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

Question 1: A patient with a diabetic foot ulcer has a wound covered with a black, hard, leathery crust. The nurse recognizes this as:

Necrotic eschar that typically requires debridement to assess wound base (Correct answer)
Healthy eschar that should be left intact
Granulation tissue forming under the crust
A scab indicating normal wound healing

Correct answer: Necrotic eschar that typically requires debridement to assess wound base

Black, hard eschar is necrotic tissue that prevents wound assessment and healing; debridement is generally required unless the wound is on a heel with good perfusion.

Question 2: A patient passes a kidney stone. The nurse correctly instructs the patient to:

Discard the stone as it has no diagnostic value
Avoid pain medication to accurately assess symptom progression
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 3: A patient in skeletal traction requires nursing care. Which action is correct?

Tape the traction ropes to prevent slipping
Reposition the patient to the lateral position every 2 hours
Ensure weights hang freely and do not rest on the floor (Correct answer)
Remove weights briefly during patient repositioning

Correct answer: Ensure weights hang freely and do not rest on the floor

Traction weights must hang freely at all times to maintain proper traction force; resting weights on the floor negates the therapeutic effect.

Question 4: What is the most common cause of acute respiratory distress syndrome (ARDS)?

Heart failure
Chronic asthma
Trauma
Lung infection (Correct answer)

Correct answer: Lung infection

Acute respiratory distress syndrome (ARDS) is a severe lung condition characterized by widespread inflammation and fluid accumulation in the alveoli, leading to impaired gas exchange. While various factors can trigger ARDS, severe lung infection, such as pneumonia or sepsis originating from a lung infection, is the most common direct cause. This infection initiates the overwhelming inflammatory response in the lungs.

Question 5: What is the most common cause of primary hypothyroidism?

Excessive iodine intake
Pituitary adenoma
Autoimmune thyroiditis (Hashimoto's disease) (Correct answer)
Thyroid cancer

Correct answer: Autoimmune thyroiditis (Hashimoto's disease)

Autoimmune thyroiditis, commonly known as Hashimoto's disease, is the most prevalent cause of primary hypothyroidism. In this condition, the body's immune system mistakenly attacks and gradually destroys the thyroid gland's cells. This chronic autoimmune assault impairs the thyroid's ability to produce sufficient thyroid hormones, leading to an underactive thyroid state.

Question 6: A patient with advanced heart failure is transitioned to comfort-focused care. Which order would the nurse anticipate discontinuing?

Daily lipid-lowering statin therapy (Correct answer)
Oral opioids for pain management
Morphine sulfate PRN for dyspnea
Mouth care and skin care

Correct answer: Daily lipid-lowering statin therapy

Preventive medications like statins that serve no immediate comfort purpose are typically discontinued in comfort-focused care to reduce the pill burden and focus on symptom management.

Question 7: A patient has a wound with red, moist, granulating tissue filling the wound bed. The nurse correctly identifies this as:

A sign of wound infection requiring cultures
Necrotic tissue requiring debridement
Eschar that should be monitored
Healthy granulation tissue indicating the wound is healing (Correct answer)

Correct answer: Healthy granulation tissue indicating the wound is healing

Bright red, moist, granulating tissue is healthy new tissue forming during the proliferative phase of wound healing.

Question 8: A patient with a sacral pressure injury has yellow, soft, stringy tissue in the wound bed. The nurse identifies this as:

Granulation tissue — a positive healing sign
Normal epithelizing tissue
Slough — non-viable tissue that impedes healing and may require debridement (Correct answer)
Necrotic eschar requiring immediate surgical debridement

Correct answer: Slough — non-viable tissue that impedes healing and may require debridement

Slough is yellow, tan, or green moist necrotic tissue that adheres to the wound bed; it must be debrided as it harbors bacteria and impedes healing.

Question 9: A patient with urinary incontinence is started on oxybutynin (Ditropan). The nurse should teach the patient to anticipate which common side effects?

Increased salivation and bradycardia
Increased urination and diarrhea
Dry mouth, constipation, and urinary retention (Correct answer)
Hypertension and tachycardia

Correct answer: Dry mouth, constipation, and urinary retention

Oxybutynin is an anticholinergic medication; classic side effects include dry mouth, constipation, blurred vision, and urinary retention.

Question 10: A patient with a spinal compression fracture related to osteoporosis reports sudden severe back pain. The nurse's priority action is to:

Assess neurological function of the lower extremities (Correct answer)
Apply a heating pad to the area
Encourage ambulation to prevent deconditioning
Administer NSAIDs without further assessment

Correct answer: Assess neurological function of the lower extremities

A spinal compression fracture can cause cord compression; assessing neurological function of the lower extremities detects potential motor or sensory deficits.

Question 11: Which assessment finding is MOST consistent with a patient experiencing sickle cell crisis?

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

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 12: Which laboratory value requires IMMEDIATE intervention in a patient with multiple myeloma?

Platelet count 150,000/mm³
Hemoglobin 10.2 g/dL
Serum calcium 13.8 mg/dL (Correct answer)
BUN 24 mg/dL

Correct answer: Serum calcium 13.8 mg/dL

A serum calcium of 13.8 mg/dL indicates hypercalcemia, a serious complication of multiple myeloma that can cause cardiac dysrhythmias, altered mental status, and renal failure.

Question 13: 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:

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

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 14: A patient with chronic neuropathic pain is prescribed gabapentin (Neurontin). The nurse should teach the patient that this medication:

Should be stopped abruptly if ineffective after one dose
Is an anticonvulsant that treats neuropathic pain by stabilizing nerve membranes; causes dizziness and somnolence (Correct answer)
Provides immediate pain relief within minutes of administration
Is an opioid analgesic that requires monitoring for respiratory depression

Correct answer: Is an anticonvulsant that treats neuropathic pain by stabilizing nerve membranes; causes dizziness and somnolence

Gabapentin is an anticonvulsant used for neuropathic pain that works via calcium channel modulation; it requires gradual dose titration and causes dizziness and sedation.

Question 15: Which intervention is most effective in preventing wound infection in a surgical patient?

Administering prophylactic antibiotics for 14 days post-operatively
Administering prophylactic IV antibiotics within 60 minutes before the surgical incision (Correct answer)
Applying antiseptic ointment to the wound daily
Shaving the surgical site the night before surgery

Correct answer: Administering prophylactic IV antibiotics within 60 minutes before the surgical incision

Evidence-based SSI prevention includes administering prophylactic antibiotics within 60 minutes of incision to achieve therapeutic tissue levels at the time of incision.

Question 16: Which symptom is characteristic of Parkinson's disease that the medical-surgical nurse should assess for?

Resting tremor, rigidity, and bradykinesia (Correct answer)
Sudden onset paralysis and aphasia
Ascending muscle weakness
Intention tremor at rest that worsens with movement

Correct answer: Resting tremor, rigidity, and bradykinesia

The classic triad of Parkinson's disease is resting tremor, muscle rigidity, and bradykinesia (slowness of movement).

Question 17: A patient recovering from acute tubular necrosis (ATN) is now in the diuretic phase. The nurse's priority is monitoring for:

Fluid overload and hypertension
Hyperkalemia
Oliguria returning
Dehydration, hypokalemia, and hyponatremia from excessive urine output (Correct answer)

Correct answer: Dehydration, hypokalemia, and hyponatremia from excessive urine output

During the diuretic phase of ATN, massive fluid and electrolyte losses (hypokalemia, hyponatremia) can lead to dehydration and hemodynamic instability.

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

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

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 19: 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)
4 hours regardless of mattress type
6 hours during nighttime hours
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 20: Which of the following laboratory tests is the best indicator of long-term glycemic control in diabetic patients?

Fasting blood glucose
Random blood glucose
Postprandial blood glucose
Hemoglobin A1c (Correct answer)

Correct answer: Hemoglobin A1c

Hemoglobin A1c (HbA1c) is the best indicator of long-term glycemic control because it measures the average blood glucose levels over the preceding 2 to 3 months. This test reflects the amount of glucose attached to hemoglobin in red blood cells, which have a lifespan of approximately 120 days. Unlike fasting or random blood glucose tests, HbA1c provides a comprehensive picture of glucose management, making it crucial for monitoring diabetes treatment effectiveness.

Question 21: A patient is receiving a blood transfusion and develops chills, fever, and back pain 15 minutes after initiation. What is the FIRST nursing action?

Slow the infusion rate and notify the provider
Administer acetaminophen and continue the transfusion
Draw blood cultures and continue monitoring
Stop the transfusion and keep the IV line open with normal saline (Correct answer)

Correct answer: Stop the transfusion and keep the IV line open with normal saline

Stopping the transfusion immediately while maintaining IV access with normal saline is the priority to prevent further exposure to incompatible blood products.

Question 22: A patient receiving IV patient-controlled analgesia (PCA) morphine is found with a respiratory rate of 7 breaths/min and is difficult to arouse. The nurse's priority action is:

Increase the PCA lockout interval
Reposition the patient and reassess in 15 minutes
Stop the PCA, administer naloxone (Narcan), and call for emergency assistance (Correct answer)
Administer supplemental oxygen and monitor

Correct answer: Stop the PCA, administer naloxone (Narcan), and call for emergency assistance

Respiratory depression from opioid overdose is life-threatening and requires immediate PCA cessation, naloxone administration, and emergency response.

Question 23: What is the primary purpose of administering bronchodilators to patients with asthma?

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

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 24: Which finding requires the nurse to hold a scheduled dose of phenobarbital and contact the provider?

Mild nausea reported by the patient
Mild drowsiness after the first dose
Respiratory rate of 8 breaths/min and decreased LOC (Correct answer)
Blood pressure 130/80 mmHg

Correct answer: Respiratory rate of 8 breaths/min and decreased LOC

Phenobarbital causes CNS and respiratory depression; a respiratory rate of 8/min with decreased LOC indicates dangerous toxicity.

Question 25: A patient's sacral wound has a foul smell, green exudate, and surrounding erythema. The nurse identifies this as:

Signs of wound infection requiring provider notification (Correct answer)
Granulation tissue formation — a sign of healing
Epithelization of the wound bed
Normal serosanguineous drainage

Correct answer: Signs of wound infection requiring provider notification

Foul odor, purulent (green/yellow) exudate, and periwound erythema are classic signs of wound infection requiring medical evaluation and possible antibiotic therapy.

Question 26: Which of the following is a common symptom of acute myocardial infarction (heart attack)?

Intermittent headaches
Gradual onset of leg pain
Sharp pain in the lower abdomen
Sudden onset of chest pain radiating to the left arm (Correct answer)

Correct answer: Sudden onset of chest pain radiating to the left arm

Acute myocardial infarction (AMI), commonly known as a heart attack, is characterized by the sudden blockage of blood flow to the heart muscle. The classic and most common symptom is severe chest pain, often described as pressure or tightness, which frequently radiates to the left arm. This distinct presentation is a critical indicator for prompt diagnosis and treatment.

Question 27: A patient with a draining wound has periwound skin breakdown from moisture. The nurse should apply which product to protect the surrounding skin?

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

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 28: Which assessment finding is an EARLY sign of tumor lysis syndrome (TLS)?

Hypoglycemia and metabolic alkalosis
Hypercalcemia and hypokalemia
Hyponatremia and hypochloremia
Hyperkalemia, hyperphosphatemia, and hyperuricemia (Correct answer)

Correct answer: Hyperkalemia, hyperphosphatemia, and hyperuricemia

TLS occurs when tumor cells rapidly lyse and release intracellular contents, causing hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.

Question 29: Which hormone is responsible for lowering blood glucose levels?

Glucagon
Epinephrine
Insulin (Correct answer)
Cortisol

Correct answer: Insulin

Insulin is a hormone produced by the beta cells of the pancreas, and its primary role is to lower blood glucose levels. After a meal, when blood glucose rises, insulin is released to facilitate the uptake of glucose from the bloodstream into cells for energy or storage. It acts as a key, allowing glucose to enter cells, thereby reducing its concentration in the blood.

Question 30: Which diagnostic test is most commonly used to confirm the presence of a myocardial infarction?

Complete blood count (CBC)
Electrocardiogram (ECG) (Correct answer)
Echocardiogram
Chest X-ray

Correct answer: Electrocardiogram (ECG)

An electrocardiogram (ECG or EKG) is the most commonly used and initial diagnostic test to confirm the presence of a myocardial infarction. It records the electrical activity of the heart and can reveal characteristic changes, such as ST-segment elevation or T-wave inversions, indicative of heart muscle damage or ischemia. The ECG provides immediate, vital information for guiding treatment decisions.

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.

Questions

35 min

Time Limit

71%

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