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

Question 1: A patient with COPD is admitted with an acute exacerbation. Which oxygen delivery method is most appropriate?

Non-rebreather mask at 15 L/min
Simple face mask at 8 L/min
Venturi mask at 24-28% FiO2 (Correct answer)
Nasal cannula at 6 L/min

Correct answer: Venturi mask at 24-28% FiO2

A Venturi mask delivers precise, controlled FiO2 (24-28%) to avoid suppressing the hypoxic drive that COPD patients may rely on for respiratory stimulation.

Question 2: During CMSRN exam preparation, a nurse should spend the MOST time studying which system-specific content area?

Dermatological disorders
Cardiovascular disorders (Correct answer)
Ear/nose/throat disorders
Ophthalmological disorders

Correct answer: Cardiovascular disorders

Cardiovascular disorders represent one of the highest-weighted system-specific content areas on the CMSRN exam.

Question 3: Which assessment finding in a patient 6 hours post-thyroidectomy requires immediate nursing intervention?

Tingling around the mouth and fingertips (Correct answer)
A sore throat with difficulty swallowing
Mild incisional swelling
Hoarseness when speaking

Correct answer: Tingling around the mouth and fingertips

Perioral and fingertip tingling indicates hypocalcemia from accidental parathyroid removal, which can progress to tetany and requires urgent calcium replacement.

Question 4: A patient post-total knee replacement complains of calf pain, warmth, and swelling. The priority nursing action is to:

Notify the provider and avoid massaging or manipulating the extremity (Correct answer)
Elevate the leg and apply a heating pad
Perform a Homan's sign test vigorously
Encourage ambulation to promote circulation

Correct answer: Notify the provider and avoid massaging or manipulating the extremity

These symptoms suggest deep vein thrombosis; the extremity should not be massaged or manipulated, and the physician must be notified to arrange imaging and anticoagulation.

Question 5: The nurse preparing a patient for surgery uses the SBAR format to communicate a critical preoperative finding to the surgeon. In which component would the nurse state 'the patient's potassium is 2.8 mEq/L'?

Situation (Correct answer)
Recommendation
Background
Assessment

Correct answer: Situation

The Situation component of SBAR describes the current clinical problem or concern — reporting the specific abnormal lab value belongs here.

Question 6: Which assessment finding in a patient receiving heparin therapy should prompt the nurse to notify the provider immediately?

A hemoglobin of 13.2 g/dL
An aPTT of 68 seconds with a target range of 60-80 seconds
A platelet count that dropped from 240,000 to 95,000 over 5 days (Correct answer)
Slight bruising at the subcutaneous injection site

Correct answer: A platelet count that dropped from 240,000 to 95,000 over 5 days

A greater than 50% drop in platelets during heparin therapy is a hallmark sign of heparin-induced thrombocytopenia (HIT), a potentially fatal complication.

Question 7: A patient with acute respiratory distress syndrome (ARDS) is on a ventilator. Which ventilation strategy is recommended to prevent ventilator-induced lung injury?

Volume-controlled ventilation at 500 mL regardless of weight
Low tidal volumes of 6 mL/kg ideal body weight (Correct answer)
CPAP only without mechanical ventilation
High tidal volumes of 10–12 mL/kg

Correct answer: Low tidal volumes of 6 mL/kg ideal body weight

Low tidal volume ventilation (6 mL/kg IBW) is the evidence-based strategy for ARDS to reduce barotrauma and ventilator-induced lung injury (VILI).

Question 8: A patient is on continuous pulse oximetry and has an SpO2 reading of 99% but appears pale and is confused. What should the nurse consider?

The probe may be on a poorly perfused site, leading to inaccurate reading (Correct answer)
The SpO2 is accurate and no further action is needed
Document findings and reassess in 2 hours
Increase FiO2 immediately

Correct answer: The probe may be on a poorly perfused site, leading to inaccurate reading

Pulse oximetry can be falsely elevated in poorly perfused extremities or in the presence of carbon monoxide; the clinical picture must always be correlated.

Question 9: A patient with irritable bowel syndrome (IBS) asks about dietary modifications to reduce symptoms. Which recommendation has the strongest evidence base?

Follow a low-FODMAP diet (Correct answer)
Eliminate all dairy products indefinitely
Consume at least 3 liters of water daily
Increase fiber with daily psyllium supplementation

Correct answer: Follow a low-FODMAP diet

The low-FODMAP diet, which restricts fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, has the strongest clinical evidence for reducing IBS symptoms.

Question 10: A patient with asthma is experiencing an acute exacerbation. What is the first-line medication the nurse should administer?

Leukotriene receptor antagonist
Short-acting beta-2 agonist (SABA) (Correct answer)
Intravenous aminophylline
Inhaled corticosteroid

Correct answer: Short-acting beta-2 agonist (SABA)

Short-acting beta-2 agonists (e.g., albuterol) are the first-line treatment for acute asthma exacerbations due to their rapid bronchodilating effect.

Question 11: A patient develops bronchospasm during general anesthesia. Which inhalational agent should be AVOIDED as it is most likely to worsen airway reactivity?

Isoflurane
Desflurane (Correct answer)
Halothane
Sevoflurane

Correct answer: Desflurane

Desflurane is a potent airway irritant that can cause bronchospasm, laryngospasm, and increased secretions, making it the worst choice for patients with reactive airways.

Question 12: Continuous ECG monitoring for a patient at a hospital reveals that the rhythm has altered to ventricular tachycardia. What should the nurse do first out of the options below?

Quickly assess the client’s level of consciousness, blood pressure, and pulse (Correct answer)
Obtain the defibrillator and defibrillate the client
Administer intravenous lidocaine according to emergency protocol
Administer a precordial thump

Correct answer: Quickly assess the client’s level of consciousness, blood pressure, and pulse

Explanation: <br> Assessing the client's degree of consciousness and determining whether the ventricular tachycardia is perfusing the body are the best first steps. An ACLS-certified nurse administers urgent defibrillation for pulseless ventricular tachycardia. The nurse may deliver lidocaine as directed or, in some circumstances, give the client a precordial thump if they have good blood pressure and pulse, are awake, and are alert.

Question 13: Which of the following doesn't result from the sympathoplegic pharmacotherapy?

Hypertension (Correct answer)
Dry oral cavity
Asthma
lethargic behavior

Correct answer: Hypertension

Sympathoplegic pharmacotherapy involves drugs that reduce sympathetic nervous system activity, often used to treat hypertension. Their effects include dry oral cavity (due to decreased salivary secretions), lethargic behavior (sedation), and potentially asthma exacerbation (if non-selective beta-blockers are used). Hypertension is the opposite of the intended effect of these medications, as they are designed to lower blood pressure.

Question 14: Which assessment finding in a postoperative patient most strongly suggests the development of malignant hyperthermia?

Unexplained rapid rise in end-tidal CO2 and muscle rigidity (Correct answer)
Decreased urine output with clear urine
Temperature of 99.8°F with mild shivering
Bradycardia with hypotension

Correct answer: Unexplained rapid rise in end-tidal CO2 and muscle rigidity

A rapid, unexplained rise in end-tidal CO2 combined with skeletal muscle rigidity is the earliest and most reliable indicator of malignant hyperthermia.

Question 15: Which cytomegalovirus (CMV) risk category has the highest risk for post-transplant CMV disease?

Donor positive / Recipient positive (D+/R+)
Donor positive / Recipient negative (D+/R-) (Correct answer)
Donor negative / Recipient negative (D-/R-)
Donor negative / Recipient positive (D-/R+)

Correct answer: Donor positive / Recipient negative (D+/R-)

D+/R− (donor CMV-seropositive, recipient CMV-seronegative) carries the highest risk because the recipient has no pre-existing immunity against the donor's CMV.

Question 16: The client's wound dehisces days after abdominal surgery. When this happens, the most secure nursing solution is to

Approximate the wound edges with tapes
Hold the abdominal contents in place with a sterile gloved hand
Cover the wound with sterile, moist saline dressing (Correct answer)
Irrigate the wound with sterile saline

Correct answer: Cover the wound with sterile, moist saline dressing

The edges of a surgical wound may partially or completely separate. The patient is then placed in the low Fowler's posture and told to lie quietly. The wound must be covered to prevent exposure, and the dressing must be sterile to guard against infection and moist to avoid sticking to the skin and impeding the healing process.

Question 17: A patient in the preoperative holding area reports that they ate a granola bar two hours ago despite NPO instructions. What should the nurse do?

Administer a proton pump inhibitor and proceed
Notify the anesthesiologist immediately about the NPO violation (Correct answer)
Induce vomiting to empty the stomach before surgery
Proceed with surgery since two hours is sufficient fasting time

Correct answer: Notify the anesthesiologist immediately about the NPO violation

An NPO violation increases aspiration risk during anesthesia induction, so the anesthesiologist must be notified immediately to determine whether to proceed, delay, or modify the anesthesia plan.

Question 18: A patient is ordered to receive adenosine 6 mg IV push for SVT. What is the correct administration technique?

Dilute in 100 mL NS and infuse over 30 minutes
Mix with D5W and administer via infusion pump
Give slowly over 5 minutes to avoid hypotension
Administer rapidly over 1-2 seconds followed immediately by a 20 mL NS flush (Correct answer)

Correct answer: Administer rapidly over 1-2 seconds followed immediately by a 20 mL NS flush

Adenosine must be pushed rapidly over 1-2 seconds and followed immediately by a rapid saline flush to reach the heart before it is metabolized in peripheral circulation.

Question 19: One of the main ways to lower a female patient's chance of getting coronary heart disease is to:

take nitroglycerin at the onset of chest pain.
enroll in a cardiac rehabilitation program.
take 81 mg of aspirin daily.
avoid excessive weight gain during pregnancy. (Correct answer)

Correct answer: avoid excessive weight gain during pregnancy.

Avoiding excessive weight gain during pregnancy is a crucial modifiable risk factor for long-term cardiovascular health in women. Gestational weight gain beyond recommended guidelines is associated with an increased risk of developing gestational diabetes, preeclampsia, and postpartum weight retention, all of which are independent risk factors for future coronary heart disease. Managing weight during pregnancy helps mitigate these risks and promotes better cardiovascular outcomes.

Question 20: When assessing a patient's cast for compartment syndrome, the nurse monitors for which primary symptom?

Mild warmth at the cast edges
Itching under the cast
Pain unrelieved by opioids and out of proportion to the injury (Correct answer)
Skin discoloration at the cast rim

Correct answer: Pain unrelieved by opioids and out of proportion to the injury

Pain that is disproportionate to the injury and unrelieved by analgesics is the earliest and most significant symptom of compartment syndrome.

Question 21: When Dervid realized that the elderly woman's leg was

Shortened, Adducted and Internally Rotated.
Shortened, Adducted and Externally Rotated (Correct answer)
Lengthened, Abducted and Internally Rotated
Shortened, Abducted and Externally Rotated

Correct answer: Shortened, Adducted and Externally Rotated

The classic presentation of a hip fracture, especially an extracapsular fracture, involves the affected leg appearing shortened, adducted (pulled inward), and externally rotated. This characteristic positioning is due to muscle spasms pulling the fractured bone fragments into this specific alignment. Recognizing these signs is essential for prompt diagnosis and management of a hip injury.

Question 22: The nurse cares for a patient diagnosed sickle cell anemia. The patient queries the nurse about signs that might indicate a crisis. Which among the following does not indicate a sickle cell crisis?

Fever
Pain
Shortness of breath
Blurred vision (Correct answer)

Correct answer: Blurred vision

Common signs and symptoms of an acute sickle cell crisis include severe pain (due to vaso-occlusion), fever (indicating infection or inflammatory response), and shortness of breath (often from acute chest syndrome or severe anemia). While sickle cell disease can eventually lead to ocular complications, blurred vision is not typically an immediate or primary indicator of an acute sickle cell crisis. The other options represent urgent manifestations requiring prompt attention.

Question 23: A patient with dilated cardiomyopathy is prescribed carvedilol. What is the primary reason beta-blockers are used in heart failure with reduced ejection fraction (HFrEF)?

To block harmful neurohormonal activation and remodel the ventricle over time (Correct answer)
To increase heart rate and improve cardiac output acutely
To prevent atrial fibrillation in all HF patients
To promote diuresis and reduce preload

Correct answer: To block harmful neurohormonal activation and remodel the ventricle over time

Beta-blockers counteract chronic sympathetic activation in HFrEF, reducing harmful neurohormonal effects and promoting reverse ventricular remodeling, improving long-term outcomes.

Question 24: A patient with peripheral arterial disease reports calf pain that occurs during walking and resolves with rest. This symptom is best described as:

Intermittent claudication (Correct answer)
Venous insufficiency
Deep vein thrombosis
Raynaud's phenomenon

Correct answer: Intermittent claudication

Intermittent claudication is ischemic muscle pain triggered by exercise and relieved by rest, caused by inadequate arterial blood flow.

Question 25: A nurse is reviewing the lab results of a patient with suspected disseminated intravascular coagulation (DIC). Which combination of findings is most consistent with this diagnosis?

Elevated fibrinogen, decreased D-dimer, normal PT
Elevated D-dimer, decreased fibrinogen, prolonged PT and aPTT (Correct answer)
Normal PT, elevated fibrinogen, increased platelet count
Decreased D-dimer, elevated platelet count, shortened aPTT

Correct answer: Elevated D-dimer, decreased fibrinogen, prolonged PT and aPTT

DIC is characterized by consumption of clotting factors resulting in elevated D-dimer, decreased fibrinogen, and prolonged clotting times.

Question 26: A patient with a new diagnosis of atrial fibrillation asks why anticoagulation therapy is necessary. What is the nurse's best response?

Atrial fibrillation causes blood to pool in the atria, increasing the risk of clot formation and stroke (Correct answer)
Anticoagulants strengthen the heart muscle to pump more effectively
The medication prevents your heart rate from becoming too fast
Anticoagulants will help convert your heart rhythm back to normal

Correct answer: Atrial fibrillation causes blood to pool in the atria, increasing the risk of clot formation and stroke

In atrial fibrillation, ineffective atrial contraction causes blood stasis, increasing thrombus formation risk and subsequent stroke.

Question 27: Which nursing intervention is the priority for a patient who has just returned from surgery for an open reduction internal fixation (ORIF) of a tibial fracture?

Administer the prescribed analgesic
Apply ice to the cast for 72 hours
Encourage active range of motion exercises immediately
Perform neurovascular checks every 1–2 hours (Correct answer)

Correct answer: Perform neurovascular checks every 1–2 hours

Frequent neurovascular assessments after ORIF detect early signs of compartment syndrome, vascular injury, or nerve damage, which are the most serious post-operative complications.

Question 28: During the immediate postoperative period, a patient who underwent thyroidectomy reports tingling around the mouth and fingertips. What should the nurse assess for first?

Neck hematoma
Chvostek sign (Correct answer)
Trousseau sign
Laryngeal nerve damage

Correct answer: Chvostek sign

Perioral and fingertip tingling after thyroidectomy suggests hypocalcemia from parathyroid damage, and Chvostek sign is the fastest bedside test.

Question 29: The nurse is taking care of Mrs. Dela Rosa, a 47-year-old Filipina woman who underwent coronary artery bypass graft (CABG) surgery on the third postoperative day. What is the optimal nursing strategy given that an important nursing diagnosis for post-CABG clients is an inadequate breathing pattern?

Ensure that Mrs. Dela Rosa performs deep breathing and vigorous coughing every hour
Auscultate lungs once a shift
Ensure that Mrs. Dela Rosa uses the incentive spirometer every hour (Correct answer)
Pre-medicate Mrs. Dela Rosa before ambulation

Correct answer: Ensure that Mrs. Dela Rosa uses the incentive spirometer every hour

Explanation: <br> For these individuals, incentive spirometry and deep breathing are the go-to lung expansion methods. It is not recommended for post-CABG patients to cough vigorously since it could increase intrathoracic pressure and lead to sternal instability. Premedication before walking will promote activity intolerance rather than an effective breathing pattern; auscultating the lungs will identify atypical lung sounds brought on by an ineffective breathing pattern but this is not a method to promote an effective breathing pattern.

Question 30: Shana was diagnosed with gastroesophageal reflux disease following an EGD (GERD). Edna is taught by the nurse how to reduce symptoms. Which of the following Edna statements suggests that more instruction is required?

“I will take a walk after I eat.”
“I will sleep with the head of the bed elevated about 12 inches.”
“I will be sure to drink tea instead of coffee.” (Correct answer)
“I will try to eat smaller meals more frequently.”

Correct answer: “I will be sure to drink tea instead of coffee.”

Explanation: <br> The client with GERD is encouraged to eat smaller, low-fat frequent meals and to avoid lying down after eating. Clients are instructed not to eat for at least 2 hours before bedtime and avoid foods that decrease lower esophageal pressure, such as anything containing caffeine (coffee, tea, cola, chocolate).

Question 31: Which intervention is highest priority when a patient reports sudden-onset severe chest pain radiating to the left arm with diaphoresis?

Administer aspirin 325 mg PO
Establish IV access
Notify the physician
Obtain a 12-lead ECG (Correct answer)

Correct answer: Obtain a 12-lead ECG

Obtaining a 12-lead ECG is the first priority to identify ST changes and determine if the patient is experiencing an acute MI requiring emergent intervention.

Question 32: A patient with aortic stenosis asks why they feel dizzy when exercising. What is the best explanation?

Exercise causes the aortic valve leaflets to fuse shut completely
The narrowed valve limits cardiac output during exertion, reducing cerebral perfusion (Correct answer)
The left ventricle dilates during exercise, reducing ejection fraction
Increased heart rate during exercise causes fluid to shift to the lungs

Correct answer: The narrowed valve limits cardiac output during exertion, reducing cerebral perfusion

The stenotic aortic valve creates a fixed obstruction to outflow; during exercise, the heart cannot increase cardiac output sufficiently to meet demand, resulting in decreased cerebral perfusion and syncope or dizziness.

Question 33: A patient with iron-deficiency anemia is started on oral ferrous sulfate. Which teaching point is most important?

Take the medication with milk to reduce GI upset
Avoid vitamin C-containing foods with the medication
Take the medication at bedtime only
Expect black, tarry stools as a side effect (Correct answer)

Correct answer: Expect black, tarry stools as a side effect

Iron supplementation commonly causes dark or black stools, which is expected and not a sign of GI bleeding, and patients must be educated about this.

Question 34: A patient on telemetry develops ventricular fibrillation. What is the immediate priority intervention?

Increase the patient's IV fluid rate
Initiate CPR and prepare for defibrillation (Correct answer)
Administer amiodarone 300 mg IV push
Synchronize cardioversion at 100 joules

Correct answer: Initiate CPR and prepare for defibrillation

Ventricular fibrillation is a pulseless rhythm requiring immediate CPR and unsynchronized defibrillation as the definitive treatment per ACLS guidelines.

Question 35: A patient with acute pancreatitis is prescribed nothing by mouth (NPO). After 48 hours the patient requests food. What is the nurse's best response?

Allow soft foods if bowel sounds are present
Consult the dietitian before any food is given
Explain that pancreatic rest is needed and foods stimulate enzyme secretion (Correct answer)
Provide clear liquids as tolerated

Correct answer: Explain that pancreatic rest is needed and foods stimulate enzyme secretion

Food stimulates pancreatic enzyme secretion, which worsens inflammation in acute pancreatitis; NPO status allows pancreatic rest and reduces enzyme-mediated autodigestion.

Question 36: Which intervention has the highest priority for a patient in diabetic ketoacidosis?

Subcutaneous insulin administration
Oral potassium replacement
Sodium bicarbonate infusion
Intravenous fluid resuscitation (Correct answer)

Correct answer: Intravenous fluid resuscitation

IV fluid resuscitation is the first priority in DKA to address severe dehydration and restore perfusion before starting insulin.

Question 37: After extubation in the PACU, a patient develops high-pitched inspiratory stridor and increasing respiratory distress. The MOST likely cause is:

Tension pneumothorax
Bronchospasm
Laryngospasm (Correct answer)
Pulmonary edema

Correct answer: Laryngospasm

High-pitched inspiratory stridor immediately after extubation is classic for laryngospasm, a forceful involuntary closure of the vocal cords.

Question 38: Which assessment technique is most effective for detecting early compartment syndrome in a patient with a long-bone fracture?

Measuring capillary refill time
Assessing pain with passive stretch of muscles in the compartment (Correct answer)
Monitoring pulse oximetry on the affected limb
Checking skin temperature distal to the fracture

Correct answer: Assessing pain with passive stretch of muscles in the compartment

Pain that is out of proportion to the injury and worsened by passive stretch is the earliest and most sensitive indicator of compartment syndrome before vascular compromise occurs.

Question 39: A patient who had a kidney transplant two months prior experiences acute rejection and is admitted to the hospital. For this patient, which intervention is appropriate?

Immediate removal of the transplanted kidney
Organ biopsy to diagnose impaired function (Correct answer)
Grief and loss counseling to prepare for loss of organ
Magnetic resonance imaging of organ

Correct answer: Organ biopsy to diagnose impaired function

When acute rejection of a transplanted kidney is suspected, the definitive diagnostic procedure is an organ biopsy. This allows for histological examination of kidney tissue to confirm the presence of immune-mediated damage, differentiate rejection from other causes of graft dysfunction, and guide appropriate immunosuppressive treatment to reverse the rejection episode. Immediate organ removal is not the first step, and imaging alone is usually not definitive.

Question 40: A nurse is caring for a patient in septic shock. Which hemodynamic finding is characteristic of the early warm phase?

Decreased systemic vascular resistance with increased cardiac output (Correct answer)
Elevated central venous pressure with jugular vein distention
Increased systemic vascular resistance with decreased cardiac output
Normal blood pressure with decreased heart rate

Correct answer: Decreased systemic vascular resistance with increased cardiac output

Early septic shock features vasodilation causing decreased SVR while the heart compensates with increased cardiac output, producing warm flushed skin.

Question 41: The nurse assesses a patient and hears diminished breath sounds at the bases bilaterally with fine crackles. This finding is most consistent with:

Normal post-operative breath sounds
Pulmonary edema or early pneumonia (Correct answer)
Pleural effusion on one side
Tension pneumothorax

Correct answer: Pulmonary edema or early pneumonia

Bilateral basilar crackles with diminished breath sounds suggest fluid accumulation in the lungs, as seen in pulmonary edema or bilateral pneumonia.

Question 42: A patient with cirrhosis has an elevated ammonia level and is prescribed lactulose. Which outcome indicates the medication is effective?

The patient has two to three soft stools per day (Correct answer)
The patient's urine output increases to 100 mL per hour
The patient reports decreased abdominal pain
The patient's bilirubin level normalizes

Correct answer: The patient has two to three soft stools per day

Lactulose reduces serum ammonia by promoting its excretion through osmotic diarrhea, with a goal of two to three soft stools daily.

Question 43: Which clinical manifestation most specifically differentiates hepatic encephalopathy from other causes of altered mental status?

Hypertension and bradycardia (Cushing's triad)
Hypoactive bowel sounds
Asterixis (liver flap tremor) (Correct answer)
Elevated white blood cell count

Correct answer: Asterixis (liver flap tremor)

Asterixis, a flapping tremor of the outstretched hands, is the hallmark neurological sign of hepatic encephalopathy caused by ammonia's toxic effect on the brain.

Question 44: A patient with a hip fracture is being assessed for neurovascular status. Which assessment finding requires immediate reporting?

Mild swelling at the fracture site
Absent distal pulse and pallor in the affected extremity (Correct answer)
Capillary refill of 2 seconds
Sensation intact to light touch

Correct answer: Absent distal pulse and pallor in the affected extremity

Absent pulse and pallor indicate arterial compromise to the limb, which is a vascular emergency requiring immediate intervention to prevent limb loss.

Question 45: A patient is being discharged after same-day surgery under monitored anesthesia care. Which discharge criterion is most important to verify?

The patient has voided at least once
The patient's SpO2 is 94% on room air
The patient has eaten a full meal
The patient has a responsible adult driver (Correct answer)

Correct answer: The patient has a responsible adult driver

Having a responsible adult driver is critical because residual sedation impairs judgment and driving ability, creating significant safety risk.

Question 46: A patient with an abdominal aortic aneurysm (AAA) suddenly develops severe, tearing back pain and hypotension. What is the nurse's priority action?

Encourage ambulation to assess for orthostatic changes
Prepare the patient for emergent surgical intervention (Correct answer)
Administer an oral analgesic and reposition the patient for comfort
Obtain a 12-lead electrocardiogram to rule out myocardial infarction

Correct answer: Prepare the patient for emergent surgical intervention

Sudden severe back pain with hypotension in a patient with AAA strongly suggests rupture, which is a surgical emergency requiring immediate intervention.

Question 47: A patient with a traumatic brain injury has an intracranial pressure of 28 mmHg. Which nursing intervention should be avoided?

Clustering nursing care activities together (Correct answer)
Administering prescribed osmotic diuretics
Elevating the head of bed to 30 degrees
Maintaining the neck in a neutral position

Correct answer: Clustering nursing care activities together

Clustering care activities causes cumulative stimulation that further elevates already dangerously high intracranial pressure.

Question 48: A nurse is caring for a patient who received a brachial plexus nerve block. Which finding requires immediate notification of the anesthesia provider?

Numbness and tingling in the blocked extremity
Progressive dyspnea and decreased breath sounds on the ipsilateral side (Correct answer)
Inability to grip objects with the affected hand
Mild bruising at the injection site

Correct answer: Progressive dyspnea and decreased breath sounds on the ipsilateral side

Progressive dyspnea with decreased ipsilateral breath sounds after brachial plexus block suggests pneumothorax or phrenic nerve paralysis, requiring urgent evaluation.

Question 49: How many scored questions appear on the CMSRN examination?

125
175
150 (Correct answer)
200

Correct answer: 150

The CMSRN exam consists of 150 scored questions administered over 3 hours.

Question 50: A patient receiving chemotherapy for colon cancer has an absolute neutrophil count (ANC) of 400/mm³. Which visitor restriction is most appropriate?

No restrictions are necessary
Restrict all visitors until ANC exceeds 1,000/mm³
Allow only family members who have received flu vaccination
Restrict all visitors with signs of infection (Correct answer)

Correct answer: Restrict all visitors with signs of infection

Severe neutropenia (ANC <500) requires neutropenic precautions, including restricting visitors with any infection signs to prevent transmission of potentially fatal infections.

Question 51: When performing post-transplant patient education, the nurse emphasizes sun protection because transplant recipients are at highest risk for which skin cancer?

Squamous cell carcinoma (Correct answer)
Malignant melanoma
Basal cell carcinoma
Merkel cell carcinoma

Correct answer: Squamous cell carcinoma

Squamous cell carcinoma is the most common skin malignancy in transplant recipients and is far more aggressive than in the general population due to immunosuppression.

Question 52: Which intervention is the priority for a patient experiencing a myocardial infarction in the emergency department?

Establish IV access
Administer aspirin 325 mg (Correct answer)
Administer morphine for pain
Obtain a 12-lead ECG

Correct answer: Administer aspirin 325 mg

Aspirin inhibits platelet aggregation and is the most time-critical intervention that reduces mortality in acute MI.

Question 53: A nurse is educating a heart transplant recipient about infection prevention. Which statement by the patient indicates a need for further teaching?

I should report any fever to my transplant team immediately
I need to wash my hands frequently
I can eat fresh salads from any restaurant without worry (Correct answer)
I should avoid crowds during flu season

Correct answer: I can eat fresh salads from any restaurant without worry

Immunosuppressed transplant recipients should avoid raw, unwashed produce from uncertain sources due to increased infection risk.

Question 54: A patient admitted with acute pancreatitis has a serum amylase of 520 U/L, back-radiating pain rated 9/10, Cullen's sign, and a blood pressure of 84/52 mmHg. Which finding requires the most immediate nursing intervention?

Blood pressure of 84/52 mmHg (Correct answer)
Serum amylase of 520 U/L
Periumbilical ecchymosis (Cullen's sign)
Pain radiating to the back rated 9/10

Correct answer: Blood pressure of 84/52 mmHg

Hypotension (84/52 mmHg) indicates hemodynamic instability and possible hypovolemic or distributive shock, which is immediately life-threatening and requires urgent fluid resuscitation and provider notification. Elevated amylase, pain, and Cullen's sign confirm the diagnosis but do not pose the same immediate threat to perfusion.

Question 55: A patient with chronic kidney disease has a hemoglobin of 8.2 g/dL. The provider orders erythropoietin-stimulating agents (ESAs). The nurse understands this medication works by:

Increasing iron absorption from the gut
Stimulating bone marrow to produce red blood cells (Correct answer)
Preventing platelet aggregation
Binding free hemoglobin in the plasma

Correct answer: Stimulating bone marrow to produce red blood cells

ESAs mimic endogenous erythropoietin to stimulate the bone marrow to produce red blood cells, correcting anemia of chronic kidney disease.

Question 56: A patient is prescribed incentive spirometry post-operatively. What is the primary goal of this intervention?

Improve cardiac output
Reduce post-operative pain
Drain pleural effusion
Prevent atelectasis and promote lung expansion (Correct answer)

Correct answer: Prevent atelectasis and promote lung expansion

Incentive spirometry encourages deep breathing to expand alveoli and prevent post-operative atelectasis.

Question 57: A patient in the PACU is showing signs of laryngospasm after extubation. Which is the priority nursing intervention?

Position the patient in high Fowler's
Prepare for immediate reintubation
Administer oxygen via nasal cannula
Apply positive pressure ventilation with a bag-valve mask (Correct answer)

Correct answer: Apply positive pressure ventilation with a bag-valve mask

Positive pressure ventilation with a bag-valve mask is the first intervention to break laryngospasm and maintain oxygenation.

Question 58: A patient develops sudden severe dyspnea, tracheal deviation to the left, and absent breath sounds on the right. What condition does the nurse suspect?

Hemothorax
Tension pneumothorax (Correct answer)
Pleural effusion
Pulmonary embolism

Correct answer: Tension pneumothorax

Tension pneumothorax presents with severe dyspnea, tracheal deviation away from the affected side, and absent breath sounds — a life-threatening emergency.

Question 59: A nurse is managing a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory finding confirms this diagnosis?

Serum sodium of 155 mEq/L with dilute urine
Serum potassium of 5.8 mEq/L with metabolic acidosis
Serum calcium of 12.5 mg/dL with bone pain
Serum sodium of 125 mEq/L with concentrated urine (Correct answer)

Correct answer: Serum sodium of 125 mEq/L with concentrated urine

SIADH causes dilutional hyponatremia with inappropriately concentrated urine due to excess water retention.

Question 60: You are watching your patient using the spirometry incentive. What kind of patient demonstration demonstrates to you that the patient knows how to operate the device correctly?

The patient blows on the mouthpiece rapidly.
The patient rapidly inhales on the devices and exhales
The patient uses the incentive spirometry once a day
The patient inhales slowly on the device and maintains the flow indicator between 600 to 900 level (Correct answer)

Correct answer: The patient inhales slowly on the device and maintains the flow indicator between 600 to 900 level

Correct use of an incentive spirometer involves a slow, deep inhalation to maximize lung expansion and hold the breath for a few seconds. The goal is to keep the flow indicator within the target range (e.g., 600-900 mL/sec) to ensure optimal inspiratory effort and sustained lung inflation. Rapid inhalation or blowing into the device are incorrect techniques that do not achieve the therapeutic effect.

Question 61: Three days ago, the patient under the nurse's care underwent kidney transplant surgery. Urine levels drop suddenly and abruptly, as noted by the nurse. When thrombosis is detected, the nurse notifies the medical professional. Which priority idea is the foundation of this complexity?

Perfusion (Correct answer)
Elimination
Cellular regulation
Infection

Correct answer: Perfusion

A sudden and abrupt drop in urine output, especially when thrombosis is detected, points to a severe issue with blood flow to the transplanted kidney. Thrombosis obstructs the blood vessels, impairing the kidney's perfusion. Adequate perfusion is fundamental for the kidney to filter blood and produce urine, making it the underlying physiological concept affected by this complication.

Question 62: Which assessment technique is used to detect ascites in a patient with liver failure?

Rebound tenderness
Auscultation for bruit
Palpation for splenomegaly
Shifting dullness on percussion (Correct answer)

Correct answer: Shifting dullness on percussion

Shifting dullness on percussion detects ascites because fluid shifts to dependent areas when the patient changes position.

Question 63: A nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which finding does the nurse expect?

Hypernatremia and increased urine output
Hyponatremia and decreased urine output (Correct answer)
Hyponatremia and decreased urine specific gravity
Hyperkalemia and increased urine specific gravity

Correct answer: Hyponatremia and decreased urine output

SIADH causes excess ADH, leading to water retention, dilutional hyponatremia, and concentrated urine with decreased output.

Question 64: A nurse is caring for a patient with a chest tube connected to a water-seal drainage system. Which finding indicates a need for immediate action?

Continuous bubbling in the water-seal chamber (Correct answer)
A total of 75 mL of sanguineous drainage over the past hour
Continuous vigorous bubbling in the suction control chamber
Tidaling observed in the water-seal chamber during breathing

Correct answer: Continuous bubbling in the water-seal chamber

Continuous bubbling in the water-seal chamber indicates an air leak in the system or from the patient, which requires immediate assessment and intervention.

Question 65: A patient is NPO for surgery and asks why they cannot drink clear liquids the morning of their procedure. The best nurse's response is:

Clear liquids slow gastric emptying and may cause nausea
Clear liquids interfere with anesthetic drug metabolism
It is hospital policy and cannot be changed
Even clear liquids increase the risk of aspiration during anesthesia (Correct answer)

Correct answer: Even clear liquids increase the risk of aspiration during anesthesia

Clear liquids in the stomach increase aspiration risk during anesthesia induction when protective airway reflexes are suppressed.

Question 66: Which sign would differentiate a venous leg ulcer from an arterial leg ulcer?

Painful with elevation of the limb
Located near the medial malleolus with irregular borders and surrounding hyperpigmentation (Correct answer)
Located on the lateral malleolus with well-defined, punched-out edges
Associated with absent pedal pulses

Correct answer: Located near the medial malleolus with irregular borders and surrounding hyperpigmentation

Venous ulcers typically appear near the medial malleolus with irregular edges and surrounding lipodermatosclerosis or hyperpigmentation from hemosiderin deposits.

Question 67: Which intraoperative position places a patient at highest risk for air embolism?

Reverse Trendelenburg
Prone with chest rolls
Supine with arms tucked
Sitting (beach chair) position (Correct answer)

Correct answer: Sitting (beach chair) position

The sitting position creates a pressure gradient that allows air to enter open venous sinuses, making venous air embolism a significant risk.

Question 68: A patient is ordered to receive packed red blood cells. The nurse verifies the blood product at the bedside. Which action is essential before beginning the transfusion?

Warm the blood to body temperature in a microwave
Obtain a baseline ECG
Confirm patient identity using two identifiers and compare with blood product label (Correct answer)
Prime the tubing with dextrose solution

Correct answer: Confirm patient identity using two identifiers and compare with blood product label

Two-identifier verification of both the patient and the blood product is the critical safety step to prevent a fatal hemolytic transfusion reaction.

Question 69: Which vasopressor is recommended in obstetric situations?

Norepinephrine
Phenylephrine
Ephinephrine
Ephedrine (Correct answer)

Correct answer: Ephedrine

Ephedrine is often the preferred vasopressor in obstetric situations, particularly for treating hypotension during spinal or epidural anesthesia. It has both alpha and beta-adrenergic effects, causing vasoconstriction and increased heart rate. Importantly, ephedrine is less likely to cause uterine vasoconstriction and fetal acidosis compared to pure alpha-agonists like phenylephrine, making it a safer choice for the mother and fetus.

Question 70: A patient with pulmonary embolism (PE) is being treated with heparin infusion. Which lab value requires immediate dose adjustment?

Hemoglobin of 10 g/dL
aPTT of 120 seconds (therapeutic range 60–100 seconds) (Correct answer)
Platelet count of 200,000/mm³
BUN of 18 mg/dL

Correct answer: aPTT of 120 seconds (therapeutic range 60–100 seconds)

An aPTT above the therapeutic range indicates excessive anticoagulation with heparin, requiring dose reduction to prevent hemorrhagic complications.

Question 71: Which post-transplant malignancy is most strongly linked to Epstein-Barr virus (EBV) reactivation?

Squamous cell carcinoma of the skin
Post-transplant lymphoproliferative disorder (PTLD) (Correct answer)
Kaposi's sarcoma
Hepatocellular carcinoma

Correct answer: Post-transplant lymphoproliferative disorder (PTLD)

PTLD is primarily driven by EBV reactivation under immunosuppression and ranges from benign hyperplasia to aggressive lymphoma.

Question 72: A patient presents with acute onset of a cold, pale, pulseless left lower extremity. Which condition should the nurse suspect?

Chronic venous insufficiency
Superficial thrombophlebitis
Acute arterial embolism (Correct answer)
Varicose vein rupture

Correct answer: Acute arterial embolism

The classic presentation of acute arterial occlusion includes the six Ps: pain, pallor, pulselessness, poikilothermia, paresthesia, and paralysis.

Question 73: Which best describes the primary focus of the CMSRN Core Curriculum when used as a study resource?

Advanced practice prescribing guidelines
Pediatric nursing across the lifespan
Comprehensive review of adult medical-surgical nursing across body systems and domains (Correct answer)
Critical care and ICU nursing procedures

Correct answer: Comprehensive review of adult medical-surgical nursing across body systems and domains

The CMSRN Core Curriculum provides a comprehensive, exam-aligned review of adult med-surg nursing content organized by body system and care domain.

Question 74: A patient receiving IV vancomycin develops sudden flushing, erythema, and hypotension during the infusion. This reaction is most consistent with:

Septic reaction
Vasovagal response
Red man syndrome (Correct answer)
Anaphylaxis

Correct answer: Red man syndrome

Red man syndrome is a non-immune infusion reaction to vancomycin characterized by flushing and hypotension, prevented by slowing the infusion rate.

Question 75: A patient with hemophilia A requires emergency surgery. Which product should the nurse anticipate administering?

Factor VIII concentrate (Correct answer)
Fresh frozen plasma only
Protamine sulfate
Platelet concentrate

Correct answer: Factor VIII concentrate

Hemophilia A is caused by factor VIII deficiency; surgical patients require factor VIII concentrate to prevent life-threatening hemorrhage.

Question 76: A candidate has 8 weeks until the CMSRN exam. Which study schedule is MOST effective?

Reading the textbook cover-to-cover once without practice questions
Focusing only on topics the nurse finds interesting
Systematic daily review of one content domain per week with integrated practice questions (Correct answer)
Cramming all content into the final 2 weeks

Correct answer: Systematic daily review of one content domain per week with integrated practice questions

A structured, domain-by-domain study plan with daily practice questions promotes retention and identifies weak areas systematically.

Question 77: Which position is best for a spontaneously breathing patient with unilateral pneumonia to improve oxygenation?

Prone position
Good lung down (unaffected side dependent) (Correct answer)
Supine with head of bed flat
Affected side down (dependent)

Correct answer: Good lung down (unaffected side dependent)

Positioning the good (unaffected) lung down uses gravity to improve perfusion to the better-ventilated lung, optimizing V/Q matching.

Question 78: A nurse is caring for a patient receiving a blood transfusion who develops fever, chills, and flank pain 15 minutes into the infusion. What is the priority action?

Stop the transfusion immediately and keep the IV open with normal saline (Correct answer)
Obtain a urine sample and continue the transfusion at a slower rate
Slow the transfusion rate and monitor vital signs
Administer diphenhydramine and continue the transfusion

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

Fever, chills, and flank pain suggest an acute hemolytic transfusion reaction, requiring immediate cessation of the transfusion while maintaining IV access.

Question 79: A man who underwent a six-hour left femoral popliteal bypass graft has returned to the Unit. Later, the client's foot appears chilly and dark, and the nurse should have seen that his dorsalis pedis pulse was absent.

assure the client that his foot is fine
immediately notify the physician (Correct answer)
continue to monitor the foot.
notify the head nurse

Correct answer: immediately notify the physician

Following a femoral popliteal bypass graft, a cold, dark foot and an absent dorsalis pedis pulse are critical signs of acute arterial occlusion or graft failure. These findings indicate a severe lack of blood flow to the limb, which is a surgical emergency. Immediate notification of the physician is paramount to prevent limb ischemia, potential amputation, or other serious complications.

Question 80: Which laboratory value requires the nurse to hold a scheduled dose of digoxin and contact the provider?

Serum digoxin level of 2.8 ng/mL (Correct answer)
Serum sodium of 138 mEq/L
BUN of 18 mg/dL
Serum potassium of 4.2 mEq/L

Correct answer: Serum digoxin level of 2.8 ng/mL

The therapeutic range for digoxin is 0.5-2.0 ng/mL; a level of 2.8 ng/mL is toxic and requires holding the dose and notifying the provider.

Question 81: A patient receiving ketamine anesthesia is most likely to experience which unique emergence phenomenon?

Severe bradycardia
Dissociative reactions and vivid hallucinations (Correct answer)
Respiratory depression and apnea
Prolonged neuromuscular blockade

Correct answer: Dissociative reactions and vivid hallucinations

Ketamine is a dissociative anesthetic that commonly causes emergence reactions including hallucinations, vivid dreams, and disorientation upon recovery.

Question 82: A patient with peripheral arterial disease (PAD) reports intermittent claudication. Which patient statement indicates a need for further teaching?

I soak my feet in hot water every evening to improve circulation (Correct answer)
I inspect my feet daily for any cuts or sores
I stop and rest when my legs start to hurt during exercise
I wear well-fitting shoes when walking

Correct answer: I soak my feet in hot water every evening to improve circulation

Patients with PAD should avoid soaking feet in hot water due to impaired sensation and risk of thermal injury.

Question 83: When a transplant is rejected, how does the immune system react to a graft?

Collateral circulation develops and the transplanted organ becomes engorged
Host's immune system starts inflammation and immunologic actions to destroy nonself cells (Correct answer)
Opportunistic infections develop because the body is immunosuppressed
Systemic tissue destruction occurs because of inability to differentiate self from nonself cells

Correct answer: Host's immune system starts inflammation and immunologic actions to destroy nonself cells

Transplant rejection occurs when the recipient's (host's) immune system recognizes the transplanted organ (graft) as foreign, or 'non-self.' This triggers a complex and coordinated immune response involving various immune cells and antibodies, leading to inflammation and immunologic actions specifically aimed at destroying the foreign tissue. This is a normal function of the immune system, but it is detrimental in the context of transplantation.

Question 84: A patient with deep vein thrombosis (DVT) is started on a heparin drip. Which laboratory value should the nurse monitor to evaluate therapeutic effectiveness?

Platelet count
Activated partial thromboplastin time (aPTT) (Correct answer)
Prothrombin time (PT)
Fibrinogen level

Correct answer: Activated partial thromboplastin time (aPTT)

aPTT is the primary lab value used to monitor the therapeutic effectiveness of unfractionated heparin therapy.

Question 85: A nurse is assessing a patient with suspected compartment syndrome of the lower leg. Which finding is the earliest indicator of this condition?

Absent distal pulses
Complete paralysis of the foot
Visible pallor of the extremity
Pain disproportionate to the injury that worsens with passive stretching (Correct answer)

Correct answer: Pain disproportionate to the injury that worsens with passive stretching

Pain out of proportion to the injury, especially with passive stretch of the affected muscles, is the earliest and most reliable sign of compartment syndrome.

Question 86: A nurse is providing discharge education to a patient prescribed oral prednisone for rheumatoid arthritis. Which instruction is most important?

Expect immediate improvement within 24 hours
Increase potassium-rich foods only if potassium is low
Take the medication on an empty stomach
Do not stop the medication abruptly (Correct answer)

Correct answer: Do not stop the medication abruptly

Long-term corticosteroid use suppresses adrenal function; abrupt discontinuation can cause adrenal crisis, so tapering under physician guidance is essential.

Question 87: A postoperative patient receiving PCA morphine has a respiratory rate of 8 breaths/min and is difficult to arouse. The FIRST nursing action is:

Decrease the PCA demand dose and basal rate
Administer naloxone and stop the PCA (Correct answer)
Call the rapid response team immediately
Stimulate the patient and apply supplemental oxygen

Correct answer: Administer naloxone and stop the PCA

Opioid-induced respiratory depression with somnolence requires immediate naloxone administration and PCA cessation to reverse narcosis.

Question 88: A patient with newly diagnosed atrial fibrillation asks why anticoagulation therapy is necessary. Which response by the nurse is most accurate?

The medication will strengthen your heart contractions to prevent further arrhythmias
Anticoagulants will convert your heart rhythm back to normal
The irregular rhythm causes blood to pool in the atria, increasing stroke risk from clot formation (Correct answer)
Anticoagulation is only needed if you have a history of prior blood clots

Correct answer: The irregular rhythm causes blood to pool in the atria, increasing stroke risk from clot formation

Atrial fibrillation causes ineffective atrial contraction, leading to blood stasis and thrombus formation in the atria, significantly increasing embolic stroke risk.

Question 89: In the early postoperative phase, a client feels confused. Which of the following evaluations is necessary to identify the confusion's cause?

Airway status (Correct answer)
Cardiac rhythm
Level of anxiety
Level of consciousness

Correct answer: Airway status

Postoperative confusion can be a sign of various complications, but the most critical and immediate concern is inadequate oxygenation or ventilation, which directly relates to airway status. Hypoxia or hypercapnia due to an obstructed airway or respiratory depression can quickly lead to brain dysfunction and confusion. Therefore, assessing airway status and ensuring adequate oxygenation is the priority to identify the cause of confusion.

Question 90: A nurse uses the MSNCB practice test as part of exam preparation. What is the PRIMARY benefit of this strategy?

Guarantees passage of the actual CMSRN exam
Familiarizes the candidate with question style and identifies knowledge gaps (Correct answer)
Provides CEUs toward renewal
Substitutes for clinical hours requirement

Correct answer: Familiarizes the candidate with question style and identifies knowledge gaps

Practice tests help candidates identify weak content areas and acclimate to the question format used on the actual exam.

Question 91: A patient in the PACU has a respiratory rate of 6 breaths/min and is unresponsive 30 minutes after receiving fentanyl. What is the priority nursing intervention?

Perform endotracheal intubation immediately
Administer naloxone IV (Correct answer)
Apply a non-rebreather mask
Administer flumazenil IV

Correct answer: Administer naloxone IV

Naloxone rapidly reverses opioid-induced respiratory depression and is the first-line pharmacological intervention in this scenario.

Question 92: When performing deep tracheal suctioning, the nurse should limit each suction pass to no more than:

30 seconds
20 seconds
5 seconds
10–15 seconds (Correct answer)

Correct answer: 10–15 seconds

Each suction pass should be limited to 10–15 seconds to minimize hypoxia and mucosal trauma.

Question 93: A patient on mechanical ventilation develops high peak airway pressures. What is the priority nursing assessment?

Decrease the FiO2
Assess for kinking of the ventilator tubing or ET tube (Correct answer)
Increase the tidal volume
Check the IV site for infiltration

Correct answer: Assess for kinking of the ventilator tubing or ET tube

High peak airway pressures often result from obstruction such as kinked tubing, secretions, or biting of the ET tube, which must be assessed immediately.

Question 94: A living-related donor is being evaluated for kidney donation. Which finding would disqualify the donor?

Bilateral kidney stones with residual nephrocalcinosis (Correct answer)
One prior urinary tract infection
BMI of 27 kg/m²
GFR of 85 mL/min/1.73m²

Correct answer: Bilateral kidney stones with residual nephrocalcinosis

Bilateral nephrolithiasis with nephrocalcinosis places the remaining kidney at risk post-donation and disqualifies the candidate.

Question 95: A patient with a nasogastric tube on low suction reports nausea and abdominal cramping. What is the nurse's first action?

Verify tube placement and patency (Correct answer)
Increase the suction pressure setting
Offer oral ice chips for comfort
Administer an antiemetic as prescribed

Correct answer: Verify tube placement and patency

Verifying NG tube placement and patency is the priority because a misplaced or occluded tube will not drain gastric contents, directly causing the reported symptoms.

Question 96: Which study resource is MOST aligned with CMSRN exam content because it directly reflects the exam blueprint?

Nursing fundamentals textbooks
Critical care nursing textbooks
NCLEX-RN review books
MSNCB CMSRN Exam Blueprint and Core Curriculum (Correct answer)

Correct answer: MSNCB CMSRN Exam Blueprint and Core Curriculum

The MSNCB's official blueprint and core curriculum are the most directly aligned resources because they define what will be tested.

Question 97: It's a left pneumonectomy for a client. Nursing interventions for a postoperative left pneumonectomy that would be planned for this client would include:

positioning the client in the semi-Fowler's position with a pillow under the shoulder and back
positioning the client on the right side
monitoring the chest tubes
monitoring the right lung for an increase in rales (Correct answer)

Correct answer: monitoring the right lung for an increase in rales

Following a left pneumonectomy, the remaining right lung must compensate for the removed lung. Monitoring the right lung for an increase in rales (crackles) is crucial because it can indicate fluid overload, pulmonary edema, or atelectasis in the remaining lung. Early detection of these complications allows for prompt intervention to maintain adequate respiratory function and prevent further compromise.

Question 98: A patient develops stridor after extubation. What is the priority nursing action?

Obtain an arterial blood gas immediately
Notify the physician and prepare for possible reintubation (Correct answer)
Administer oral fluids to soothe the airway
Place the patient in the Trendelenburg position

Correct answer: Notify the physician and prepare for possible reintubation

Post-extubation stridor indicates laryngeal edema or obstruction and requires immediate physician notification and preparation for airway rescue.

Question 99: A patient with chronic kidney disease develops normocytic normochromic anemia. Which medication should the nurse anticipate administering?

Epoetin alfa (Procrit) (Correct answer)
Ferrous sulfate
Vitamin B12 injections
Folic acid supplements

Correct answer: Epoetin alfa (Procrit)

Chronic kidney disease causes decreased erythropoietin production, and epoetin alfa is a synthetic erythropoietin used to stimulate red blood cell production.

Question 100: Which finding in a patient with a urinary catheter most strongly suggests catheter-associated urinary tract infection (CAUTI)?

Urine output of 35 mL/hr
Urine that appears cloudy with a foul odor and patient has fever (Correct answer)
Urine specific gravity of 1.020
Mild hematuria noted on day 1 post-insertion

Correct answer: Urine that appears cloudy with a foul odor and patient has fever

Cloudy, malodorous urine combined with fever in a catheterized patient meets clinical criteria for suspected CAUTI and warrants urine culture.

Question 101: A patient is admitted with acute pancreatitis. Which laboratory value is most consistent with this diagnosis?

Elevated serum lipase (Correct answer)
Decreased white blood cell count
Elevated serum albumin
Low serum amylase

Correct answer: Elevated serum lipase

Serum lipase is the most sensitive and specific marker for acute pancreatitis and remains elevated longer than amylase.

Question 102: A patient returns after a coronary artery bypass graft to the Cardiovascular Intensive Care Unit." (CABG). The most crucial electrolyte to keep an eye on when organizing the client's care is:

sodium
potassium (Correct answer)
bicarbonate
chloride

Correct answer: potassium

After a Coronary Artery Bypass Graft (CABG), patients are at high risk for electrolyte imbalances, particularly with potassium. Both hypokalemia and hyperkalemia can lead to life-threatening cardiac arrhythmias, which are a major concern in the immediate postoperative period. Close monitoring and management of potassium levels are therefore crucial to ensure cardiac stability and prevent serious complications.

Question 103: The medical-surgical nurse evaluates a patient who suffered a head injury 24 hours earlier and observes the emergence of slurred speech and a loss of sense of time and location. The nurse's first move is to:

Inform the neurosurgeon of the patient's status (Correct answer)
Prepare the patient for emergency surgery
Continue the hourly neurologic assessments
Recheck the patient's neurologic status in 15 minutes

Correct answer: Inform the neurosurgeon of the patient's status

Explanation: <br> In the given scenario, where a patient who sustained a head injury 24 hours ago is showing new symptoms such as slurred speech and disorientation, the nurse's initial action should be to inform the neurosurgeon of the patient's status.

Question 104: Which reversal agent is used to antagonize non-depolarizing neuromuscular blocking agents such as rocuronium?

Neostigmine only
Flumazenil
Sugammadex (Correct answer)
Naloxone

Correct answer: Sugammadex

Sugammadex is a selective relaxant binding agent that directly encapsulates rocuronium and vecuronium, providing rapid and complete reversal.

Question 105: A patient is admitted with a suspected pulmonary embolism (PE). The nurse should prioritize which of the following assessments?

Checking for peripheral edema and skin discoloration.
Measuring calf circumference daily.
Monitoring oxygen saturation and respiratory rate. (Correct answer)
Assessing for a positive Homans' sign.

Correct answer: Monitoring oxygen saturation and respiratory rate.

A pulmonary embolism is a life-threatening condition where a clot obstructs the pulmonary artery, impairing gas exchange. Therefore, the priority assessment is to monitor the patient's respiratory status, including oxygen saturation and respiratory rate, to detect hypoxemia and respiratory distress promptly. While assessing for signs of DVT (peripheral edema, calf circumference, Homans' sign) is important because DVT is the most common cause of PE, the immediate threat to life is respiratory compromise. Homans' sign is also considered an unreliable indicator for DVT.

Question 106: A renal transplant recipient is started on fluconazole for a fungal infection. The nurse anticipates which medication adjustment?

Decrease tacrolimus dose due to CYP3A4 inhibition (Correct answer)
Increase tacrolimus dose due to reduced absorption
Stop mycophenolate mofetil temporarily
Double the prednisone dose

Correct answer: Decrease tacrolimus dose due to CYP3A4 inhibition

Fluconazole inhibits CYP3A4, dramatically increasing tacrolimus levels and requiring a significant dose reduction to avoid toxicity.

Question 107: A nurse is assessing a patient with suspected pulmonary embolism. Which finding is most consistent with this diagnosis?

Bilateral crackles with pink frothy sputum
Jugular venous distention with clear lung fields
Gradual onset of peripheral edema
Sudden onset dyspnea with pleuritic chest pain (Correct answer)

Correct answer: Sudden onset dyspnea with pleuritic chest pain

Sudden dyspnea with sharp, pleuritic chest pain is the hallmark presentation of pulmonary embolism.

Question 108: Which instruction is most important when teaching a patient about warfarin therapy?

Limit fluid intake to 1 liter per day
Avoid consistent consumption of vitamin K-rich foods (Correct answer)
Take an extra dose if a scheduled dose is missed
Report any yellow discoloration of the skin immediately

Correct answer: Avoid consistent consumption of vitamin K-rich foods

Consistent vitamin K intake is essential because vitamin K antagonizes warfarin; drastic changes in dietary vitamin K can cause INR fluctuations.

Question 109: A patient with neutropenia following chemotherapy develops a fever of 38.5°C (101.3°F). What is the nurse's priority action?

Place the patient in reverse isolation and monitor
Obtain blood cultures and initiate prescribed antibiotics immediately (Correct answer)
Administer a cooling blanket
Administer acetaminophen and reassess in 4 hours

Correct answer: Obtain blood cultures and initiate prescribed antibiotics immediately

Febrile neutropenia is a medical emergency; cultures must be drawn and broad-spectrum antibiotics started within one hour to prevent septic shock.

Question 110: A patient with heart failure is prescribed spironolactone. Which dietary instruction is most important for the nurse to provide?

Limit fluid to 500 mL daily
Increase sodium intake
Avoid potassium-rich foods (Correct answer)
Eat more citrus fruits

Correct answer: Avoid potassium-rich foods

Spironolactone is a potassium-sparing diuretic, so avoiding excess dietary potassium helps prevent life-threatening hyperkalemia.

Question 111: A patient undergoing a procedure under moderate (conscious) sedation stops responding to verbal stimuli. The nurse should FIRST:

Stimulate the patient and assess airway patency (Correct answer)
Increase the supplemental oxygen flow rate only
Administer flumazenil to reverse the sedation
Immediately call a code blue

Correct answer: Stimulate the patient and assess airway patency

The immediate priority is to assess responsiveness and airway patency, as the patient may have inadvertently progressed to deep sedation requiring airway intervention.

Question 112: A patient with heart failure is prescribed furosemide 40 mg IV. Which assessment finding should the nurse report immediately?

Urine output of 200 mL in 2 hours
Blood pressure of 128/78 mmHg
Potassium level of 2.8 mEq/L (Correct answer)
Mild pedal edema

Correct answer: Potassium level of 2.8 mEq/L

A potassium level of 2.8 mEq/L indicates hypokalemia, a dangerous side effect of loop diuretics that can cause fatal cardiac dysrhythmias.

Question 113: The kidney transplant patient, who was recently moved from the recovery unit, is being attended to by the intensive care nurse. Which of the following findings during the first 12 hours following surgery is the most dangerous and has to be reported to the transplant surgeon right away?

Abrupt decrease in urine (Correct answer)
Pink or dark reddish urine
Diuresis with increased output
Small clots in bladder irrigation fluid

Correct answer: Abrupt decrease in urine

An abrupt decrease in urine output during the first 12 hours following a kidney transplant is a critical and dangerous finding. It can indicate serious complications such as acute tubular necrosis, vascular thrombosis (e.g., renal artery or vein thrombosis), or urinary obstruction, all of which can threaten the viability of the transplanted kidney. This requires immediate reporting to the transplant surgeon for urgent evaluation and intervention.

Question 114: A patient with a long-bone fracture of the femur suddenly develops petechiae on the chest and axillae, confusion, and dyspnea 24 hours post-injury. What complication does the nurse suspect?

Compartment syndrome
Disseminated intravascular coagulation
Fat embolism syndrome (Correct answer)
Pulmonary embolism from DVT

Correct answer: Fat embolism syndrome

Fat embolism syndrome presents with the classic triad of petechiae (especially on upper body), respiratory distress, and neurological changes 24–72 hours after long-bone fracture.

Question 115: Based on ECG alterations, the doctor has determined that Mr. Stanford, a 67-year-old retired college professor who collapsed in his front yard and was taken to the emergency room, had a myocardial infarction. Mr. Stanford is being routinely evaluated by the nurse, who observes that he frequently forgets what the ECG and non-invasive blood pressure monitors are for. Which of the following best explains Mr. Stanford's response, according to the nurse?

Nurses in the Emergency Department are too busy to properly explain the purpose of the equipment
Mr. Stanford is showing signs of Alzheimer’s disease
Memory lapses are common with clients experiencing myocardial infarction
Mr. Stanford is showing signs of fear and anxiety (Correct answer)

Correct answer: Mr. Stanford is showing signs of fear and anxiety

Memory lapses are common with clients experiencing myocardial infarction

Question 116: Which patients are most likely to be turned away from transplantation? SATA

Serum creatinine level
Organ biopsy to diagnose impaired function
Natural killer cells & Cytotoxic / cytolytic T-cells (Correct answer)
Natural killer cells & Cytotoxic/cytolytic T-cells

Correct answer: Natural killer cells & Cytotoxic / cytolytic T-cells

Patients with a highly sensitized immune system, characterized by the presence of pre-formed antibodies or a strong cellular immune response involving natural killer cells and cytotoxic T-cells, are at a significantly increased risk for hyperacute or acute rejection. Such a robust immune profile makes finding a compatible donor extremely difficult and increases the likelihood of graft failure, leading to a patient being deemed unsuitable or 'turned away' from transplantation.

Question 117: Which finding on a chest X-ray is most consistent with pneumothorax?

Diffuse bilateral infiltrates
Hyperinflation with flattened diaphragm
Consolidation in the lower lobes
Absence of lung markings on one side (Correct answer)

Correct answer: Absence of lung markings on one side

Pneumothorax appears on chest X-ray as absence of lung markings with a visible pleural line on the affected side.

Question 118: A patient scheduled for a total knee arthroplasty reports taking aspirin 325 mg daily. What is the priority nursing action during the preoperative phase?

Administer the aspirin as scheduled
Instruct the patient to double the dose before surgery
Notify the surgeon about the aspirin use (Correct answer)
Document the aspirin use and proceed with preparation

Correct answer: Notify the surgeon about the aspirin use

Aspirin inhibits platelet aggregation and increases surgical bleeding risk, so the surgeon must be notified to determine when to discontinue it preoperatively.

Question 119: Which position should the nurse place a patient in immediately after a liver biopsy?

Supine with legs elevated on pillows
Left lateral with the head elevated 30 degrees
Right lateral with a pillow under the costal margin (Correct answer)
Prone with arms above the head

Correct answer: Right lateral with a pillow under the costal margin

Right lateral positioning applies pressure to the biopsy site via the body's weight, reducing the risk of hemorrhage.

Question 120: A nurse is caring for a patient with acute pancreatitis. Which serum lab value is most specific for confirming this diagnosis?

Alkaline phosphatase
Bilirubin
Amylase
Lipase (Correct answer)

Correct answer: Lipase

Serum lipase is the most specific marker for acute pancreatitis because it remains elevated longer and is more specific to pancreatic tissue than amylase.

Question 121: Which intraoperative finding is MOST consistent with an air embolism during surgery?

Increased end-tidal CO2
Hypertension and bradycardia
Decreased end-tidal CO2 with hypotension (Correct answer)
Increased oxygen saturation

Correct answer: Decreased end-tidal CO2 with hypotension

Air embolism causes a sudden decrease in end-tidal CO2 due to increased dead space, accompanied by cardiovascular collapse and hypotension.

Question 122: A patient with COPD has an SpO2 of 88% and is on 2L/min nasal cannula. What is the most appropriate nursing action?

Increase oxygen to 4L/min immediately
Maintain current settings as 88% is acceptable for COPD patients (Correct answer)
Notify the physician and monitor closely
Apply a non-rebreather mask at 15L/min

Correct answer: Maintain current settings as 88% is acceptable for COPD patients

COPD patients often retain CO2 and rely on hypoxic drive; SpO2 of 88–92% is the target range to avoid suppressing respiratory drive.

Question 123: On the day of operation, a patient with type 2 diabetes mellitus is admitted, and their glucose level is 610 mg/dl. The patient may be at risk for the following, according to the perianesthesia nurse:

Diabetic Inspidu
Diabetic Ketoacidosis
Hyperalcemia
Hyperkalemia (Correct answer)

Correct answer: Hyperkalemia

The patient is at risk for "Diabetic ketoacidosis (DKA)," a dangerous consequence of diabetes marked by hyperglycemia, ketosis, and metabolic acidosis, if they have a history of type 2 diabetes mellitus and a glucose level of 610 mg/dl upon admission. Patients with type 1 diabetes are most affected, however people with type 2 diabetes may also experience it, particularly after stressful procedures like surgery. As a result, the perianesthesia nurse needs to watch out for any indications that the patient is experiencing DKA. In the setting of type 2 diabetes mellitus, uncontrolled hyperglycemia is generally not associated with hypercalcemia, diabetes insipidus, or hyperkalemia.

Question 124: Which assessment finding in a patient 6 hours post-thyroidectomy requires the most urgent nursing intervention?

Low-grade temperature of 99.2°F
Tingling and numbness around the mouth and fingertips (Correct answer)
Incisional pain rated 5 out of 10
Mild hoarseness when speaking

Correct answer: Tingling and numbness around the mouth and fingertips

Perioral and fingertip tingling indicates hypocalcemia from accidental parathyroid removal, which can progress to tetany and laryngospasm.

Question 125: A patient with a tracheostomy has thick, tenacious secretions. Which independent nursing intervention is most appropriate?

Administer mucolytic medication
Perform postural drainage every 4 hours
Increase IV fluid rate without a physician order
Increase humidification of inspired air (Correct answer)

Correct answer: Increase humidification of inspired air

Increasing humidification of inspired air is an independent nursing intervention that helps thin secretions for easier clearance.

Question 126: A nurse is caring for a patient in cardiogenic shock. Which hemodynamic finding is expected?

Decreased PAWP and increased cardiac output
Normal PAWP with elevated mixed venous oxygen saturation
Elevated pulmonary artery wedge pressure (PAWP) and decreased cardiac output (Correct answer)
Elevated cardiac output and decreased systemic vascular resistance

Correct answer: Elevated pulmonary artery wedge pressure (PAWP) and decreased cardiac output

Cardiogenic shock results from pump failure, leading to elevated PAWP due to fluid backup and decreased cardiac output from impaired contractility.

Question 127: A patient with polycythemia vera is at highest risk for which complication?

Aplastic anemia
Thromboembolism (Correct answer)
Hemorrhagic stroke
Disseminated intravascular coagulation

Correct answer: Thromboembolism

The elevated red blood cell mass in polycythemia vera increases blood viscosity, dramatically raising the risk of arterial and venous thrombosis.

Question 128: A patient with a new tracheostomy requires suctioning. What is the maximum recommended suction duration per pass?

10 seconds (Correct answer)
20 seconds
15 seconds
5 seconds

Correct answer: 10 seconds

Each suction pass should not exceed 10 seconds to prevent hypoxia, mucosal trauma, and vagal stimulation.

Question 129: Which position is most appropriate for a patient immediately after a lumbar puncture?

Trendelenburg
High Fowler's (60-90 degrees)
Left lateral Sims
Supine (flat) (Correct answer)

Correct answer: Supine (flat)

Lying flat after a lumbar puncture helps prevent post-procedural headache by reducing CSF leakage through the puncture site.

Question 130: A patient undergoing a laparoscopic procedure develops sudden onset hypotension, bradycardia, and decreased SpO2 after insufflation. The nurse suspects:

CO2 embolism from pneumoperitoneum (Correct answer)
Pulmonary embolism from DVT
Anaphylaxis to the surgical prep
Vasovagal reaction from pain

Correct answer: CO2 embolism from pneumoperitoneum

CO2 embolism is a known complication of laparoscopic surgery when gas enters the vasculature, causing cardiovascular collapse and hypoxia.

Question 131: A patient receives a final lung cancer diagnosis. The patient accuses his parents of smoking in their house when he was a child after learning the diagnosis. Which of the five stages of mourning according to Kübler-Ross best fits this patient?

Denial
Depression
Anger (Correct answer)
Bargaining

Correct answer: Anger

In the period of fury, this patient is. Instead than concentrating on what he can do to accept and prepare for his death, he blames his parents for his diagnosis. Denial, rage, bargaining, sadness, and acceptance are the five stages. Not everyone experiences all of the phases of grieving, and they aren't always felt in that order either. Patients may visit one or more stages repeatedly before being able to move through them.

Question 132: Two days ago, a hemicolectomy was performed on a customer. A tiny portion of the abdominal viscera was visible peeking through the wound when the nurse examined it today. This wound healing problem is referred to as:

dehiscence
decortication
excoriation
evisceration (Correct answer)

Correct answer: evisceration

Evisceration is a severe wound complication where the surgical incision separates, and internal organs (viscera) protrude through the opening. This is a medical emergency requiring immediate intervention to protect the exposed organs and prevent infection. Dehiscence, in contrast, is the separation of wound edges without organ protrusion.

Question 133: A patient post-CABG has a chest tube output of 250 mL in the last hour. What is the priority nursing action?

Document as a normal finding and continue monitoring
Notify the surgeon and prepare for possible return to the OR (Correct answer)
Clamp the chest tube to prevent further blood loss
Increase IV fluid rate to compensate for losses

Correct answer: Notify the surgeon and prepare for possible return to the OR

Chest tube drainage exceeding 200 mL/hr after cardiac surgery indicates excessive bleeding and requires immediate surgical notification for possible re-exploration.

Question 134: A patient post-gastric bypass surgery is being discharged. Which dietary teaching is most important to prevent dumping syndrome?

Eat small, frequent meals and avoid concentrated sweets (Correct answer)
Eat three large structured meals per day for adequate nutrition
Maximize protein at each meal and limit carbohydrates only
Drink 8 ounces of fluid with each meal to aid digestion

Correct answer: Eat small, frequent meals and avoid concentrated sweets

Small frequent meals and eliminating concentrated sweets prevent rapid gastric emptying that triggers early and late dumping syndrome after gastric bypass.

Question 135: Which reversal agent should the medical-surgical nurse have available when moderate sedation with midazolam is administered?

Protamine sulfate
Flumazenil (Correct answer)
Naloxone
Sugammadex

Correct answer: Flumazenil

Flumazenil is a competitive benzodiazepine antagonist that reverses the sedative effects of midazolam.

Question 136: A renal transplant patient's cyclosporine level is subtherapeutic. The patient reports starting rifampin for latent TB prophylaxis. This interaction occurs because rifampin:

Displaces cyclosporine from plasma protein binding
Inhibits CYP3A4, reducing cyclosporine metabolism
Induces CYP3A4, accelerating cyclosporine metabolism (Correct answer)
Increases renal excretion of cyclosporine

Correct answer: Induces CYP3A4, accelerating cyclosporine metabolism

Rifampin is a potent CYP3A4 inducer that markedly increases cyclosporine metabolism, leading to subtherapeutic levels and risk of rejection.

Question 137: A nurse is caring for a patient with heart failure who develops frothy, pink-tinged sputum and severe dyspnea. What is the priority nursing intervention?

Encourage deep breathing exercises
Position the patient upright and administer oxygen (Correct answer)
Administer a scheduled beta-blocker
Restrict oral fluids immediately

Correct answer: Position the patient upright and administer oxygen

Frothy pink-tinged sputum indicates pulmonary edema, and the priority is to position upright to reduce preload and administer supplemental oxygen.

Question 138: When teaching a patient with newly diagnosed COPD about breathing techniques, the nurse should emphasize:

Pursed-lip breathing to prevent airway collapse (Correct answer)
Rapid shallow breathing to conserve energy
Valsalva maneuver during exertion
Mouth breathing at all times

Correct answer: Pursed-lip breathing to prevent airway collapse

Pursed-lip breathing slows exhalation, maintains positive airway pressure, and prevents premature airway collapse in COPD patients.

Question 139: A medical-surgical nurse who examines a patient who is paralyzed below the T4 level anticipates finding:

hyperreflexia and spasticity of the upper extremities.
flaccidity of the upper extremities.
impaired diaphragmatic function requiring ventilator support.
independent use of upper extremities and efficient cough. (Correct answer)

Correct answer: independent use of upper extremities and efficient cough.

A spinal cord injury at the T4 level means that the diaphragm (innervated by C3-C5) and most intercostal muscles remain functional, allowing for independent breathing and an efficient cough. Patients with T4 injuries typically retain full use of their upper extremities because the nerves controlling arm and hand function originate from the cervical spinal cord, which is above the injury level.

Question 140: A nurse is caring for a patient who received a living-donor liver transplant. Which postoperative complication is UNIQUE to living-donor liver recipients compared to deceased-donor recipients?

Bile leak
Small-for-size syndrome (Correct answer)
Portal vein thrombosis
Hepatic artery stenosis

Correct answer: Small-for-size syndrome

Small-for-size syndrome occurs when the transplanted partial graft is insufficient for the recipient's metabolic demands, a complication specific to living-donor and split-liver transplants.

Question 141: During a cardiac-vascular nurse's evaluation for intermittent claudication, she looks for leg pain and cramps when exerted. She then questions the patient:

"Is the leg pain relieved with elevation?"
"Does shortness of breath accompany the leg pain?"
"Does this same type of pain occur without activity?"
"Is the leg pain relieved by rest?" (Correct answer)

Correct answer: "Is the leg pain relieved by rest?"

Intermittent claudication is a hallmark symptom of peripheral artery disease (PAD), characterized by muscle pain or cramping in the legs that is consistently brought on by exertion and relieved by rest. This occurs because the narrowed arteries cannot supply enough blood flow to the muscles during activity. Therefore, asking if the leg pain is relieved by rest is a crucial diagnostic question to identify this classic pattern.

Question 142: Which post-transplant infection is associated with a CD4+ count below 200 cells/µL and reactivation of a latent opportunistic organism?

CMV viremia
BK virus nephropathy
Pneumocystis jirovecii pneumonia (PJP) (Correct answer)
Post-transplant lymphoproliferative disorder

Correct answer: Pneumocystis jirovecii pneumonia (PJP)

PJP occurs when profound immunosuppression lowers CD4+ counts, reactivating latent Pneumocystis jirovecii; TMP-SMX prophylaxis is standard.

Question 143: A nurse notes ST-segment elevation in leads II, III, and aVF on a 12-lead ECG. Which coronary artery is most likely occluded?

Left main coronary artery
Right coronary artery (Correct answer)
Left circumflex artery
Left anterior descending artery

Correct answer: Right coronary artery

ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, which is most commonly caused by right coronary artery occlusion.

Question 144: A patient with acute pancreatitis has a Ranson score of 6 on admission. What does this indicate to the nurse?

Mild disease manageable on a medical unit
High mortality risk requiring ICU-level care (Correct answer)
Readiness for oral diet advancement
Need for immediate surgical intervention

Correct answer: High mortality risk requiring ICU-level care

A Ranson score of 6 or higher indicates severe acute pancreatitis with a mortality rate exceeding 50%, requiring intensive monitoring.

Question 145: Which assessment is the nurse's PRIMARY responsibility when monitoring a patient receiving IV moderate sedation per institutional protocol?

Continuously monitoring level of consciousness, respiratory rate, and oxygen saturation (Correct answer)
Measuring urine output every 30 minutes
Titrating the sedation infusion rate based on pain scores
Documenting the surgeon's technique every 15 minutes

Correct answer: Continuously monitoring level of consciousness, respiratory rate, and oxygen saturation

The dedicated monitoring nurse must continuously assess LOC, respiratory status, and oxygen saturation to detect early respiratory depression or over-sedation.

Question 146: A CMSRN study plan should prioritize which type of questions to best prepare for the exam format?

Application and analysis-level questions (Correct answer)
Recall and memorization questions
True/false questions
Fill-in-the-blank calculations only

Correct answer: Application and analysis-level questions

The CMSRN exam primarily tests application and analysis, requiring nurses to apply knowledge to clinical scenarios rather than simply recall facts.

Question 147: Which assessment technique should the nurse use to evaluate for asterixis in a patient with hepatic encephalopathy?

Inflate a blood pressure cuff above systolic pressure
Tap the facial nerve anterior to the ear
Ask the patient to extend the arms with wrists dorsiflexed (Correct answer)
Stroke the lateral aspect of the sole of the foot

Correct answer: Ask the patient to extend the arms with wrists dorsiflexed

Asterixis, or liver flap, is assessed by having the patient hold the arms outstretched with wrists hyperextended and observing for flapping tremor.

Question 148: What action sums up a sentinel event alert the best?

Signaling the need for immediate investigation and response. (Correct answer)
Indicating that a community or institution is unsafe.
Documenting the breakdown in communication during a shift report.
Recording the harm done when a medication error occurs.

Correct answer: Signaling the need for immediate investigation and response.

A sentinel event alert signifies an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Its primary purpose is to signal the immediate need for a thorough investigation (root cause analysis) and a rapid, comprehensive response to prevent recurrence. It is a critical call to action within healthcare organizations to address serious safety issues.

Question 149: A patient is 24 hours post-total knee replacement. Which finding indicates a potential deep vein thrombosis?

Knee swelling at the surgical site
Mild incisional pain rated 3/10
Calf pain with dorsiflexion of the foot (Correct answer)
Bilateral ankle edema

Correct answer: Calf pain with dorsiflexion of the foot

Calf pain with dorsiflexion (Homans' sign) may indicate DVT, though duplex ultrasound is required for definitive diagnosis.

Question 150: The nurse is reviewing a consent form signed by a patient who is now medicated with midazolam. The nurse should:

Have the patient re-sign the consent under observation
Verify with the chart when the consent was signed relative to medication administration (Correct answer)
Proceed — midazolam does not affect consent validity
Accept the consent because the patient signed before sedation was given

Correct answer: Verify with the chart when the consent was signed relative to medication administration

Consent must be obtained before sedation; the nurse must verify the timeline, as midazolam impairs cognition and renders post-medication consent invalid.

Question 151: The nurse is performing a preoperative assessment and learns the patient has a latex allergy. Which intervention is MOST important?

Place the patient last on the surgical schedule
Have diphenhydramine available at bedside
Notify the entire perioperative team and ensure a latex-free environment (Correct answer)
Avoid using rubber-tipped instruments only

Correct answer: Notify the entire perioperative team and ensure a latex-free environment

The entire perioperative team must be notified and a fully latex-free environment ensured to prevent potentially life-threatening anaphylaxis.

Question 152: When a patient is examined while supine, enlarged jugular veins can be seen running from the base of the neck to the angle of the jaw. This result suggests:

increased central venous pressure. (Correct answer)
decreased venous return.
left-sided heart failure.
increased pulmonary artery capillary pressure.

Correct answer: increased central venous pressure.

Enlarged jugular veins, especially when visible while supine, are a classic sign of increased central venous pressure (CVP). CVP reflects the pressure in the right atrium and vena cava, indicating the heart's ability to pump blood effectively and the overall fluid status. Conditions like right-sided heart failure, fluid overload, or tricuspid valve stenosis can lead to elevated CVP and distended jugular veins.

Certified Medical-Surgical Registered Nurse (CMSRN)

This exam certifies registered nurses who demonstrate expertise and commitment to medical-surgical nursing practice.

150

Questions

180 min

Time Limit

70%

To Pass

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