves a median
sternotomy.
MIDCAB (minimally invasive direct coronary artery bypass) is performed on a beating heart
without CPB and without the use of a median sternotomy. MIDCAB is commonly done through
an anterior thoracotomy incision and is used to bypass the mid to distal LAD with a left internal
mammary artery (LIMA) graft. A ministernotomy can also be used to gain access during
MIDCAB.
Which of the following patients is at highest risk for neurological complications after CABG?
A. A 63-year- old patient with a BMI of 30 undergoing OPCAB
B. A 85-year-old patient with an atherosclerotic aorta undergoing CPB
C. A previously healthy 50-year-old woman undergoing CPB
D. A 67-year-old man having a MIDCAB to the LAD with no known history of hypertension -
B. Severe atherosclerosis of the aorta, advanced age, use of CPB, aortic cross-clamping, diabetes,
hypertension, female sex, and history of stroke place patients at high risk for neurological
complications following cardiac surgery. Other factors contributing to neurological complications
include alcohol abuse, heart failure, arrhythmias, and hyperglycemia.
The nurse caring for the post operative cardiac surgery patient recognizes the following as
potential contributors to post-operative vasodilation that can cause hypotension:
A. Cooling that occurs while on cardiopulmonary bypass, and use of vasodilators post op.
B. Use of norepinephrine or dopamine to support BP immediately post-op.
C. Inflammatory response due to CPB and use of norepinephrine to support BP
D. Rewarming that occurs after return to the ICU, and the inflammatory response to use of
cardiopulmonary bypass during surgery - D. Intraoperative cooling results in vasoconstriction;
rewarming after surgery causes vasodilation and can contribute to hypotension if volume
administration is inadequate for the increased size of the vascular space caused by vasodilation.
The use of CPB stimulates an inflammatory response that results in vasodilation that
contributes to hypotension.
Norepinephrine and dopamine cause peripheral vasoconstriction, not vasodilation.
A characteristic of a fast-track pathway after CABG would include:
,A. anticipated discharge between post-op days 7 and 8.
B. a defined medication strategy to prevent postoperative atrial fibrillation.
C. liberal use of opioid medications to increase patient comfort during the ventilator
weaning process.
D. extubation by the third post-op day - C. Low-risk patients can be selected for fast
tracking after CABG. These patients are targeted for early extubation, early ambulation, and
early discharge. Patients who are fast tracked receive sedation and analgesia to allow for
early extubation. Pharmacological strategies to prevent atrial fibrillation and early phase I
cardiac rehabilitation are also key components of fast tracking.
You are caring for an early post-operative CABG patient who remains hypotensive despite
treatment with adequate fluid administration and an alpha constricting agent. You know that
one potential post-operative complication responsible for this persistent hypotension could be:
A. Acute kidney injury.
B. Acute saphenous vein graft closure.
C. Acute respiratory distress syndrome (ARDS).
D. Vasoplegia. - D. Vasoplegia is a form of vasodilatory shock that can occur after separation
from CPB. It is characterized by significant hypotension despite adequate fluid resuscitation, low
SVR(due to vasodilation), and is resistant to vasopressors. When vasopressors (norepinephrine,
epinephrine, high dose dopamine, or vasopressin) are not able to maintain blood pressure in the
presence of adequate filling pressures, then vasoplegia may be present. There are several theories
behind the cause of vasoplegia, including leukocyte activation and the release of pro-
inflammatory mediators during cardiopulmonary bypass, and vasoplegia has been associated
with long-term use of ACE inhibitors, calcium channel blockers, amiodarone, and heparin.
Patients with EF <35%, heart failure and diabetes are at higher risk. Vasoplegia can also be seen
after OPCAB.
Acute respiratory distress syndrome (ARDS) and acute kidney failure can both be complications in
the cardiac surgery patient, but do not typically occur early in the post-operative course and are not
necessarily associated with hypotension and failure to respond to vasopressors.
An acute saphenous vein occlusion can occur as a result of persistent hypotension. The
most direct clinical signs of acute saphenous vein graft closure would be those of ischemia.
Mediastinal drainage in the following amount meets criteria for re-exploration:
A. > 300 ml/hr for 2-3 hours.
B. > 200 ml/hr for 4 hours.
C. > 400 ml to 500 ml for 1 hour.
D. All of the above. - D. Chest tube drainage criteria for surgical re-exploration:
• > 400 to 500 ml for 1 hour
• > 300 ml/hr for 2 to 3 hours
• > 200 ml/hr for 4 hours
, • Acute onset of bleeding >300 ml/hr after period of stable and minimal bleeding
Patients with prolonged CPB times are likely to experience:
A. An increased likelihood of early extubation.
B. An increase in coagulopathies.
C. A decrease in total body fluid due to dehydration.
D. A decrease in chest tube drainage. - B. Coagulopathy is present to some degree with all
CPB. During CPB, blood contacts the non-physiological surfaces of the bypass circuit and an
inflammatory response is initiated. A coagulopathy can develop from activation of platelets and
the fibrinolytic system. Clotting factors, platelets, and RBCs are diluted during CPB. A longer
pump time is associated with increased coagulopathies.
Postoperatively, patients have an increased amount of total body fluid due to priming of the
CPB pump and administration of fluids during surgery. Extra volume is given to the patient
during cardiopulmonary bypass to assure adequate circulating volume through the
cardiopulmonary circuit.
Long pump times are associated with increased bleeding and therefore increased chest tube
drainage, and prolongs time to extubation.
Coagulopathy is present to some degree with all CPB. During CPB, blood contacts the non-
physiological surfaces of the bypass circuit and an inflammatory response is initiated. A
coagulopathy can develop from activation of platelets and the fibrinolytic system. Clotting
factors, platelets, and RBCs are diluted during CPB. A longer pump time is associated with
increased coagulopathies.
Postoperatively, patients have an increased amount of total body fluid due to priming of the
CPB pump and administration of fluids during surgery. Extra volume is given to the patient
during cardiopulmonary bypass to assure adequate circulating volume through the
cardiopulmonary circuit.
A. Long pump times are associated with increased bleeding and therefore increased chest
tube drainage, and prolongs time to extubation.
B. The patient is excessively dry from the hemoconcentration that occurs
during cardiopulmonary bypass.
C. The patient is still vasoconstricted from being cool during the prolonged
cardiopulmonary bypass time.
D. The patient has capillary leak and fluid is shifting into the interstitial space.
E. All of the above. - D. Failure of fluid challenges to raise preload may indicate the presence
of capillary leak and fluid shifting into the interstitial space. Patients with longer CPB times are
at greater risk for capillary leak. In patients with capillary leak, a large amount of fluid is
required to maintain adequate circulating volume. Administration of large amounts of volume
also increases the interstitial volume. Inotropes and vasopressors may also be needed for
hemodynamic support in the patient with capillary leak.
Exam Questions and Answers |Fall 2026/2027 Update | 100%
Correct Latest (Graded A+)
You are caring for a patient with an intra-aortic balloon pump and note blood in the tubing.
Your initial action should be:
A. Stop the balloon pump and notify the physician.
B. Administer 100% oxygen to help displace the helium and notify the
physician C. Leave the IABP running and notify the physician.
D. Purge the IABP manually to clear the blood from the tubing. - A. Blood in the IABP tubing
indicates a balloon rupture which can cause gas embolus. However, helium is thought to be
easily absorbed in the presence of balloon rupture and oxygen is not generally indicated. The
appropriate action is to disconnect the balloon from the console or turn it on standby so the
movement of helium is stopped and notify the physician. The nurse will need to prepare for
IABP removal and replacement if needed.
When caring for a patient immediately post CABG the nurse recognizes that the most
likely cause of hypotension in the immediate post-operative period is
A. Decreased circulating volume requiring no intervention unless persistent > 12 hours.
B. LV failure requiring an inotrope as first line treatment for any hypotension.
C. Decreased circulating volume representing the need for increased fluid administration.
D. LV failure requiring an assist device. - C. Hypotension in the immediate postoperative period
is usually caused by low circulating volume and responds to treatment with fluids. Volume is the
first line treatment for hypotension. If there is no immediate response to volume administration,
500 mg of IV calcium chloride is often given. Existing vasopressors, such as norepinephrine,
can also be adjusted. It is important for hypotension to be promptly treated. Persistent
hypotension can result in hypoperfusion and end organ damage.
LV failure is not the most common cause of hypotension in the immediate post-operative period
and therefore inotropic agents are not first line agents used in the treatment of hypotension.
Hypotension that does not respond to fluid administration may require an inotrope.
Preoperative clopidogrel should be held for how many days in the elective surgery patient:
A.It does not need to be held.
B. 1-2 days.
C. 5-7 days.
D. 30 days. - C. Clopidogrel inhibits the P2Y12 receptor on the platelet for the lifetime of the
platelet (10 days). Inhibited platelets cannot participate in clotting, so the risk of bleeding
increases with antiplatelet drugs. Most clinical trials have identified an increased risk in
bleeding, transfusion, and re-exploration when clopidogrel is taken within 5 days of surgery, and
no increase in bleeding or transfusions when clopidogrel is stopped for > 5 days prior to surgery.
Therefore, clopidogrel should be stopped for 5 to 7 days prior to elective surgery. Emergent
,surgery can be done regardless of when the last dose of clopidogrel was taken, but will be
associated with increased bleeding and need for platelet transfusions.
The term OPCAB refers to:
A. combination open heart surgery and percutaneous procedure.
B. CABG surgery without the use of cardiopulmonary bypass (CPB).
C. the use of thoracotomy instead of sternotomy.
D. patients who are fast tracked to be discharged in less than 5 days. - B. OPCAB refers to
off-pump coronary artery bypass. Surgery is done without CPB but it still involves a median
sternotomy.
MIDCAB (minimally invasive direct coronary artery bypass) is performed on a beating heart
without CPB and without the use of a median sternotomy. MIDCAB is commonly done through
an anterior thoracotomy incision and is used to bypass the mid to distal LAD with a left internal
mammary artery (LIMA) graft. A ministernotomy can also be used to gain access during
MIDCAB.
Which of the following patients is at highest risk for neurological complications after CABG?
A. A 63-year- old patient with a BMI of 30 undergoing OPCAB
B. A 85-year-old patient with an atherosclerotic aorta undergoing CPB
C. A previously healthy 50-year-old woman undergoing CPB
D. A 67-year-old man having a MIDCAB to the LAD with no known history of hypertension -
B. Severe atherosclerosis of the aorta, advanced age, use of CPB, aortic cross-clamping, diabetes,
hypertension, female sex, and history of stroke place patients at high risk for neurological
complications following cardiac surgery. Other factors contributing to neurological complications
include alcohol abuse, heart failure, arrhythmias, and hyperglycemia.
The nurse caring for the post operative cardiac surgery patient recognizes the following as
potential contributors to post-operative vasodilation that can cause hypotension:
A. Cooling that occurs while on cardiopulmonary bypass, and use of vasodilators post op.
B. Use of norepinephrine or dopamine to support BP immediately post-op.
C. Inflammatory response due to CPB and use of norepinephrine to support BP
D. Rewarming that occurs after return to the ICU, and the inflammatory response to use of
cardiopulmonary bypass during surgery - D. Intraoperative cooling results in vasoconstriction;
rewarming after surgery causes vasodilation and can contribute to hypotension if volume
administration is inadequate for the increased size of the vascular space caused by vasodilation.
The use of CPB stimulates an inflammatory response that results in vasodilation that
contributes to hypotension.
Norepinephrine and dopamine cause peripheral vasoconstriction, not vasodilation.
A characteristic of a fast-track pathway after CABG would include:
,A. anticipated discharge between post-op days 7 and 8.
B. a defined medication strategy to prevent postoperative atrial fibrillation.
C. liberal use of opioid medications to increase patient comfort during the ventilator
weaning process.
D. extubation by the third post-op day - C. Low-risk patients can be selected for fast
tracking after CABG. These patients are targeted for early extubation, early ambulation, and
early discharge. Patients who are fast tracked receive sedation and analgesia to allow for
early extubation. Pharmacological strategies to prevent atrial fibrillation and early phase I
cardiac rehabilitation are also key components of fast tracking.
You are caring for an early post-operative CABG patient who remains hypotensive despite
treatment with adequate fluid administration and an alpha constricting agent. You know that
one potential post-operative complication responsible for this persistent hypotension could be:
A. Acute kidney injury.
B. Acute saphenous vein graft closure.
C. Acute respiratory distress syndrome (ARDS).
D. Vasoplegia. - D. Vasoplegia is a form of vasodilatory shock that can occur after separation
from CPB. It is characterized by significant hypotension despite adequate fluid resuscitation, low
SVR(due to vasodilation), and is resistant to vasopressors. When vasopressors (norepinephrine,
epinephrine, high dose dopamine, or vasopressin) are not able to maintain blood pressure in the
presence of adequate filling pressures, then vasoplegia may be present. There are several theories
behind the cause of vasoplegia, including leukocyte activation and the release of pro-
inflammatory mediators during cardiopulmonary bypass, and vasoplegia has been associated
with long-term use of ACE inhibitors, calcium channel blockers, amiodarone, and heparin.
Patients with EF <35%, heart failure and diabetes are at higher risk. Vasoplegia can also be seen
after OPCAB.
Acute respiratory distress syndrome (ARDS) and acute kidney failure can both be complications in
the cardiac surgery patient, but do not typically occur early in the post-operative course and are not
necessarily associated with hypotension and failure to respond to vasopressors.
An acute saphenous vein occlusion can occur as a result of persistent hypotension. The
most direct clinical signs of acute saphenous vein graft closure would be those of ischemia.
Mediastinal drainage in the following amount meets criteria for re-exploration:
A. > 300 ml/hr for 2-3 hours.
B. > 200 ml/hr for 4 hours.
C. > 400 ml to 500 ml for 1 hour.
D. All of the above. - D. Chest tube drainage criteria for surgical re-exploration:
• > 400 to 500 ml for 1 hour
• > 300 ml/hr for 2 to 3 hours
• > 200 ml/hr for 4 hours
, • Acute onset of bleeding >300 ml/hr after period of stable and minimal bleeding
Patients with prolonged CPB times are likely to experience:
A. An increased likelihood of early extubation.
B. An increase in coagulopathies.
C. A decrease in total body fluid due to dehydration.
D. A decrease in chest tube drainage. - B. Coagulopathy is present to some degree with all
CPB. During CPB, blood contacts the non-physiological surfaces of the bypass circuit and an
inflammatory response is initiated. A coagulopathy can develop from activation of platelets and
the fibrinolytic system. Clotting factors, platelets, and RBCs are diluted during CPB. A longer
pump time is associated with increased coagulopathies.
Postoperatively, patients have an increased amount of total body fluid due to priming of the
CPB pump and administration of fluids during surgery. Extra volume is given to the patient
during cardiopulmonary bypass to assure adequate circulating volume through the
cardiopulmonary circuit.
Long pump times are associated with increased bleeding and therefore increased chest tube
drainage, and prolongs time to extubation.
Coagulopathy is present to some degree with all CPB. During CPB, blood contacts the non-
physiological surfaces of the bypass circuit and an inflammatory response is initiated. A
coagulopathy can develop from activation of platelets and the fibrinolytic system. Clotting
factors, platelets, and RBCs are diluted during CPB. A longer pump time is associated with
increased coagulopathies.
Postoperatively, patients have an increased amount of total body fluid due to priming of the
CPB pump and administration of fluids during surgery. Extra volume is given to the patient
during cardiopulmonary bypass to assure adequate circulating volume through the
cardiopulmonary circuit.
A. Long pump times are associated with increased bleeding and therefore increased chest
tube drainage, and prolongs time to extubation.
B. The patient is excessively dry from the hemoconcentration that occurs
during cardiopulmonary bypass.
C. The patient is still vasoconstricted from being cool during the prolonged
cardiopulmonary bypass time.
D. The patient has capillary leak and fluid is shifting into the interstitial space.
E. All of the above. - D. Failure of fluid challenges to raise preload may indicate the presence
of capillary leak and fluid shifting into the interstitial space. Patients with longer CPB times are
at greater risk for capillary leak. In patients with capillary leak, a large amount of fluid is
required to maintain adequate circulating volume. Administration of large amounts of volume
also increases the interstitial volume. Inotropes and vasopressors may also be needed for
hemodynamic support in the patient with capillary leak.
