Cardiac Surgery Certification (CSC) Test Review
The Cardiac Surgery Certification indicates specialization in all aspects of patient care in the area of cardiac surgery. Healthcare professionals with this certification are frequently employed to assess and treat cardiac patients throughout the perioperative period.
In order to take the Cardiac Surgery Certification exam, the applicant must be a licensed Registered Nurse or Advanced Registered Nurse Practitioner. The applicant must also hold current certification in critical care nursing or a specialized surgical certification such as Certified Nurse OR or Certified Registered Nurse First Assistant. At least 1,750 hours of patient care in an acute or critical care must have been completed with at least 875 of those hours devoted to the care of patients within the first 48 hours following cardiac surgery.
The CSC exam is available year-round at testing centers across the United States. The fee to take the CSC exam is $135 for members of the American Association of Critical Care Nurses (AACN) or $180 for nonmembers.
The CSC exam consists of 90 multiple-choice questions and 2 hours are allotted to complete the CSC exam. Over one-half of the CSC exam tests the RN and ARNP's knowledge on patient problems that may develop within the first 48 hours following cardiac surgery. This includes problems that may arise in all of the body's systems. The remainder of the CSC exam focuses on specific nursing interventions to be performed to treat these problems.
The Cardiac Surgery Certification is valid for 3 years. At the end of that time period, the licensed RN or ARNP must have been employed for at least 432 hours, with 144 of those hours within the past year, in the area of caring for patients who underwent cardiac surgery within the past 48 hours. In addition, at least 25 continuing education hours should have been completed in the area of cardiac surgery or the RN or ARNP can retake the certification exam. The cost for renewal of the Cardiac Surgery Certification is $110 for AACN members and $155 for nonmembers.
Cardiac Surgery Certification (CSC) Practice Questions
1. An obese 70-year-old man with a history of atrial fibrillation is recovering from open-heart surgery for aortic valve replacement. To decrease the risk of developing postoperative atrial fibrillation, which of the following medications is most commonly administered for prophylaxis?
- Metoprolol or atenolol
- Magnesium sulfate
2. When emergent chest reopening and internal defibrillation are necessary in the intensive care unit (ICU), the primary responsibility of the sterile cardiac ICU nurse is
- removing dressings and Steri-strips.
- preparing medications and gathering equipment.
- ensuring strict sterile technique.
- preparing the defibrillator machine
3. Patients with nasogastric tubes inserted during surgery for gastric decompression should receive which of the following medications by instillation during the first 12-24 hours?
- H2-blocker (ranitidine)
- Proton-pump inhibitor (omeprazole)
- Promotility agent (metoclopramide)
- Antiulcer drug (sucralfate)
4. A postoperative patient is evaluated for extubation in the intensive care unit. Which of the following findings regarding respiratory mechanics meets extubation criteria?
- Vital capacity: 8 mL/kg
- Negative inspiratory force: 23 cm H2O
- Spontaneous respiratory rate: 28 breaths/min
- Tidal volume: 6 mL/kg.
5. Postoperative administration of aspirin after coronary artery bypass grafting surgery is specifically indicated to prevent occlusion of
- internal thoracic artery grafts.
- gastroepiploic artery grafts.
- saphenous vein grafts.
- radial artery grafts.
Cardiac Surgery Certification (CSC) Answer Key
1. Answer: A
Low-dose beta-blockers, such as metoprolol (25-50 mg twice daily) or atenolol (25 mg daily), are the most common drugs to prevent atrial fibrillation (Afib), decreasing the incidence of Afib by up to 65%. Atrial flutter (> 380 bpm) and Afib (> 380 bpm) occur in up to 30% of patients with open heart surgery. Risk factors include obesity, chronic obstructive pulmonary disease, valve surgery, and a history of Afib. Amiodarone is sometimes given alone or with beta-blockers. Sotalol is an effective negative inotrope but has a number adverse effects. Magnesium sulfate is most effective if administered with beta-blockers and with low serum magnesium levels
2. Answer: C
When the intensive care unit is used as an operating room, a sterile nurse must ensure that strict sterile technique is followed. A nonsterile nurse may remove the dressing and Steri-strips, but the scrub (usually with povidone iodine poured over the chest) should be done by the sterile nurse. The paddles for the internal defibrillator are maintained in sterile coverings, but the machine is not. During the procedure, one nurse should be responsible for recording details of the procedure, another for administration of medications and fluids, and another (circulator) to get necessary equipment or prepare medications while the sterile nurse assists with sterile procedures.
3. Answer: D
Antiulcer drugs, such as sucralfate, should be instilled into nasogastric or orogastric tubes in the first 12-24 hours to reduce the incidence of stress ulcers. Other drugs, such as H2-blockers and proton-pump inhibitors, increase gastric pH and should be avoided; however, if patients are very high risk, a proton-pump inhibitor may be given in conjunction with sucralfate. Metoclopramide is sometimes used to reduce nausea and vomiting when an nasogastric tube is inserted into a patient who is awake.
4. Answer: D
A tidal volume of 6 mL/kg meets extubation criteria in the initial postoperative period. Extubation should be done after the patient meets weaning criteria. Extubation can be done from continuous positive airway pressure (CPAP) or T-piece. Criteria include awake state without stimulation and acceptable respiratory mechanics and blood gases (on ??5 cm CPAP or partial specific volume): Tidal volume: more than 5 mL/kg Negative inspiratory force: more than 25 cm H2O. Vital capacity: more than 10-15 mL/kg Respirations (spontaneous): less than 25 breaths/min Partial pressure of oxygen in arterial blood: more than 70 torr (on fraction of inspired oxygen <= 0.5) Partial pressure of carbon dioxide: less than 48 torr pH: 7.3297.45
5. Answer: C
Postoperative administration of aspirin is indicated to prevent occlusion of saphenous vein grafts. Aspirin has not been shown to improve patency of arterial grafts. Postoperative aspirin (75- 100 mg) should be administered within 24 hours after surgery, usually starting at 6 hours. Although the beneficial effects of aspirin on patency are not evident after a year, ongoing use of aspirin in recommended for all graft recipients to prevent further coronary artery disease.
Last Updated: 12/14/2017