CSC exam guide
About the Cardiac Surgery Certification (CSC) exam
CSC is an adult cardiac surgery subspecialty certification for specialty-certified nurses who provide direct care to acutely and critically ill adult cardiac surgery patients during the first 48 hours postoperatively. This guide uses AACN's revised test plan for examinations taken on or after November 19, 2026. Use the diagnostic to identify gaps in procedure knowledge, complication recognition, therapeutic management, and diagnostic interpretation, then build a study plan around the four official domains.
MedPorium is an independent education platform and is not affiliated with or endorsed by AACN Certification Corporation. Exam details can change; confirm them with the official source before applying.
CSC exam format at a glance
- Questions
- 90
- 75 scored; 15 unscored
- Time
- 2 hours
- Delivery
- Computer-based through PSI at a testing center or by live remote proctoring
Knowledge to review for the CSC exam
These foundations support the practical tasks in the official examination matrix.
Procedures and immediate postoperative priorities
- On-pump and off-pump CABG, valve repair or replacement, minimally invasive surgery, and robotic or MIDCAB approaches
- Percutaneous structural heart intervention, acquired defect repair, surgical left atrial appendage closure, Maze procedures, and pericardial window
- Endovascular and open repair of thoracic aortic aneurysm or dissection during the high-risk first 48 postoperative hours
Complications and rescue
- Shock, bleeding, ischemia, stunning, right heart failure, tamponade, dysrhythmia, vasoplegia, systolic anterior motion, and air embolus
- Respiratory failure, ARDS, TRALI or TACO, pleural complications, aspiration, atelectasis, effusion, failure to wean, and pulmonary hypertension
- Coagulopathy, protamine reaction, HIT, stroke, delirium, acute kidney injury, ileus, MODS, acid-base disturbance, malignant hyperthermia, SIRS, and withdrawal
Therapies, monitoring, and coordinated care
- Volume and blood-product management, vasoactive and antidysrhythmic therapy, analgesia and sedation, ventilation, renal replacement, and glycemic control
- Defibrillation, cardioversion, cardiac surgery resuscitation, emergent resternotomy, pacing, IABP, temporary VAD, ECMO, and surgical drains
- Hemodynamics, ECG, echocardiography, laboratory and blood-gas trends, oxygenation, capnography, radiography, education, mobility, infection prevention, and goals of care
CSC examination matrix
The percentages below are the approximate exam-score weights published by AACN Certification Corporation. Use them to allocate study time, then adjust for your own weak areas.
9%
Procedures
Recognize the operative or interventional approach, expected early postoperative course, and procedure-specific surveillance needs.
- Differentiate on-pump and off-pump CABG, valve repair or replacement, and minimally invasive, robotic, or MIDCAB procedures
- Recognize care priorities after percutaneous structural intervention, acquired defect repair, left atrial appendage closure, Maze, and pericardial window
- Anticipate monitoring and complications after endovascular or open thoracic aortic aneurysm and dissection repair
37%
Complications
Identify early postoperative cardiovascular, respiratory, hematologic, neurologic, renal, gastrointestinal, multisystem, and psychosocial deterioration.
- Differentiate cardiogenic shock, volume or pressure abnormalities, bleeding, ischemia, stunning, right heart failure, tamponade, vasoplegia, systolic anterior motion, graft complications, and air embolus
- Recognize respiratory failure, ARDS, TRALI or TACO, pneumothorax or hemothorax, air leak, aspiration, atelectasis, effusion, failure to wean, and pulmonary hypertension
- Respond to protamine reactions, coagulopathy, anemia, HIT, thromboembolism, stroke, delirium, cognitive change, and spinal cord or lower-extremity deficits
- Integrate AKI, electrolyte and acid-base disorders, bowel ischemia, ileus, MODS, pain, malignant hyperthermia, SIRS, behavioral health conditions, and substance withdrawal into the care plan
43%
Therapeutic Interventions
The dominant domain covers immediate postoperative resuscitation, circulatory and respiratory support, pharmacology, drains, renal therapy, and standards of care.
- Manage fluid and blood volume, defibrillation or cardioversion, cardiac surgery CPR, emergent resternotomy, temporary pacing, IABP, temporary VAD, ECMO, and pericardial or mediastinal drains
- Monitor antiplatelets, anticoagulants, thrombolytics, vasoactive agents, antidysrhythmics, inotropes, diuretics, beta-blockers, lipid agents, hemostatic therapy, pulmonary vasodilators, sedatives, neuromuscular blockers or reversal agents, calcium-channel blockers, and analgesics
- Manage pleural drains, invasive and noninvasive ventilation, oxygen delivery, post-extubation care, glycemic control, blood products, multimodal pain control, and renal replacement therapy
- Apply DVT and GI prophylaxis, early mobility, surgical-site, sternal and graft care, anesthesia recovery, temperature management, and pneumonia prevention
11%
Monitoring and Diagnostics
Interpret multimodal postoperative data to recognize instability, guide treatment, and evaluate the response to intervention.
- Interpret invasive and noninvasive hemodynamics, ECG and continuous rhythm findings, laboratory results, arterial blood gases, and mixed venous gases
- Integrate echocardiography and radiography with the patient's procedure, physical assessment, and clinical trajectory
- Trend pulse oximetry and end-tidal capnography to guide oxygenation, ventilation, extubation, and escalation decisions
- Communicate meaningful changes, reassess after intervention, and use findings to update collaborative goals and the plan of care
How to use this CSC diagnostic
The 15 questions sample all four revised CSC domains, with the largest share focused on Therapeutic Interventions and Complications. A short set cannot represent every operation, device, medication, complication, or monitoring pattern in the plan. Review every rationale, classify each gap as assessment, interpretation, prioritization, intervention, complication recognition, response monitoring, education, or escalation, and follow with larger mixed sets. If your examination is scheduled before November 19, 2026, confirm the applicable plan with AACN.
High-yield CSC study priorities
Priority 1
Study interventions and complications as one system
Together, Therapeutic Interventions and Complications account for 80% of the revised plan. For every complication, rehearse the earliest clue, differentiating data, immediate nursing priorities, therapy, expected response, and escalation threshold.
Priority 2
Organize cases by operation and postoperative hour
Build timelines for CABG, valve, aortic, structural, and other included procedures. Link the operation to expected hemodynamics, drains, pacing, ventilation, laboratory trends, bleeding risk, graft or valve concerns, and the complications most likely during the first 48 hours.
Priority 3
Master high-risk rescue pathways
Practise rapidly distinguishing tamponade, hemorrhage, graft ischemia, right ventricular failure, vasoplegia, systolic anterior motion, tension physiology, transfusion reactions, and failure to wean. Include cardiac surgery CPR and emergent resternotomy roles within institutional protocols.
Priority 4
Make every monitoring value actionable
Do not memorize hemodynamics, gases, ECGs, echo findings, laboratory values, capnography, or radiographs in isolation. Use serial trends to select an intervention, evaluate its effect, identify a new complication, and communicate the next priority.
CSC exam FAQ
How many questions are on the CSC exam?
AACN's CSC Exam Handbook lists 90 multiple-choice questions: 75 scored items and 15 unscored items used to collect performance data for future examinations.
How long is the CSC exam?
AACN lists a two-hour testing time for the CSC examination.
How is the revised CSC test plan weighted?
For examinations taken on or after November 19, 2026, the plan assigns 9% to Procedures, 37% to Complications, 43% to Therapeutic Interventions, and 11% to Monitoring and Diagnostics.
When does this CSC test plan take effect?
The supplied AACN test plan applies to examinations taken on or after November 19, 2026. Candidates testing before that date should use the prior plan and verify the applicable outline with AACN.
Who is eligible for CSC certification?
AACN requires a current, unencumbered U.S. RN or APRN license, a qualifying nationally accredited clinical nursing specialty certification, and the required direct-care practice hours with acutely or critically ill adult cardiac surgery patients during the first 48 postoperative hours. Candidates should verify all current requirements with AACN before applying.
Is the CSC exam entirely clinical judgment?
Yes. AACN describes the CSC exam as 100% Clinical Judgment because candidates must already hold a qualifying specialty certification that tests professional caring and ethical practice competencies.
Can the CSC exam be taken remotely?
AACN describes computer-based testing at a PSI Testing Center or through live remote proctoring from a suitable private location.
Does this diagnostic predict whether I will pass?
No. A 15-question diagnostic is a low-confidence baseline, not a validated pass prediction. Use it to identify review priorities and confirm the test plan that applies to your exam date with AACN.
Is MedPorium affiliated with AACN?
No. MedPorium is an independent education platform and is not affiliated with or endorsed by AACN or AACN Certification Corporation.
Review and official source
Clinical reviewer: T. J. Michaels
Exam format and matrix information were checked against the AACN CSC Adult certification page. Source reviewed October 11, 2026.
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