Certified Medical-Surgical Registered Nurse (CMSRN) — Questions and Answers

Question 1: The nurse differentiates a myasthenic crisis from a cholinergic crisis in a patient with myasthenia gravis. Which finding suggests a cholinergic crisis?

Rapid fatigue with repetitive muscle use
SLUDGE symptoms: salivation, lacrimation, urination, defecation, GI upset, emesis (Correct answer)
Ptosis and diplopia without other autonomic symptoms
Muscle weakness that improves with edrophonium (Tensilon)

Correct answer: SLUDGE symptoms: salivation, lacrimation, urination, defecation, GI upset, emesis

Cholinergic crisis from excessive anticholinesterase medication causes SLUDGE symptoms due to excessive acetylcholine stimulation.

Question 2: A patient is receiving IV phenytoin for seizure management. The nurse should monitor for which priority adverse effect?

Cardiac dysrhythmias (Correct answer)
Hypokalemia
Hyperglycemia
Constipation

Correct answer: Cardiac dysrhythmias

IV phenytoin administered too rapidly can cause severe cardiac dysrhythmias, including bradycardia and heart block.

Question 3: Which medication is often prescribed to manage symptoms of inflammatory bowel disease (IBD)?

Antacids
Proton pump inhibitors (PPIs)
Corticosteroids (Correct answer)
Statins

Correct answer: Corticosteroids

Corticosteroids are frequently prescribed for inflammatory bowel disease (IBD) due to their powerful anti-inflammatory and immunosuppressive properties. They work by reducing the body's immune response, which helps to decrease the severe inflammation in the gastrointestinal tract characteristic of conditions like Crohn's disease and ulcerative colitis. While effective for managing acute flares and inducing remission, they are often used short-term due to potential side effects.

Question 4: A patient with benign prostatic hyperplasia (BPH) is unable to void and has a distended bladder. After catheterization, 900 mL of urine is drained. The nurse should:

Irrigate the bladder with normal saline
Continue draining until the bladder is completely empty immediately
Remove the catheter after draining 200 mL
Clamp the catheter after 400–600 mL and monitor for hematuria or hypotension (Correct answer)

Correct answer: Clamp the catheter after 400–600 mL and monitor for hematuria or hypotension

Rapid decompression of a severely distended bladder can cause decompression hematuria and vasovagal hypotension; clamping after 400–600 mL allows gradual decompression.

Question 5: A patient with a history of opioid use disorder requires post-operative pain management. The nurse understands that:

Patients with opioid use disorder have the right to effective pain management; coordinate with pain/addiction specialists (Correct answer)
Opioids must never be used in this patient under any circumstances
Lower than standard opioid doses should be used since the patient is drug-seeking
Only NSAIDs should be used regardless of pain severity

Correct answer: Patients with opioid use disorder have the right to effective pain management; coordinate with pain/addiction specialists

Patients with opioid use disorder are entitled to effective pain management; undertreating pain is unethical, and coordination with addiction medicine optimizes both comfort and safety.

Question 6: A patient taking carbamazepine (Tegretol) for seizure management requires monitoring for which serious adverse effect?

Hypertension
Pulmonary fibrosis
Nephrolithiasis
Aplastic anemia and agranulocytosis (Correct answer)

Correct answer: Aplastic anemia and agranulocytosis

Carbamazepine can cause potentially fatal hematologic reactions including aplastic anemia, requiring routine CBC monitoring.

Question 7: A patient with a cervical spinal cord injury at C4 suddenly develops bradycardia and hypotension with warm, flushed skin below the injury. The nurse should recognize this as:

Neurogenic shock (Correct answer)
Hypovolemic shock
Septic shock
Autonomic dysreflexia

Correct answer: Neurogenic shock

Neurogenic shock following high spinal cord injury causes loss of sympathetic tone, resulting in bradycardia, hypotension, and vasodilation below the injury.

Question 8: Which tool is most appropriate for assessing pain in a non-verbal patient with dementia on a medical-surgical unit?

PAINAD (Pain Assessment in Advanced Dementia) scale (Correct answer)
Numeric Rating Scale (NRS 0–10)
Visual Analog Scale (VAS)
Wong-Baker FACES scale

Correct answer: PAINAD (Pain Assessment in Advanced Dementia) scale

The PAINAD scale assesses behavioral pain indicators (breathing, vocalization, facial expression, body language, consolability) in non-verbal dementia patients.

Question 9: The nurse is educating a patient newly diagnosed with polycythemia vera. Which statement reflects accurate understanding of the condition?

'I should avoid all physical activity to prevent bleeding.'
'My bone marrow is producing too few red blood cells.'
'I need to drink more fluids and may need phlebotomy to reduce my blood thickness.' (Correct answer)
'This condition means I am at lower risk for blood clots.'

Correct answer: 'I need to drink more fluids and may need phlebotomy to reduce my blood thickness.'

Polycythemia vera involves overproduction of RBCs, increasing blood viscosity and clot risk; phlebotomy and hydration are key management strategies.

Question 10: A patient is receiving negative pressure wound therapy (NPWT/VAC). The nurse notes the therapy has lost suction. The priority action is:

Increase the prescribed negative pressure setting
Remove the dressing and apply a dry gauze dressing
Inspect the dressing for air leaks, reinforce with foam and drape to restore seal (Correct answer)
Discontinue therapy and notify provider immediately

Correct answer: Inspect the dressing for air leaks, reinforce with foam and drape to restore seal

Loss of suction in NPWT is most commonly due to a dressing air leak; inspecting and reinforcing the seal restores therapeutic function without discontinuing treatment.

Question 11: A medical-surgical nurse is inserting an indwelling urinary catheter in a female patient. To prevent catheter-associated UTI (CAUTI), which action is MOST important?

Routinely irrigate the catheter with antibiotic solution
Change the catheter every 48 hours
Secure the catheter to the bed rail
Use strict aseptic technique during catheter insertion (Correct answer)

Correct answer: Use strict aseptic technique during catheter insertion

Strict aseptic technique during insertion is the single most important intervention to prevent CAUTI by preventing bacterial introduction.

Question 12: A patient passes a kidney stone. The nurse correctly instructs the patient to:

Avoid pain medication to accurately assess symptom progression
Discard the stone as it has no diagnostic value
Strain all urine and save the stone for laboratory analysis (Correct answer)
Restrict all fluids for 24 hours

Correct answer: Strain all urine and save the stone for laboratory analysis

Stone analysis determines composition (calcium, uric acid, struvite, cystine), which guides dietary modifications and medication therapy to prevent recurrence.

Question 13: A patient with a venous stasis ulcer on the lower leg is prescribed compression therapy. The nurse should apply compression wraps:

With the greatest pressure at the knee and decreasing distally
Only during sleep to reduce discomfort
After assessing for arterial insufficiency — do not apply if ABIs are below 0.5 (Correct answer)
With the greatest pressure at the ankle and decreasing toward the knee (graduated compression)

Correct answer: After assessing for arterial insufficiency — do not apply if ABIs are below 0.5

Compression is contraindicated in severe arterial disease (ABI <0.5); assessing ankle-brachial index (ABI) before applying compression prevents dangerous ischemia.

Question 14: A patient has a Stage II pressure injury on the sacrum. Which wound characteristic best describes a Stage II pressure injury?

Full-thickness tissue loss with visible subcutaneous fat
Full-thickness tissue loss with exposed bone, tendon, or muscle
Intact skin with non-blanchable redness
Partial-thickness skin loss presenting as a shallow open ulcer or intact/ruptured blister (Correct answer)

Correct answer: Partial-thickness skin loss presenting as a shallow open ulcer or intact/ruptured blister

Stage II pressure injury involves partial-thickness skin loss (epidermis and/or dermis), presenting as a shallow pink/red wound or intact or ruptured serum-filled blister.

Question 15: A patient with a draining wound has periwound skin breakdown from moisture. The nurse should apply which product to protect the surrounding skin?

Moisture barrier ointment or liquid skin protectant to the periwound area (Correct answer)
Wet-to-dry dressings to the entire wound and periwound area
Dry gauze taped over the area
Adhesive film dressing directly over the macerated skin

Correct answer: Moisture barrier ointment or liquid skin protectant to the periwound area

Moisture barrier ointments or liquid skin protectants create a waterproof barrier over the periwound skin, preventing further maceration from wound exudate.

Question 16: To prevent pressure injury development, the nurse should reposition an immobile patient at minimum every:

2 hours on a standard mattress, or every 4 hours on a high-specification foam mattress (Correct answer)
6 hours during nighttime hours
4 hours regardless of mattress type
1 hour if on a standard mattress

Correct answer: 2 hours on a standard mattress, or every 4 hours on a high-specification foam mattress

NPIAP guidelines recommend repositioning every 2 hours on standard mattresses, or every 4 hours on high-specification foam mattresses to relieve pressure.

Question 17: Which of the following is a hallmark symptom of chronic obstructive pulmonary disease (COPD)?

Sudden onset of chest pain
Intermittent fever
Acute abdominal pain
Progressive shortness of breath (Correct answer)

Correct answer: Progressive shortness of breath

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by persistent airflow obstruction. The hallmark symptom is progressive shortness of breath (dyspnea), which worsens over time and with exertion. This debilitating symptom significantly impacts a patient's quality of life and is a defining feature of the condition.

Question 18: A patient with a hip replacement is being repositioned by the nurse. Which action should be AVOIDED to prevent hip dislocation?

Adducting the leg across the midline (Correct answer)
Keeping the head of the bed below 90 degrees
Keeping the operative leg abducted
Using a wedge pillow between the legs

Correct answer: Adducting the leg across the midline

After total hip arthroplasty, adduction beyond midline, extreme flexion >90°, and internal rotation are the three movements most likely to cause dislocation.

Question 19: Which of the following is a common symptom of gastroesophageal reflux disease (GERD)?

Jaundice
Acute lower abdominal pain
Chronic cough (Correct answer)
Diarrhea

Correct answer: Chronic cough

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the esophagus. While heartburn and regurgitation are classic symptoms, chronic cough is also a common and often overlooked symptom of GERD. The refluxed acid can irritate the esophagus and trigger a cough reflex, or it can be aspirated into the lungs, leading to persistent coughing.

Question 20: A nurse is caring for a patient with a dehisced abdominal wound healing by secondary intention with a wound VAC. The nurse understands that the primary goal of secondary intention healing is:

Delayed primary closure after 3–5 days
Gradual filling of the wound with granulation tissue from the base upward (Correct answer)
Direct edge-to-edge surgical closure
Applying skin grafts immediately

Correct answer: Gradual filling of the wound with granulation tissue from the base upward

Secondary intention healing allows wounds to fill from the base with granulation tissue; wound contraction and epithelialization occur over time without surgical closure.

Question 21: What is the most common cause of acute pancreatitis?

Ulcerative colitis
Gallstones (Correct answer)
Appendicitis
Chronic constipation

Correct answer: Gallstones

Gallstones are the most common cause of acute pancreatitis because they can obstruct the common bile duct, which shares an opening with the pancreatic duct. This blockage prevents pancreatic enzymes from flowing into the small intestine, causing them to back up and prematurely activate within the pancreas itself. This auto-digestion leads to inflammation and damage of the pancreatic tissue, resulting in acute pancreatitis.

Question 22: A patient returns from surgery for an open reduction and internal fixation (ORIF) of the femur. The nurse assesses the 5 Ps of neurovascular status. Which finding requires immediate intervention?

Mild swelling at the operative site
Pain rated 6/10 managed with opioids
Bruising around the incision site
Pulselessness and pallor of the affected extremity (Correct answer)

Correct answer: Pulselessness and pallor of the affected extremity

Pulselessness and pallor indicate arterial compromise or compartment syndrome, which are surgical emergencies requiring immediate action.

Question 23: A patient is to receive ketorolac (Toradol) IV for post-operative pain. The nurse knows that ketorolac should not be administered for more than:

24 hours
5 days (Correct answer)
30 days
10 days

Correct answer: 5 days

Ketorolac is limited to 5 days maximum (IV or IM) due to cumulative risk of GI bleeding, renal impairment, and platelet dysfunction with prolonged use.

Question 24: A patient with a skin tear on the forearm requires wound care. The nurse should first:

Apply a tight compression bandage immediately
Apply povidone-iodine to prevent infection
Gently irrigate with normal saline and approximate the skin flap if viable before dressing (Correct answer)
Scrub the wound with a stiff brush to clean it

Correct answer: Gently irrigate with normal saline and approximate the skin flap if viable before dressing

Skin tears should be gently irrigated with saline, with the skin flap repositioned if viable to minimize tissue loss before applying a non-adherent dressing.

Question 25: Which assessment finding is MOST consistent with a patient experiencing sickle cell crisis?

Petechiae and prolonged bleeding
Bradycardia and hypotension
Jaundice and elevated platelet count
Severe localized bone pain and fever (Correct answer)

Correct answer: Severe localized bone pain and fever

Vaso-occlusive (painful) sickle cell crisis causes severe bone and joint pain due to microvascular obstruction, often accompanied by fever.

Question 26: A nurse is debriding a wound using wet-to-dry dressing changes. The nurse understands this method works by:

Providing a moist wound environment for healing
Mechanically removing necrotic tissue as the gauze dries and adheres to the wound (Correct answer)
Applying enzymatic agents to break down necrosis
Promoting autolysis through moisture balance

Correct answer: Mechanically removing necrotic tissue as the gauze dries and adheres to the wound

Wet-to-dry debridement works mechanically — the moist gauze dries and adheres to necrotic tissue, which is removed when the dressing is changed.

Question 27: A nurse is providing discharge teaching to a patient using crutches after a lower extremity fracture. Which instruction is correct for three-point non-weight-bearing gait?

Step with the unaffected leg first, then advance crutches
Move both crutches and the affected leg forward together, then swing the unaffected leg through (Correct answer)
Bear equal weight on both legs and crutches simultaneously
Move both crutches forward, then step with the good leg, then the affected leg

Correct answer: Move both crutches and the affected leg forward together, then swing the unaffected leg through

In three-point gait, both crutches and the injured extremity advance together, followed by the unaffected leg, keeping all weight off the injured limb.

Question 28: What is the primary purpose of administering bronchodilators to patients with asthma?

To increase mucus production
To dilate the airways and improve airflow (Correct answer)
To treat bacterial infections
To reduce inflammation

Correct answer: To dilate the airways and improve airflow

Bronchodilators are a class of medications specifically designed to relax the smooth muscles surrounding the airways in the lungs. In patients with asthma, these airways can constrict, making breathing difficult. By dilating the airways, bronchodilators help to open them up, reduce airflow obstruction, and improve the patient's ability to breathe more easily.

Question 29: A nurse is caring for a patient with thrombocytopenia (platelet count 18,000/mm³). Which action should the nurse AVOID?

Using a soft-bristled toothbrush
Applying firm pressure after venipuncture
Administering stool softeners
Administering aspirin for headache (Correct answer)

Correct answer: Administering aspirin for headache

Aspirin inhibits platelet aggregation and is contraindicated in thrombocytopenia because it further increases the risk of serious bleeding.

Question 30: A patient with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L and peaked T waves on ECG. The nurse's priority action is:

Administer a potassium supplement
Prepare to administer calcium gluconate and notify the provider immediately (Correct answer)
Encourage increased fluid intake
Restrict dietary potassium intake only

Correct answer: Prepare to administer calcium gluconate and notify the provider immediately

Hyperkalemia with ECG changes is a cardiac emergency; calcium gluconate is administered first to stabilize the myocardium while definitive treatment is arranged.

Certified Medical-Surgical Registered Nurse (CMSRN)

The CMSRN certification, administered by the Medical-Surgical Nursing Certification Board (MSNCB) under AMSN, validates expertise in medical-surgical nursing practice including patient care management, interprofessional collaboration, and professional nursing concepts.

150

Questions

180 min

Time Limit

71%

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Sources & references

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msncb.org — Score validity, eligibility, exam format, passing score, time limit, fees, late registration, retake fee, retake policy, score release · verified Oct 2026
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