Registered nurses seeking the Certified Medical-Surgical Registered Nurse credential through the Medical-Surgical Nursing Certification Board take this examination. Candidates need a current, unencumbered RN license in the US, its territories, or Canada, along with 2,000 med-surg practice hours in the past 3 years. This page provides practice questions across clinical topics, clear details on scheduling and fees, and structured steps to prepare for the test.

AMSN Exam at a Glance

What the AMSN is and how it works

According to Medical-Surgical Nursing Certification Board, “The CMSRN exam has 150 multiple choice questions, and 125 of the questions count toward your score.”^[1]

The Certified Medical-Surgical Registered Nurse examination, administered by the Medical-Surgical Nursing Certification Board, validates knowledge in adult medical-surgical care. Eligibility requires an unencumbered RN license in the US, its territories, or Canada, plus 2,000 practice hours in a medical-surgical setting within the past 3 years as a clinical nurse, manager, or educator. Because nursing license requirements and verifications vary by jurisdiction, verify your credentials with your state licensing board and the official board website.

Testing is available year-round through Pearson VUE test centers or OnVUE online proctoring. Candidates receive an Authorization to Test and have 90 days to test. If more time is needed, candidates can request a 90-day extension for a $90 fee. The test has 150 multiple-choice questions, and 125 count toward your score. You have 3 hours to finish. To pass, you must earn a standard score of 95, which is about 71% correct. Test centers print a pass or fail notice at check-out, and a detailed score report appears online within 24 hours.

Initial exam fees are $394 for standard applicants and $267 for AMSN members, which includes a non-refundable $90 processing fee. Retake fees are $315 standard or $189 for members. The credential remains valid for 5 years before recertification.

Worked examples: how to reason through AMSN questions

These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.

Example 1

Question: Which dietary restriction is essential for a patient with end-stage renal disease (ESRD) on hemodialysis?

1. Restrict calcium and vitamin C only
2. Restrict potassium, phosphorus, sodium, and fluid intake
3. Increase protein to compensate for dialysis losses
4. Restrict all fruits and vegetables permanently

Answer: B. Restrict potassium, phosphorus, sodium, and fluid intake

Explanation:

Option B is correct because impaired kidneys cannot excrete excess fluid and electrolytes between hemodialysis sessions. Restricting potassium prevents cardiac arrhythmias, limiting phosphorus protects bone health, and restricting sodium and fluid prevents volume overload and pulmonary edema. Option A is incorrect because calcium and vitamin C are not the primary restrictions, and water-soluble vitamins often need replacement after dialysis. Option C is incorrect because unmonitored protein increases nitrogenous waste and urea accumulation. Option D is incorrect because patients do not need to eliminate all produce; they select low-potassium fruits and vegetables instead. The general rule is to manage fluid intake and electrolytes strictly while preserving nutrition.

Example 2

Question: Which assessment finding in a post-stroke patient indicates a deteriorating neurological status requiring immediate notification of the provider?

1. Blood pressure of 148/90 mmHg
2. New onset confusion and unequal pupils
3. Mild headache rated 3/10
4. Muscle weakness on the affected side

Answer: B. New onset confusion and unequal pupils

Explanation:

Option B is correct because new confusion paired with unequal pupils indicates rising intracranial pressure, impending brain herniation, or intracranial hemorrhage, which constitutes an emergency. Option A is incorrect because a blood pressure of 148/90 mmHg is often tolerated or managed within targeted parameters after a stroke to preserve cerebral perfusion. Option C is incorrect because a mild headache rated 3/10 requires documentation and comfort measures, but it does not signal catastrophic neurological collapse. Option D is incorrect because focal muscle weakness on the affected side reflects expected neurological deficits from the initial vascular injury rather than rapid deterioration. The general rule is that acute shifts in consciousness and pupillary symmetry require immediate escalation.

Example 3

Question: 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:

1. Restrict dietary potassium intake only
2. Prepare to administer calcium gluconate and notify the provider immediately
3. Encourage increased fluid intake
4. Administer a potassium supplement

Answer: B. Prepare to administer calcium gluconate and notify the provider immediately

Explanation:

Option B is correct because a serum potassium level of 6.8 mEq/L paired with peaked T waves creates an imminent risk of lethal ventricular dysrhythmias. Intravenous calcium gluconate rapidly stabilizes myocardial membranes, protecting cardiac conduction while the team initiates potassium-lowering treatments. Option A is incorrect because dietary restriction is far too slow to manage an acute cardiac emergency. Option C is incorrect because increasing fluids cannot promptly reverse potassium toxicity and risks severe volume overload in acute kidney injury. Option D is incorrect because giving additional potassium worsens toxicity and risks cardiac arrest. The general rule is that ECG changes from hyperkalemia demand immediate myocardial stabilization before initiating potassium-eliminating therapies.

How to use these practice tests

Begin your review by aligning clinical topics with practice questions. Test your knowledge across core systems using targeted sets such as AMSN Cardiovascular Disorders, AMSN Respiratory Conditions, and AMSN Renal and Urological Disorders. Rotate through specialized areas like AMSN Neurological Nursing Care and AMSN Pain Management and Palliative Care to identify where your rationale needs reinforcement.

When working through practice questions, analyze every option rather than memorizing correct choices. Note why incorrect choices fail, particularly for emergency interventions, medication administration, and electrolyte imbalances. Because the CMSRN examination allows 3 hours for 150 multiple-choice questions, build endurance by completing longer question blocks without interruptions. The passing standard requires a standard score of 95, which is about 71% correct across the 125 scored questions. Schedule your exam session well within the 90 days granted by your Authorization to Test to prevent scheduling conflicts.

Sources & last verified

1. Medical-Surgical Nursing Certification Board — number of questions, time limit, passing score, eligibility (official source). “The CMSRN exam has 150 multiple choice questions, and 125 of the questions count toward your score.” Verified Oct 20, 2026 · source checked Oct 20, 2026.
2. Medical-Surgical Nursing Certification Board — exam fee, retake fee, delivery, score release (official source). “Initial Exam $394 $267 First-time Retake Exam $315 $189 There is a non-refundable processing fee of $90 associated with each application.” Verified Oct 20, 2026 · source checked Oct 20, 2026.
3. Medical-Surgical Nursing Certification Board — validity (official source). “As a certificant, you are required to recertify every five years to keep your CMSRN credential.” Verified Oct 20, 2026 · source checked Oct 20, 2026.

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