100+ Free CSC Practice Questions

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A patient is admitted to the cardiac surgery ICU 1 hour after CABG with median sternotomy. Which assessment finding requires the MOST immediate intervention?

Mediastinal chest tube output of 50 mL in the first hour

Mediastinal chest tube output of 250 mL in the first hour

Temperature of 35.6 C with active rewarming in progress

Serous oozing at the sternal incision site

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2026 Statistics

Key Facts: CSC Exam

Total Items

AACN CSC handbook

75 + 15

Scored + Unscored

AACN CSC handbook

Exam Time

AACN CSC handbook

60%

Cardiovascular Weight

AACN CSC test plan

48h

Post-Op Focus Window

AACN CSC eligibility

$140/$215

Member/Nonmember Fee

AACN CSC handbook

AACN's CSC subspecialty exam is a 90-item, 2-hour test (75 scored, 15 unscored) covering the immediate 48-hour postoperative cardiac surgery patient. The test plan weights Cardiovascular ~60% (post-CABG, valve surgery, hemodynamics, mechanical circulatory support, arrhythmias), Pulmonary ~14%, Renal/Fluid/Electrolytes ~10%, Neurologic ~6%, Hematology/Immunology ~6%, and Multisystem/Endocrine ~4%. Candidates must hold a current AACN acute/critical care certification (CCRN, PCCN, CCRN-K, PCCN-K, ACCNS, or ACNPC-AG) as a prerequisite.

Sample CSC Practice Questions

Try these sample questions to test your CSC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A patient is admitted to the cardiac surgery ICU 1 hour after CABG with median sternotomy. Which assessment finding requires the MOST immediate intervention?

A.Mediastinal chest tube output of 50 mL in the first hour

B.Mediastinal chest tube output of 250 mL in the first hour

C.Temperature of 35.6 C with active rewarming in progress

D.Serous oozing at the sternal incision site

Explanation: Mediastinal output greater than 200 mL/hr in the first hour after cardiac surgery suggests significant bleeding and warrants immediate evaluation for surgical re-exploration. Outputs of 50 mL/hr, mild post-op hypothermia during rewarming, and serous oozing are within expected post-CABG parameters.

2Which post-CABG hemodynamic goal BEST supports graft patency in the first 24 hours?

A.Maintain MAP greater than 90 mmHg to maximize flow

B.Maintain MAP 70-90 mmHg with adequate cardiac index

C.Allow MAP to drift to 50 mmHg to reduce graft tension

D.Maintain SBP greater than 160 mmHg consistently

Explanation: Post-CABG patients typically benefit from MAP 70-90 mmHg balanced with adequate cardiac index. Excessively high pressures stress fresh anastomoses, while hypotension below 60-65 mmHg risks graft hypoperfusion and thrombosis.

3A patient with a left internal mammary artery (LIMA) graft to the LAD is being repositioned. Which action BEST protects the graft?

A.Lift the patient by pulling on the left arm

B.Avoid extreme abduction or external rotation of the left shoulder

C.Place the patient in left lateral decubitus immediately

D.Restrict all left upper extremity movement for 6 weeks

Explanation: The LIMA graft runs along the inner chest wall; extreme left arm abduction or external rotation can stretch or kink the pedicle. Gentle range of motion is encouraged, but extremes are avoided in the early post-op period.

4Compared to on-pump CABG, off-pump CABG (OPCAB) patients typically present with which post-op pattern?

A.More severe coagulopathy and longer ventilator times

B.Less hemodilution and often shorter ventilator weaning

C.Higher incidence of post-pump syndrome

D.Mandatory IABP support for 48 hours

Explanation: OPCAB avoids cardiopulmonary bypass, generally producing less hemodilution, less inflammatory response, less coagulopathy, and often faster ventilator weaning. Post-pump syndrome is associated with on-pump cases.

5A patient arrives from the OR after CABG with a core temperature of 35.2 C. Which intervention is MOST appropriate?

A.Active external rewarming with forced-air warmer

B.Iced saline lavage to prevent shivering

C.Cold IV fluids to suppress metabolic demand

D.No intervention; allow passive rewarming over 12 hours

Explanation: Mild post-op hypothermia is common after CPB. Active rewarming with forced-air warming devices is the standard to prevent shivering, increased oxygen consumption, coagulopathy, and arrhythmias.

6Which finding 5 days after sternotomy is MOST concerning for deep sternal wound infection?

A.Mild incisional erythema with no drainage

B.Sternal click on palpation with purulent drainage and fever

C.Steri-strips intact with serosanguinous staining

D.Itching along the incision line

Explanation: Sternal instability (click) plus purulent drainage and fever raise strong concern for mediastinitis or deep sternal wound infection requiring urgent imaging, cultures, and surgical consult.

7Which post-CABG pain management strategy BEST supports early extubation and pulmonary recovery?

A.High-dose continuous opioid infusion alone

B.Multimodal analgesia with scheduled non-opioids and as-needed opioids

C.Withhold analgesia until extubation is complete

D.Benzodiazepine-based sedation throughout the first 24 hours

Explanation: Multimodal analgesia (acetaminophen, regional or local techniques, dexmedetomidine, opioids as needed) controls sternotomy pain while minimizing respiratory depression and delirium, supporting early extubation.

8A patient with a radial artery graft develops sudden ST elevation in the territory of that graft 4 hours post-op. The MOST likely mechanism is:

A.Atherosclerotic occlusion of the native vessel

B.Radial graft spasm

C.Pericardial tamponade

D.Pulmonary embolism

Explanation: Radial artery grafts are prone to vasospasm in the early post-op period. Standard prophylaxis includes calcium channel blockers (often diltiazem or nicardipine). Acute ST changes in that territory should prompt antispasmodic therapy and surgical notification.

9A patient who underwent minimally invasive direct coronary artery bypass (MIDCAB) via left mini-thoracotomy reports increased pain with deep breathing on post-op day 1. The BEST initial response is:

A.Restrict deep breathing to limit pain

B.Provide adequate analgesia and encourage incentive spirometry

C.Avoid splinting because it traps secretions

D.Administer prophylactic antibiotics

Explanation: Mini-thoracotomy patients often have significant incisional pain that limits inspiratory effort. Adequate analgesia, splinting with a pillow, and incentive spirometry prevent atelectasis and pneumonia.

10Which medication is typically initiated within 6 hours after CABG to support graft patency?

A.Warfarin

B.Aspirin

C.Apixaban

D.Clopidogrel monotherapy

Explanation: Aspirin within 6 hours post-CABG is the standard of care to improve saphenous vein graft patency and reduce mortality, per cardiac surgery guidelines.

About the CSC Exam

CSC is AACN's cardiac surgery subspecialty certification for adult critical care RNs caring for cardiac surgery patients in the immediate 48-hour postoperative period in the cardiac surgery ICU or step-down setting. Requires current CCRN, PCCN, or other AACN acute/critical care certification.

Questions

90 scored questions

Time Limit

2 hours

Passing Score

62 out of 75 scored items (cut score varies by AACN psychometric updates)

Exam Fee

$140 AACN members / $215 non-members (AACN Certification Corporation / PSI)

CSC Exam Content Outline

60%

Cardiovascular

Post-CABG management, valve surgery (AVR, MVR, TAVR), aortic surgery, hemodynamic monitoring, post-op arrhythmias, mechanical circulatory support (IABP, VAD, ECMO), inotropes/vasopressors, and bleeding/coagulopathy

14%

Pulmonary

Post-cardiac-surgery ventilator weaning, oxygenation/ventilation failure, atelectasis, pleural effusions, and chest tube management

10%

Renal, Fluid, and Electrolytes

Post-bypass AKI, fluid balance, potassium and magnesium replacement, contrast-induced nephropathy, and CRRT considerations

Neurologic

Post-op stroke, delirium, neurocognitive dysfunction, anoxic injury, and sedation/analgesia priorities

Hematology and Immunology

Coagulopathy after CPB, heparin reversal, HIT, transfusion management, and infection prevention (mediastinitis, sternal wound)

Multisystem and Endocrine

Glycemic control, sepsis recognition, multi-organ dysfunction, and integrated post-op escalation priorities

How to Pass the CSC Exam

What You Need to Know

Passing score: 62 out of 75 scored items (cut score varies by AACN psychometric updates)
Exam length: 90 questions
Time limit: 2 hours
Exam fee: $140 AACN members / $215 non-members

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CSC Study Tips from Top Performers

1Master the post-CPB hemodynamic story: preload, afterload, contractility, and rhythm in the first 6-24 hours

2Drill IABP and VAD troubleshooting scenarios with timing, MAP targets, and weaning indicators

3Practice post-op AF and heart block algorithms including epicardial pacing wire identification and capture

4Build differential reasoning for post-op bleeding: surgical vs coagulopathic, with chest tube output triggers for re-exploration

5Use timed mixed sets weighted heavily toward cardiovascular content to mirror the real CSC blueprint

Frequently Asked Questions

How many questions are on the AACN CSC exam?

AACN's CSC handbook lists 90 items total: 75 scored and 15 unscored, delivered in a 2-hour appointment.

What prerequisites are required for the CSC exam?

Candidates must hold a current AACN acute/critical care certification (CCRN, PCCN, CCRN-K, PCCN-K, ACCNS, or ACNPC-AG) and complete cardiac surgery practice hours within the eligibility window.

How much does the CSC exam cost?

The CSC subspecialty exam fee is $140 for AACN members and $215 for non-members per AACN's CSC handbook.

What patient population does the CSC exam cover?

CSC focuses on adult patients in the immediate 48-hour postoperative period after cardiac surgery in cardiac surgery ICU or step-down units.

What is the highest-weight CSC content area?

Cardiovascular content carries the largest weight (~60%), covering post-CABG management, valve surgery, hemodynamic monitoring, mechanical circulatory support, arrhythmias, and bleeding management.

How long is the CSC certification valid?

AACN CSC certification is valid for 3 years and renews via CERPs or by retesting, alongside maintaining the underlying AACN credential.