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

Question 1: A circulating nurse notices that the sterile field has been contaminated during surgery. The appropriate response is to:

Document the contamination and monitor for signs of infection postoperatively
Immediately notify the scrub tech and surgeon and replace contaminated items (Correct answer)
Continue the procedure if it was a minor contamination
Apply additional sterile drapes over the contaminated area

Correct answer: Immediately notify the scrub tech and surgeon and replace contaminated items

Any breach of the sterile field must be reported immediately and contaminated items replaced to prevent surgical site infection.

Question 2: It's a left pneumonectomy for a client. Nursing interventions for a postoperative left pneumonectomy that would be planned for this client would include:

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

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 3: The CMSRN exam allows candidates how much total time to complete all questions?

4 hours
3 hours (Correct answer)
2 hours
5 hours

Correct answer: 3 hours

Candidates are given 3 hours to complete the 150-question CMSRN examination.

Question 4: A nurse is caring for a patient with a ventricular assist device (VAD). The patient's family asks why there is no palpable pulse. What is the best explanation?

Continuous-flow VADs provide non-pulsatile blood flow, so a traditional pulse may not be felt (Correct answer)
The patient is in cardiac arrest and needs immediate resuscitation
The lack of pulse indicates the device is not providing adequate cardiac output
The device has malfunctioned and the physician should be notified immediately

Correct answer: Continuous-flow VADs provide non-pulsatile blood flow, so a traditional pulse may not be felt

Most modern VADs use continuous-flow technology that produces non-pulsatile circulation, meaning a palpable pulse is often absent despite adequate perfusion.

Question 5: The nurse is caring for a patient in skeletal traction. Which assessment finding warrants immediate notification of the healthcare provider?

The patient requests repositioning for comfort
The patient reports numbness and tingling distal to the fracture site (Correct answer)
The weights are hanging freely off the bed
The pin sites have small amounts of clear drainage

Correct answer: The patient reports numbness and tingling distal to the fracture site

Numbness and tingling distal to the fracture suggest neurovascular compromise, which can lead to permanent damage if not addressed promptly.

Question 6: Following surgery, your patient's vital signs are within normal ranges and they are semicomatose. Which position would be ideal for this patient, as the nurse?

Semi-Fowlers
Side positioning preferably on the left side (Correct answer)
Low-Fowlers
Prone

Correct answer: Side positioning preferably on the left side

For a semicomatose patient post-surgery, maintaining a patent airway and preventing aspiration are paramount. Side positioning, especially on the left side, helps to prevent the tongue from falling back and obstructing the airway. It also facilitates drainage of oral secretions, significantly reducing the risk of aspiration, making it safer than supine positions for patients with altered consciousness.

Question 7: A nurse is caring for a patient in septic shock. Which hemodynamic finding is characteristic of the early warm phase?

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

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 8: Which medication is the definitive treatment for malignant hyperthermia and should be immediately available in the medical-surgical unit?

Succinylcholine
Neostigmine
Dantrolene sodium (Correct answer)
Atropine sulfate

Correct answer: Dantrolene sodium

Dantrolene sodium is the only specific pharmacological treatment for malignant hyperthermia, acting by inhibiting calcium release from the sarcoplasmic reticulum.

Question 9: A patient with a chest tube has continuous bubbling in the water seal chamber. What does this indicate?

Normal functioning of the chest tube
The lung has fully re-expanded
An air leak in the system (Correct answer)
The suction pressure is too high

Correct answer: An air leak in the system

Continuous bubbling in the water seal chamber indicates an air leak either at the insertion site, tubing connections, or from the lung itself.

Question 10: A patient with chronic kidney disease has a glomerular filtration rate of 12 mL/min. Which clinical manifestation should the nurse anticipate?

Polyuria and polydipsia
Uremic frost and pruritus (Correct answer)
Decreased serum creatinine
Hypotension and tachycardia

Correct answer: Uremic frost and pruritus

A GFR of 12 mL/min indicates stage 5 CKD where uremic toxins accumulate, causing uremic frost, pruritus, and other systemic symptoms.

Question 11: A nurse is caring for a patient with cirrhosis who has developed ascites. Which dietary modification is most appropriate?

Sodium restriction to 2 g per day (Correct answer)
Increased potassium-rich foods
Fluid intake of 3 liters per day
High-protein diet of 100 g per day

Correct answer: Sodium restriction to 2 g per day

Sodium restriction helps reduce fluid retention and ascites formation in patients with cirrhosis.

Question 12: A nurse is monitoring a patient after a cardiac catheterization via the femoral artery. Which finding requires immediate intervention?

A rapidly expanding hematoma at the insertion site (Correct answer)
Mild soreness at the catheter insertion site
A palpable dorsalis pedis pulse in the affected extremity
Blood pressure of 128/78 mmHg

Correct answer: A rapidly expanding hematoma at the insertion site

A rapidly expanding hematoma at the femoral access site indicates possible arterial bleeding and requires immediate pressure application and physician notification.

Question 13: Which patients are most likely to be turned away from transplantation? SATA

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

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 14: A pancreas transplant recipient reports persistent hyperglycemia despite a functioning graft confirmed by C-peptide levels. What should the nurse assess NEXT?

Whether the patient needs insulin sliding scale
Blood type compatibility records
Medication compliance with immunosuppressants (Correct answer)
Dietary carbohydrate intake only

Correct answer: Medication compliance with immunosuppressants

Certain immunosuppressants like tacrolimus can cause drug-induced diabetes, so medication compliance and drug levels should be assessed when hyperglycemia occurs despite a functioning graft.

Question 15: Which instruction is most important when teaching a patient about warfarin therapy?

Limit fluid intake to 1 liter per day
Take an extra dose if a scheduled dose is missed
Avoid consistent consumption of vitamin K-rich foods (Correct answer)
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 16: A patient returns to the unit after a Whipple procedure (pancreaticoduodenectomy). Which complication should the nurse be most vigilant for in the first 24 postoperative hours?

Atelectasis only
Hypertensive crisis
Anastomotic leak and hemorrhage (Correct answer)
Deep vein thrombosis

Correct answer: Anastomotic leak and hemorrhage

Anastomotic leak and hemorrhage are the most serious early life-threatening complications of the Whipple procedure due to the extensive resection and multiple bowel anastomoses.

Question 17: Which patient teaching point is most important for a patient discharged with a new mechanical heart valve?

Take antibiotic prophylaxis before dental procedures for life and maintain lifelong anticoagulation (Correct answer)
Avoid all green vegetables permanently
Blood pressure monitoring is no longer necessary
Restrict all physical activity for one year

Correct answer: Take antibiotic prophylaxis before dental procedures for life and maintain lifelong anticoagulation

Patients with mechanical heart valves require lifelong anticoagulation due to thromboembolic risk and prophylactic antibiotics before procedures that may cause bacteremia.

Question 18: A patient develops cardiogenic shock after a large anterior MI. Which hemodynamic pattern is expected?

Low CO, low SVR, low PAWP
High CO, low SVR, low PAWP
High CO, high SVR, low PAWP
Low CO, high SVR, high PAWP (Correct answer)

Correct answer: Low CO, high SVR, high PAWP

Cardiogenic shock produces low cardiac output due to pump failure, compensatory high SVR from vasoconstriction, and high PAWP from backward failure.

Question 19: 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
Provides CEUs toward renewal
Substitutes for clinical hours requirement
Familiarizes the candidate with question style and identifies knowledge gaps (Correct answer)

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 20: During induction of anesthesia, the anesthesiologist requests cricoid pressure (Sellick maneuver). The nurse applies pressure to which landmark?

The thyroid cartilage (Adam's apple)
The cricoid cartilage to compress the esophagus (Correct answer)
The sternal notch
The hyoid bone

Correct answer: The cricoid cartilage to compress the esophagus

Cricoid pressure is applied to the cricoid cartilage to occlude the esophagus and prevent passive regurgitation of gastric contents during rapid sequence induction.

Question 21: A nurse is assessing a patient 24 hours after a thyroidectomy. Which finding is the highest priority to report?

A positive Chvostek sign (Correct answer)
Hoarseness when speaking
Sore throat and difficulty swallowing
Mild swelling at the incision site

Correct answer: A positive Chvostek sign

A positive Chvostek sign indicates hypocalcemia from inadvertent parathyroid gland removal or damage, which can progress to tetany and laryngospasm.

Question 22: Which of the following best describes the purpose of the CMSRN certification for nurses and patients?

Qualifies nurses for advanced practice prescriptive authority
Validates specialized knowledge and improves patient outcomes (Correct answer)
Replaces the RN license in medical-surgical settings
Satisfies mandatory continuing education requirements in all states

Correct answer: Validates specialized knowledge and improves patient outcomes

CMSRN certification validates expertise in medical-surgical nursing and is associated with improved patient safety and outcomes.

Question 23: A living-related donor is being evaluated for kidney donation. Which finding would disqualify the donor?

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

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 24: A patient with cirrhosis develops increasing abdominal girth and a fluid wave on examination. Which laboratory value should the nurse monitor most closely?

Hemoglobin A1C
Serum glucose
Erythrocyte sedimentation rate
Serum albumin (Correct answer)

Correct answer: Serum albumin

Low serum albumin reduces oncotic pressure, directly contributing to ascites formation in cirrhotic patients.

Question 25: A patient with asthma is experiencing an acute exacerbation. What is the first-line medication the nurse should administer?

Intravenous aminophylline
Leukotriene receptor antagonist
Short-acting beta-2 agonist (SABA) (Correct answer)
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 26: A transplant coordinator is discussing organ preservation with a new nurse. Which solution is most commonly used for cold storage of kidneys during transport?

Normal saline
Lactated Ringer's solution
Hypertonic saline
University of Wisconsin (UW) solution (Correct answer)

Correct answer: University of Wisconsin (UW) solution

University of Wisconsin solution is the standard cold storage solution for kidney preservation, maintaining cellular integrity for up to 30–36 hours.

Question 27: 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)
Document findings and reassess in 2 hours
The SpO2 is accurate and no further action is needed
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 28: A patient develops sudden severe dyspnea, tracheal deviation to the left, and absent breath sounds on the right. What condition does the nurse suspect?

Pulmonary embolism
Pleural effusion
Tension pneumothorax (Correct answer)
Hemothorax

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 29: The nurse should arrange for the following after a thyroid scan using radioactive iodine to check for a thyroid nodule:

Radiation precautions that are limited to urine and feces.
Full radiation precautions to be instituted for 8 hours (the half-life of radioactive iodine).
Complete radiation safety measures, such as putting the client in a separate room, must be implemented.
No special radiations precautions. (Correct answer)

Correct answer: No special radiations precautions.

After injecting radioactive iodine for the thyroid scan, no radiation protection measures are required. Option B relates to implants made of radium. When radioactive iodine therapy is used to reduce and regulate thyroid hypersecretion (hyperthyroidism), option C may be used. Option 4 does not represent standard radiation therapy practice.

Question 30: During exam registration, a CMSRN candidate must provide which of the following as proof of eligibility?

Graduate school transcripts
Specialty course completion certificate
NCLEX-RN score report
Current RN license number and employment verification of med-surg hours (Correct answer)

Correct answer: Current RN license number and employment verification of med-surg hours

Candidates must verify their active RN license and provide documentation of 2,000+ hours of medical-surgical nursing practice.

Question 31: A patient is admitted with acute pancreatitis. Which laboratory value is most consistent with this diagnosis?

Serum albumin of 3.2 g/dL
White blood cell count of 11,000/mcL
Hemoglobin A1C of 7.2%
Serum lipase elevated to 5 times the upper limit of normal (Correct answer)

Correct answer: Serum lipase elevated to 5 times the upper limit of normal

Serum lipase elevated to 5 times normal is highly specific for acute pancreatitis and remains elevated longer than amylase.

Question 32: When is a CMSRN credential renewal required?

Annually
Every 5 years (Correct answer)
Every 2 years
Every 3 years

Correct answer: Every 5 years

CMSRN certification must be renewed every 5 years through continuing education or re-examination.

Question 33: A patient with a tracheostomy has thick, tenacious secretions. Which independent nursing intervention is most appropriate?

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

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 34: Which position should the nurse place a patient in who is experiencing autonomic dysreflexia?

Left lateral recumbent
Trendelenburg position
Supine with legs elevated
Sitting upright with legs dangling (Correct answer)

Correct answer: Sitting upright with legs dangling

Sitting the patient upright immediately helps lower the dangerously elevated blood pressure that occurs during autonomic dysreflexia.

Question 35: A patient is scheduled for a thyroidectomy. Which preoperative assessment is most specific to this procedure?

Cardiac stress test
Baseline voice quality and neck range of motion (Correct answer)
Coagulation studies
Renal function tests

Correct answer: Baseline voice quality and neck range of motion

Baseline voice quality and neck mobility are critical because thyroidectomy risks injury to the recurrent laryngeal nerve, affecting voice postoperatively.

Question 36: Three hours after knee reduction surgery, a 27-year-old patient complains of soreness in his right leg. The nurse's initial course of action should be to:

remind the client of the PCA pump and re-instruct the client on its use
perform a lower extremity neurovascular check (Correct answer)
elevate the extremity
assess vital signs

Correct answer: perform a lower extremity neurovascular check

After orthopedic surgery like knee reduction, new or worsening pain can signify serious complications such as compartment syndrome or neurovascular compromise. Performing a lower extremity neurovascular check (assessing pulses, capillary refill, sensation, motor function, and pain) is the priority. This immediate assessment helps to quickly identify or rule out limb-threatening conditions, guiding subsequent interventions.

Question 37: A medical-surgical nurse is caring for a patient admitted with an acute exacerbation of heart failure. Which of the following nursing diagnoses is the highest priority?

Activity Intolerance related to fatigue and dyspnea.
Excess Fluid Volume related to compromised regulatory mechanisms. (Correct answer)
Knowledge Deficit related to the disease process and self-care.
Anxiety related to breathlessness and fear of death.

Correct answer: Excess Fluid Volume related to compromised regulatory mechanisms.

During an acute exacerbation of heart failure, excess fluid volume is the priority problem as it leads to pulmonary congestion, impaired gas exchange, and respiratory distress. Addressing the fluid overload through interventions like diuretic administration and fluid restriction is critical to stabilize the patient's cardiopulmonary status. While the other nursing diagnoses are relevant, they are secondary to the immediate life-threatening issue of fluid volume excess.

Question 38: When teaching a patient about postoperative incentive spirometry, the nurse instructs the patient to:

Inhale slowly and deeply to maximally expand alveoli (Correct answer)
Exhale rapidly into the device to clear secretions
Use the device only when experiencing dyspnea
Complete two breaths per session every 4 hours

Correct answer: Inhale slowly and deeply to maximally expand alveoli

Incentive spirometry requires slow, maximal inhalation to fully expand alveoli and prevent atelectasis — the primary postoperative pulmonary complication.

Question 39: A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which intervention should the nurse implement first?

Administer sodium polystyrene sulfonate as ordered
Obtain a repeat blood sample to confirm the result
Place the patient on continuous cardiac monitoring (Correct answer)
Restrict dietary potassium intake

Correct answer: Place the patient on continuous cardiac monitoring

Hyperkalemia at this level poses an immediate risk for fatal cardiac dysrhythmias, making cardiac monitoring the priority intervention.

Question 40: When discussing prescribed activities with a patient who experienced a myocardial infarction, the cardiac-vascular nurse steps in. "It doesn't really matter what I do or don't do. I will either get better or die," the patient says. The statement illustrates:

feelings of loss of control. (Correct answer)
acceptance of changed health status.
projection.
an internal locus of control.

Correct answer: feelings of loss of control.

The patient's statement, 'It doesn't really matter what I do or don't do. I will either get better or die,' expresses a sense of powerlessness and fatalism regarding their health outcome. This indicates a feeling of loss of control over their situation and the effectiveness of their actions. Such feelings are common psychological responses to serious health events like a myocardial infarction.

Question 41: A patient develops bronchospasm during general anesthesia. Which inhalational agent should be AVOIDED as it is most likely to worsen airway reactivity?

Halothane
Desflurane (Correct answer)
Sevoflurane
Isoflurane

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 42: A patient is brought to the OR for an emergent procedure and states they last ate a full meal 2 hours ago. The anesthesia provider will MOST likely use which induction technique?

Awake fiber-optic intubation or rapid sequence induction (RSI) (Correct answer)
LMA placement without intubation
Standard slow inhalational induction
Spinal anesthesia only

Correct answer: Awake fiber-optic intubation or rapid sequence induction (RSI)

RSI or awake intubation is used for patients at high aspiration risk (full stomach) to rapidly secure the airway and minimize the window for passive regurgitation.

Question 43: A patient's kidney function has been gradually declining since receiving a kidney transplant five years ago. For this patient, which intervention is appropriate?

Patient should be educated about retransplantation; related living donor should be sought (Correct answer)
Patient should be immediately prepped for surgical removal of the organ
Patient should be admitted to intensive care for observation and possible dialysis
Drug management may limit the damage and allow the graft to be maintained

Correct answer: Patient should be educated about retransplantation; related living donor should be sought

When a transplanted kidney's function gradually declines over several years, it often indicates chronic rejection or graft failure. At this stage, medical management may no longer be sufficient to maintain the graft. The most appropriate long-term intervention is to prepare the patient for a second transplant, which includes educating them about the process and exploring options like finding a related living donor for better compatibility.

Question 44: Which position should the nurse place a patient in immediately after a liver biopsy?

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

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 45: A nurse is caring for a patient post-thyroidectomy. Which assessment finding requires the most immediate intervention?

Positive Chvostek's sign (Correct answer)
Temperature of 37.5°C
Hoarse voice
Serum calcium of 8.8 mg/dL

Correct answer: Positive Chvostek's sign

A positive Chvostek's sign (facial muscle twitching when tapping the facial nerve) indicates hypocalcemia from accidental parathyroid removal, risking tetany.

Question 46: Which of the following is the correct order for the surgical hand scrub?

Nails → fingertips → hands → forearms (Correct answer)
Fingertips → nails → hands → forearms
Forearms → hands → fingertips → nails
Hands → forearms → nails → fingertips

Correct answer: Nails → fingertips → hands → forearms

The surgical scrub begins at the nails/fingertips (most contaminated) and progresses to the forearms, working from most-to-least contaminated.

Question 47: A patient with a history of obstructive sleep apnea (OSA) is admitted to the PACU. Which postoperative monitoring is most critical for this patient?

Continuous pulse oximetry and capnography (Correct answer)
Hourly urine output measurement
Continuous cardiac telemetry monitoring
Blood glucose checks every 2 hours

Correct answer: Continuous pulse oximetry and capnography

Patients with OSA are at high risk for postoperative respiratory depression; continuous SpO2 and capnography monitoring is essential to detect early desaturation and hypoventilation.

Question 48: A patient with chronic venous insufficiency asks the nurse what causes their leg ulcers. What is the best explanation?

Incompetent venous valves cause venous hypertension and tissue breakdown (Correct answer)
Lymphatic obstruction prevents protein removal from tissues
Arterial spasm reduces oxygen delivery to tissues
High platelet counts cause clot formation in capillaries

Correct answer: Incompetent venous valves cause venous hypertension and tissue breakdown

Incompetent venous valves lead to venous hypertension, edema, and poor tissue oxygenation, resulting in ulcer formation typically near the medial malleolus.

Question 49: 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
A platelet count that dropped from 240,000 to 95,000 over 5 days (Correct answer)
Slight bruising at the subcutaneous injection site
An aPTT of 68 seconds with a target range of 60-80 seconds

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

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

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 51: Which immunosuppressive protocol is considered standard induction therapy to prevent early rejection in solid organ transplantation?

Methotrexate alone
Rituximab with plasmapheresis
Basiliximab with corticosteroids (Correct answer)
Intravenous immunoglobulin only

Correct answer: Basiliximab with corticosteroids

Basiliximab, an IL-2 receptor antagonist, combined with corticosteroids is a standard induction regimen to prevent early acute rejection.

Question 52: In the immediate postoperative period, which assessment finding indicates the patient is NOT yet ready for extubation?

Respiratory rate of 8 breaths/min with shallow tidal volumes (Correct answer)
Train-of-four ratio ≥ 0.9
Ability to sustain head lift for 5 seconds
Oxygen saturation of 98% on supplemental oxygen

Correct answer: Respiratory rate of 8 breaths/min with shallow tidal volumes

A respiratory rate of 8 with shallow tidal volumes suggests residual neuromuscular blockade or opioid effect, indicating inadequate ventilatory drive for safe extubation.

Question 53: Which assessment finding in a patient receiving a blood transfusion requires the nurse to immediately stop the transfusion?

Fever with chills and flank pain (Correct answer)
Mild urticaria on one arm
The patient reports feeling anxious
A slight increase in temperature of 0.5°F

Correct answer: Fever with chills and flank pain

Fever with chills and flank pain suggests an acute hemolytic transfusion reaction, which requires immediately stopping the transfusion.

Question 54: Which ECG change is most characteristic of hyperkalemia?

Prolonged QT interval
Tall, peaked T waves (Correct answer)
Prominent U waves
ST-segment depression

Correct answer: Tall, peaked T waves

Hyperkalemia first produces tall, peaked T waves, progressing to widened QRS and sine-wave pattern as potassium rises further.

Question 55: Treatment for acute glomerulonephritis primarily aims to:

Maintain fluid balance (Correct answer)
Encourage high protein intake
Encourage activity
Teach intermittent urinary catheterization

Correct answer: Maintain fluid balance

Explanation: <br> The main goal of treatment for acute glomerulonephritis is not specifically focused on maintaining fluid balance, although that is an important aspect of management.

Question 56: A pancreas transplant patient develops hyperglycemia requiring insulin on post-op day 5 after previously achieving normoglycemia. Which complication should be investigated first?

Pancreatic fistula
Acute rejection of the pancreas graft (Correct answer)
Surgical site infection
Medication-induced hyperglycemia from steroids

Correct answer: Acute rejection of the pancreas graft

Return of hyperglycemia after initial normoglycemia is a sign of pancreatic graft rejection; rising amylase/lipase and imaging confirm the diagnosis.

Question 57: A nurse is preparing to administer a blood transfusion. Which action is essential before starting the infusion?

Administer prophylactic diphenhydramine to all patients
Run the blood through IV tubing with dextrose solution
Warm the blood product in a microwave for 30 seconds
Verify patient identity and blood product with two licensed nurses at the bedside (Correct answer)

Correct answer: Verify patient identity and blood product with two licensed nurses at the bedside

Two licensed nurses must verify patient identification and blood product compatibility at the bedside to prevent transfusion reactions.

Question 58: A patient with peripheral arterial disease reports leg pain that occurs with walking and is relieved by rest. The nurse documents this as:

Venous claudication
Intermittent claudication (Correct answer)
Rest pain
Raynaud's phenomenon

Correct answer: Intermittent claudication

Intermittent claudication is the classic symptom of PAD, characterized by reproducible muscle pain during exertion that resolves with rest.

Question 59: A nurse is caring for a patient 6 hours after percutaneous coronary intervention (PCI) via the right femoral artery. Which finding requires immediate intervention?

Heart rate 78 bpm with normal sinus rhythm
Expanding ecchymosis and firmness at the access site (Correct answer)
Patient reports mild soreness at the groin site
Blood pressure 132/84 mmHg in the left arm

Correct answer: Expanding ecchymosis and firmness at the access site

Expanding ecchymosis with firmness at the femoral access site suggests retroperitoneal bleeding or hematoma formation, requiring urgent evaluation.

Question 60: Which clinical finding in a cardiac transplant recipient should alert the nurse to possible chronic rejection?

Fever and elevated white blood cell count within 24 hours of surgery
Acute pulmonary edema with pink frothy sputum
Progressive exercise intolerance and coronary artery vasculopathy on angiography (Correct answer)
Sudden onset of chest pain radiating to the left arm

Correct answer: Progressive exercise intolerance and coronary artery vasculopathy on angiography

Cardiac allograft vasculopathy is the hallmark of chronic rejection in heart transplants, presenting as gradual exercise intolerance rather than typical angina.

Question 61: The nurse assesses a patient and hears diminished breath sounds at the bases bilaterally with fine crackles. This finding is most consistent with:

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

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 62: 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
Laryngeal nerve damage
Chvostek sign (Correct answer)
Trousseau sign

Correct answer: Chvostek sign

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

Question 63: 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)
Apply a non-rebreather mask at 15L/min
Notify the physician and monitor closely

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 64: A nurse is reviewing laboratory results for a patient suspected of having SIADH. Which finding is most consistent with this diagnosis?

Serum osmolality 310 mOsm/kg
Serum sodium 152 mEq/L
Urine specific gravity 1.030 (Correct answer)
Blood urea nitrogen 8 mg/dL

Correct answer: Urine specific gravity 1.030

In SIADH, excess ADH causes water retention and urine concentration, resulting in a high urine specific gravity (>1.020–1.030). Serum sodium and osmolality are characteristically LOW due to dilutional hyponatremia, not elevated.

Question 65: A nurse is preparing to administer a unit of packed red blood cells. Which action is correct regarding transfusion safety?

Add normal saline and dextrose to the blood bag
Verify the blood product with two licensed nurses at the bedside (Correct answer)
Use a 22-gauge catheter in the antecubital vein
Infuse the unit rapidly within the first 30 minutes

Correct answer: Verify the blood product with two licensed nurses at the bedside

Two licensed nurses must independently verify patient identity and blood product compatibility at the bedside before transfusion.

Question 66: Which post-transplant malignancy is most strongly linked to Epstein-Barr virus (EBV) reactivation?

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

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 67: A patient with a seizure disorder is in active status epilepticus. After ensuring airway patency, which medication does the nurse anticipate administering first?

IV lorazepam or diazepam (Correct answer)
Oral carbamazepine
Phenytoin IV loading dose
Intramuscular phenobarbital

Correct answer: IV lorazepam or diazepam

Benzodiazepines (e.g., lorazepam or diazepam IV) are the first-line emergency treatment for status epilepticus due to their rapid onset in terminating seizure activity.

Question 68: A cardiac-vascular nurse treating a patient with intermittent claudication suggests the following to the patient:

elevate the legs when sitting.
apply graduated compression stockings before getting out of bed.
walk as tolerated. (Correct answer)
refrain from exercise.

Correct answer: walk as tolerated.

For patients with intermittent claudication due to peripheral artery disease, a supervised exercise program, particularly walking, is a cornerstone of treatment. Walking to the point of pain, resting, and then resuming helps to promote the development of collateral circulation and improve walking distance and functional capacity. Refraining from exercise would worsen the condition, and other options are not primary treatments for claudication.

Question 69: A patient with a new diagnosis of heart failure has a B-type natriuretic peptide (BNP) level of 1,200 pg/mL. How should the nurse interpret this result?

The level is only mildly elevated and unlikely to be clinically significant
The value is within normal limits and requires no action
The elevation indicates significant ventricular volume overload and myocardial wall stress (Correct answer)
The result suggests chronic kidney disease rather than heart failure

Correct answer: The elevation indicates significant ventricular volume overload and myocardial wall stress

A BNP level of 1,200 pg/mL is markedly elevated (normal <100 pg/mL) and reflects significant ventricular wall stress consistent with heart failure.

Question 70: A renal transplant patient is noted to have a rising creatinine 3 weeks post-op along with a urine cytology showing decoy cells. Which complication should the nurse suspect?

BK virus nephropathy (Correct answer)
Urinary tract infection
Ureteral obstruction
Acute cellular rejection

Correct answer: BK virus nephropathy

BK virus nephropathy presents with rising creatinine and decoy cells (virally infected tubular cells) on urine cytology and is managed by reducing immunosuppression.

Question 71: A patient presents with an INR of 8.2 and active gum bleeding while on warfarin. Which treatment is most appropriate?

Administer protamine sulfate IV
Increase the warfarin dose to restore balance
Administer fresh frozen plasma only, without holding warfarin
Hold warfarin and administer oral or IV vitamin K (Correct answer)

Correct answer: Hold warfarin and administer oral or IV vitamin K

For supratherapeutic INR with bleeding, holding warfarin and administering vitamin K (with FFP for significant bleeding) reverses anticoagulation by restoring clotting factor synthesis.

Question 72: When treating acute glomerulonephritis, the primary objective is to:

encourage high protein intake.
encourage activity.
maintain fluid balance. (Correct answer)
teach intermittent urinary catheterization.

Correct answer: maintain fluid balance.

Acute glomerulonephritis often impairs kidney function, leading to fluid retention, edema, and hypertension. Therefore, the primary objective in managing AGN is to maintain fluid and electrolyte balance, often through dietary restrictions (sodium, fluid) and diuretics. This helps prevent severe complications such as pulmonary edema and uncontrolled hypertension, which can be life-threatening.

Question 73: A patient develops sudden pleuritic chest pain, dyspnea, and tachycardia 72 hours after a total hip arthroplasty. What is the nurse's priority action?

Obtain a 12-lead ECG and prepare for cardioversion
Place the patient in a high Fowler's position and administer an analgesic
Encourage deep breathing and splinted coughing
Administer supplemental oxygen and notify the provider immediately (Correct answer)

Correct answer: Administer supplemental oxygen and notify the provider immediately

The presentation is classic for pulmonary embolism, a life-threatening post-orthopedic surgery complication. Administering supplemental oxygen addresses hypoxemia and notifying the provider allows for rapid diagnostic workup and anticoagulation. Oxygen delivery is the immediate physiologic priority.

Question 74: When teaching a patient with newly diagnosed COPD about breathing techniques, the nurse should emphasize:

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

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

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

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

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

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 77: Which type of wound healing occurs when a wound closes by granulation tissue filling a large tissue defect?

Delayed primary closure
Tertiary intention
Secondary intention (Correct answer)
Primary intention

Correct answer: Secondary intention

Secondary intention healing occurs when wound edges are not approximated, and the wound fills with granulation tissue from the bottom up.

Question 78: 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)
Background
Assessment
Recommendation

Correct answer: Situation

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

Question 79: 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
Allow only family members who have received flu vaccination
Restrict all visitors until ANC exceeds 1,000/mm³
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 80: A patient is ordered to receive adenosine 6 mg IV push for SVT. What is the correct administration technique?

Mix with D5W and administer via infusion pump
Give slowly over 5 minutes to avoid hypotension
Dilute in 100 mL NS and infuse over 30 minutes
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 81: A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which intervention should the nurse prioritize?

Increase IV normal saline infusion rate
Administer sodium polystyrene sulfonate as ordered (Correct answer)
Encourage intake of potassium-rich foods
Apply a warm compress to the AV fistula

Correct answer: Administer sodium polystyrene sulfonate as ordered

Sodium polystyrene sulfonate binds potassium in the GI tract and promotes its excretion, which is the priority intervention for hyperkalemia.

Question 82: A patient is having a procedure under spinal anesthesia and complains of a severe headache that worsens when sitting up and improves when lying flat. This presentation is MOST consistent with:

Post-dural puncture headache (PDPH) (Correct answer)
Hypertensive crisis
Meningitis from contaminated spinal needle
Migraine triggered by the stress of surgery

Correct answer: Post-dural puncture headache (PDPH)

Post-dural puncture headache is positional (worse upright, relieved supine) and results from CSF leakage through the dural puncture site reducing intracranial pressure.

Question 83: A patient is receiving a dobutamine infusion for acute decompensated heart failure. The nurse notes the heart rate has increased from 88 to 122 bpm. What action is appropriate?

Increase the infusion rate to improve contractility further
Document the finding and continue monitoring per protocol
Notify the provider because dobutamine-induced tachycardia increases myocardial oxygen demand (Correct answer)
Discontinue all IV access immediately

Correct answer: Notify the provider because dobutamine-induced tachycardia increases myocardial oxygen demand

Dobutamine can cause dose-related tachycardia, which increases myocardial oxygen demand and may worsen ischemia; the provider should be notified to consider dose adjustment.

Question 84: A nurse is caring for a patient with deep vein thrombosis (DVT) of the left leg. Which intervention is contraindicated?

Administering prescribed anticoagulants
Applying warm compresses as ordered
Massaging the affected calf to relieve discomfort (Correct answer)
Elevating the affected extremity

Correct answer: Massaging the affected calf to relieve discomfort

Massaging a limb with DVT can dislodge the thrombus and cause a pulmonary embolism.

Question 85: A patient returns from surgery with a Jackson-Pratt drain. The nurse notes the bulb is firm and not compressed. What action should be taken?

Irrigate the drain with normal saline
Remove the drain and apply a pressure dressing
Leave it as it is; a firm bulb is normal
Empty the drain and recompress the bulb to restore suction (Correct answer)

Correct answer: Empty the drain and recompress the bulb to restore suction

A Jackson-Pratt drain works by closed suction; the bulb must be emptied and recompressed to maintain negative pressure and effective drainage.

Question 86: 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
Administer acetaminophen and reassess in 4 hours
Obtain blood cultures and initiate prescribed antibiotics immediately (Correct answer)
Administer a cooling blanket

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 87: 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?

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

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 88: A nurse is caring for a patient 2 hours post-thyroidectomy. Which assessment finding requires immediate intervention?

Serosanguineous drainage on the dressing
Pain rated 4 out of 10
Mild sore throat with hoarseness
Tingling and numbness around the mouth (Correct answer)

Correct answer: Tingling and numbness around the mouth

Perioral tingling indicates hypocalcemia from inadvertent parathyroid removal, a serious post-thyroidectomy complication.

Question 89: A nurse is caring for a patient 12 hours after a total hip arthroplasty. Which finding requires immediate intervention?

A hemoglobin drop from 12.0 to 10.8 g/dL
The affected leg appears shorter and externally rotated (Correct answer)
Serosanguineous drainage on the surgical dressing
Moderate incisional pain rated 5 out of 10

Correct answer: The affected leg appears shorter and externally rotated

A shortened and externally rotated leg after total hip arthroplasty indicates posterior hip dislocation, which requires emergent medical intervention.

Question 90: A patient with type 2 diabetes is scheduled for a CT scan with contrast dye in the morning. The nurse notes the patient takes metformin 1000 mg twice daily. What is the priority nursing action?

Administer the metformin dose as scheduled the morning of the procedure
Increase the patient's IV fluid rate to prevent dehydration
Hold the metformin and notify the provider before the procedure (Correct answer)
Switch the patient to insulin coverage for the day of the procedure

Correct answer: Hold the metformin and notify the provider before the procedure

Metformin must be held before and after contrast administration due to the risk of contrast-induced nephropathy, which can reduce renal clearance of metformin and lead to lactic acidosis, a life-threatening complication.

Question 91: A patient receiving a blood transfusion develops fever, flank pain, and dark urine 15 minutes into the infusion. What should the nurse do first?

Slow the transfusion rate and administer acetaminophen
Administer diphenhydramine and continue monitoring
Obtain a blood sample for a direct Coombs test
Stop the transfusion immediately and keep the IV line open with normal saline (Correct answer)

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

These symptoms indicate an acute hemolytic transfusion reaction, and the nurse must immediately stop the transfusion to prevent further hemolysis and potential renal failure.

Question 92: 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?

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
Administer a proton pump inhibitor and proceed

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

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 94: 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
High tidal volumes of 10–12 mL/kg
CPAP only without mechanical ventilation
Low tidal volumes of 6 mL/kg ideal body weight (Correct answer)

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 95: A patient in the PACU is shivering uncontrollably following general anesthesia. Which medication is commonly administered to treat postanesthetic shivering?

Lorazepam IV
Ondansetron IV
Meperidine (Demerol) 12.5-25 mg IV (Correct answer)
Haloperidol IV

Correct answer: Meperidine (Demerol) 12.5-25 mg IV

Low-dose meperidine is the most effective pharmacological treatment for postanesthetic shivering by acting on kappa opioid receptors and reducing the shivering threshold.

Question 96: A patient with a chest tube has continuous bubbling in the water seal chamber. What does this indicate?

The suction pressure is set correctly
The lung has fully re-expanded
The drainage system needs to be replaced
There is an air leak in the system (Correct answer)

Correct answer: There is an air leak in the system

Continuous bubbling in the water seal chamber indicates an air leak either at the insertion site, in the tubing connections, or from the lung itself.

Question 97: A nurse is teaching a patient about warfarin therapy after mechanical valve replacement. Which patient statement indicates correct understanding?

I need to have my INR checked regularly and maintain consistent vitamin K intake (Correct answer)
I should double my dose if I miss one day to catch up
I can stop taking this medication once my symptoms improve
I should take aspirin along with warfarin whenever I have a headache

Correct answer: I need to have my INR checked regularly and maintain consistent vitamin K intake

Patients on warfarin require regular INR monitoring and consistent dietary vitamin K intake to maintain stable anticoagulation levels.

Question 98: Which finding on a chest X-ray is most consistent with pneumothorax?

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

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 99: A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which ECG change should the nurse anticipate?

U waves
ST segment depression
Prolonged QT interval
Peaked T waves (Correct answer)

Correct answer: Peaked T waves

Hyperkalemia causes tall, peaked T waves due to altered cardiac cell repolarization.

Question 100: What signs and symptoms accompany tuberculosis?

Short attention span. Poor judgment. Impulsive behaviour. Slow learning Delayed language and speech development.
Chest pain, or pain with breathing or coughing. Unintentional weight loss. Fatigue. Fever. Night sweats. Chills. (Correct answer)
Nausea. Headaches. Cranky and agitated. Gains weight too quickly. Nausea. Headaches. Cranky and agitated. Gains weight too quickly.
Decreased or poor muscle tone. Short neck, with excess skin at the back of the neck. Flattened facial profile and nose. Small head, ears, and mouth.

Correct answer: Chest pain, or pain with breathing or coughing. Unintentional weight loss. Fatigue. Fever. Night sweats. Chills.

The symptoms listed—chest pain with breathing/coughing, unintentional weight loss, fatigue, fever, night sweats, and chills—are classic indicators of active pulmonary tuberculosis. These signs reflect the chronic inflammatory and destructive processes occurring in the lungs and the body's systemic response to the mycobacterial infection. The other options describe symptoms of unrelated conditions.

Question 101: A medical-surgical nurse treating a patient with Crohn's disease suggests a diet that is:

high in fiber, and low in protein and calories
low in fiber, and high in protein and calories (Correct answer)
low in potassium
high in potassium

Correct answer: low in fiber, and high in protein and calories

For patients with Crohn's disease, especially during active flares, a low-fiber (low-residue) diet is often recommended to reduce bowel irritation and inflammation. Simultaneously, a diet high in protein and calories is crucial to combat malnutrition, weight loss, and muscle wasting, which are common issues due to malabsorption and increased metabolic demands from chronic inflammation.

Question 102: A patient with myasthenia gravis is admitted for a myasthenic crisis. Which clinical manifestation differentiates a myasthenic crisis from a cholinergic crisis?

Hypertension distinguishes myasthenic crisis
Excessive secretions and miosis in myasthenic crisis
Presence of bradycardia in myasthenic crisis
Muscle weakness responds to edrophonium (Tensilon) test — improvement indicates myasthenic crisis (Correct answer)

Correct answer: Muscle weakness responds to edrophonium (Tensilon) test — improvement indicates myasthenic crisis

In the Tensilon test, improvement in muscle strength indicates myasthenic crisis (under-medication), while worsening indicates cholinergic crisis (over-medication).

Question 103: Which clinical manifestation most specifically differentiates hepatic encephalopathy from other causes of altered mental status?

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

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 104: When preparing a patient for general anesthesia who takes daily aspirin, the nurse understands that aspirin is typically:

Continued for most procedures but stopped 7 days before neurosurgery or high bleeding-risk cases (Correct answer)
Replaced with heparin bridging therapy
Always stopped 30 days before any surgery
Stopped 24 hours before all surgical procedures

Correct answer: Continued for most procedures but stopped 7 days before neurosurgery or high bleeding-risk cases

Aspirin is often continued perioperatively for cardiac risk reduction, but is typically held 7-10 days before high bleeding-risk surgeries per surgeon and anesthesia team guidance.

Question 105: A patient taking warfarin has an INR of 5.8 and is not bleeding. Which action should the nurse anticipate?

Administer protamine sulfate
Administer IV vitamin K 10 mg
Begin fresh frozen plasma transfusion
Hold warfarin and monitor closely (Correct answer)

Correct answer: Hold warfarin and monitor closely

For supratherapeutic INR without active bleeding, the standard approach is to hold warfarin doses and monitor until INR returns to the therapeutic range.

Question 106: 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:

bicarbonate
sodium
potassium (Correct answer)
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 107: A patient recovering from a myocardial infarction develops a new holosystolic murmur at the left sternal border with signs of acute heart failure on day 3 post-MI. Which complication does the nurse suspect?

Pericarditis with pericardial friction rub
Mitral valve prolapse
Aortic stenosis exacerbation
Ventricular septal rupture (Correct answer)

Correct answer: Ventricular septal rupture

Ventricular septal rupture is a serious mechanical complication of MI that typically occurs 3–7 days post-infarction. Necrosis of the interventricular septum causes a left-to-right shunt, producing a new holosystolic murmur and rapid hemodynamic deterioration with signs of heart failure.

Question 108: Which test result would necessitate the nurse's quick attention for the patient who was supposed to have surgery?

Calcium 9.2 mg/dL.
Hemoglobin 15 g/dL.
Bleeding time 2 minutes.
Potassium 2.4 mEq/L. (Correct answer)

Correct answer: Potassium 2.4 mEq/L.

A potassium level of 2.4 mEq/L indicates severe hypokalemia, which is a critical electrolyte imbalance. Hypokalemia can lead to life-threatening cardiac dysrhythmias, muscle weakness, and respiratory compromise, especially in the perioperative period. This abnormal finding requires immediate attention and correction before surgery to ensure patient safety.

Question 109: During electrocardiogram (ECG) interpretation, the nurse notes ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

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

Correct answer: Right coronary artery

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

Question 110: A patient underwent a total colectomy and ileostomy. For this patient, the most crucial nursing intervention is to:

use warm tap water irrigations to prevent stool retention.
monitor the patient for fluid and electrolyte imbalances. (Correct answer)
administer proteolytic enzymes to aid digestion of fats and proteins.
use mild antidiarrheal medications to prevent nutritional losses.

Correct answer: monitor the patient for fluid and electrolyte imbalances.

Large volumes of fluid and electrolytes from the upper GI tract are present in ileostomy discharge. Therefore, it's essential to keep track of the patient's fluid and electrolyte levels in order to prevent dehydration. Patients with pancreatic failure are treated with proteolytic enzymes. Ileostomies never receive irrigation; instead, a steady stream of fluids is drained from them. The upper GI tract is not responsive to antidiarrheal drugs.

Question 111: A patient with heart failure has a BNP level of 900 pg/mL. What does this finding indicate?

Myocardial infarction in progress
Severe ventricular wall stress and volume overload (Correct answer)
Pulmonary embolism
Adequate cardiac compensation

Correct answer: Severe ventricular wall stress and volume overload

Elevated BNP (>100 pg/mL) reflects ventricular wall stress due to volume or pressure overload, commonly seen in decompensated heart failure.

Question 112: Which arterial blood gas (ABG) result indicates respiratory acidosis?

pH 7.48, PaCO2 40, HCO3 30
pH 7.30, PaCO2 55, HCO3 24 (Correct answer)
pH 7.50, PaCO2 30, HCO3 22
pH 7.35, PaCO2 40, HCO3 22

Correct answer: pH 7.30, PaCO2 55, HCO3 24

Respiratory acidosis is characterized by low pH and elevated PaCO2 due to inadequate ventilation and CO2 retention.

Question 113: A patient receiving a blood transfusion develops a fever, chills, and back pain within 15 minutes. The nurse's priority action is to:

Obtain a urine specimen and continue monitoring
Stop the transfusion and maintain IV access with normal saline (Correct answer)
Notify the physician before stopping the transfusion
Administer antipyretics and slow the infusion

Correct answer: Stop the transfusion and maintain IV access with normal saline

Stopping the transfusion immediately and maintaining IV access is the priority action when a hemolytic transfusion reaction is suspected.

Question 114: 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 115: A patient with newly diagnosed atrial fibrillation asks why anticoagulation therapy is necessary. Which response by the nurse is most accurate?

Anticoagulants will convert your heart rhythm back to normal
The medication will strengthen your heart contractions to prevent further arrhythmias
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 116: A patient is admitted with acute pancreatitis. Which laboratory value is most consistent with this diagnosis?

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

Correct answer: Elevated serum lipase

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

Question 117: The nurse is caring for a patient with a C5 spinal cord injury. Which complication should be the priority concern?

Skin breakdown on heels
Bowel impaction
Deep vein thrombosis in lower extremities
Respiratory compromise due to loss of diaphragmatic function (Correct answer)

Correct answer: Respiratory compromise due to loss of diaphragmatic function

Injuries at or above C4 affect the phrenic nerve and diaphragm; C5 injuries may partially spare diaphragm function but respiratory compromise remains the top priority.

Question 118: A liver transplant patient develops jaundice, elevated liver enzymes, and pruritus 6 months post-transplant. These findings are most consistent with:

Acute cellular rejection
Chronic rejection (ductopenic rejection) (Correct answer)
Primary non-function
Hepatic artery thrombosis

Correct answer: Chronic rejection (ductopenic rejection)

Chronic rejection, also called ductopenic rejection, presents months to years post-transplant with progressive cholestasis and loss of bile ducts.

Question 119: Which finding distinguishes nephrotic syndrome from nephritic syndrome?

Massive proteinuria (>3.5 g/day) and edema (Correct answer)
Hypertension
Hematuria
Oliguria

Correct answer: Massive proteinuria (>3.5 g/day) and edema

Nephrotic syndrome is defined by massive proteinuria leading to hypoalbuminemia and pitting edema, distinguishing it from the hematuria-dominant nephritic syndrome.

Question 120: When teaching a patient about dietary management of hypertension, which recommendation is most evidence-based?

Avoid all caffeine permanently
Eliminate all fat from the diet
Follow the DASH diet and limit sodium to <2,300 mg/day (Correct answer)
Increase potassium by eating bananas only

Correct answer: Follow the DASH diet and limit sodium to <2,300 mg/day

The DASH diet combined with sodium restriction is the most evidence-based dietary approach to reducing blood pressure.

Question 121: Sirolimus (rapamycin) differs from tacrolimus in its mechanism of action because it:

Depletes B lymphocytes via anti-CD20 binding
Inhibits calcineurin and reduces IL-2 transcription
Blocks the mTOR pathway to inhibit T-cell proliferation (Correct answer)
Inhibits inosine monophosphate dehydrogenase

Correct answer: Blocks the mTOR pathway to inhibit T-cell proliferation

Sirolimus binds FKBP12 but inhibits mTOR rather than calcineurin, blocking T-cell proliferation in response to IL-2 signaling.

Question 122: A patient is admitted with a hemoglobin of 6.2 g/dL and is prescribed a transfusion of packed red blood cells. Which action should the nurse take first?

Obtain a set of vital signs after starting the infusion
Set the infusion pump to deliver the unit over 6 hours
Verify the blood product with another licensed nurse at the bedside (Correct answer)
Premedicate the patient with diphenhydramine

Correct answer: Verify the blood product with another licensed nurse at the bedside

Two licensed nurses must verify patient identity and blood product compatibility at the bedside before initiating a transfusion.

Question 123: A patient with pulmonary embolism (PE) is being treated with heparin infusion. Which lab value requires immediate dose adjustment?

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

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 124: A patient with a traumatic brain injury has an intracranial pressure (ICP) reading of 24 mmHg. Which nursing intervention should be implemented first?

Apply sequential compression devices to the lower extremities
Administer acetaminophen for pain management
Encourage the patient to cough and perform deep breathing exercises
Elevate the head of the bed to 30–45 degrees (Correct answer)

Correct answer: Elevate the head of the bed to 30–45 degrees

Elevating the head of the bed to 30–45 degrees promotes cerebral venous drainage and reduces ICP. Normal ICP is below 20 mmHg, so 24 mmHg requires prompt intervention. Coughing increases intrathoracic pressure and worsens ICP elevation; it should be avoided.

Question 125: A patient is 48 hours post-kidney transplant and develops oliguria, fever, and tenderness over the graft site. Which complication should the nurse suspect first?

Acute rejection (Correct answer)
Hyperacute rejection
Chronic rejection
Urinary tract infection

Correct answer: Acute rejection

Acute rejection typically occurs days to weeks after transplant and presents with decreased urine output, fever, and graft tenderness.

Question 126: The nurse is caring for a patient with a pleural effusion. Which intervention would the nurse anticipate assisting with to relieve symptoms?

Chest tube insertion for pneumothorax
Bronchoscopy for direct visualization
Thoracentesis to drain fluid (Correct answer)
Pericardiocentesis

Correct answer: Thoracentesis to drain fluid

Thoracentesis is performed to drain fluid from the pleural space, relieving dyspnea and allowing lung re-expansion.

Question 127: A patient with heart failure is prescribed furosemide 40 mg IV push. Which electrolyte imbalance should the nurse anticipate?

Hypercalcemia
Hyperkalemia
Hypernatremia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Furosemide is a loop diuretic that causes significant potassium loss in the urine, leading to hypokalemia.

Question 128: A patient with a small bowel obstruction has a nasogastric tube in place. Which finding indicates the tube is functioning properly?

Patient reports relief of nausea
Abdominal girth decreasing (Correct answer)
Absence of bowel sounds
Tube draining bile-colored fluid

Correct answer: Abdominal girth decreasing

Decreasing abdominal girth indicates the NG tube is effectively decompressing the bowel by removing accumulated gas and fluid proximal to the obstruction.

Question 129: A patient receiving IV vancomycin develops sudden flushing, erythema, and hypotension during the infusion. This reaction is most consistent with:

Vasovagal response
Red man syndrome (Correct answer)
Septic reaction
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 130: Which immunosuppressant combination is standard maintenance therapy for solid organ transplant recipients?

Basiliximab + tacrolimus + azathioprine
Cyclosporine + azathioprine + prednisone
Tacrolimus + mycophenolate mofetil + prednisone (Correct answer)
Sirolimus + methotrexate + prednisone

Correct answer: Tacrolimus + mycophenolate mofetil + prednisone

The standard triple immunosuppression regimen is tacrolimus, mycophenolate mofetil, and a corticosteroid.

Question 131: Which intervention is the priority for a patient experiencing autonomic dysreflexia?

Elevate the head of the bed to 90 degrees (Correct answer)
Administer a PRN antihypertensive
Insert a urinary catheter
Remove constrictive clothing

Correct answer: Elevate the head of the bed to 90 degrees

Raising the head of the bed uses orthostatic effects to immediately lower dangerously elevated blood pressure.

Question 132: A patient with a pulmonary embolism suddenly becomes restless with a SpO2 of 84%. Which intervention takes priority?

Administer high-flow oxygen via non-rebreather mask (Correct answer)
Start a heparin drip per protocol
Obtain a stat CT pulmonary angiography
Elevate the head of the bed to 45 degrees

Correct answer: Administer high-flow oxygen via non-rebreather mask

Immediate oxygenation is the priority for acute hypoxemia to prevent organ damage while other interventions are initiated.

Question 133: A nurse is caring for a patient in cardiogenic shock. Which hemodynamic finding is expected?

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

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 134: 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:

Hyperkalemia (Correct answer)
Diabetic Inspidu
Hyperalcemia
Diabetic Ketoacidosis

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 135: A patient with a pulmonary embolism is receiving thrombolytic therapy with alteplase. During the infusion, the nurse observes new-onset neurological changes and facial drooping. What is the nurse's priority action?

Stop the alteplase infusion immediately and notify the provider (Correct answer)
Administer protamine sulfate to reverse the thrombolytic
Slow the infusion rate and continue monitoring neurological status
Obtain a stat ECG and increase oxygen delivery

Correct answer: Stop the alteplase infusion immediately and notify the provider

New neurological changes during thrombolytic therapy are a critical warning sign of intracranial hemorrhage, the most serious complication. The infusion must be stopped immediately and the provider notified for emergent neuroimaging and management.

Question 136: The main ways that nursing diagnoses differ from medical diagnoses are as follows:

Primarily concerned with caring, while medical diagnoses are primarily concerned with curing
Primarily concerned with psychosocial parameters, while medical diagnoses are primarily concerned with physiologic parameters
Primarily concerned with human response, while medical diagnoses are primarily concerned with pathology (Correct answer)
Dependent upon medical diagnoses for the direction of appropriate interventions

Correct answer: Primarily concerned with human response, while medical diagnoses are primarily concerned with pathology

Explanation: <br> Nursing diagnoses differ from medical diagnoses in that nursing diagnoses focus on the patient's response to a health condition or disease, rather than solely on the pathological or medical aspects of the condition. Nursing diagnoses are formulated based on the patient's signs, symptoms, and individualized assessment data, considering their physical, emotional, social, and environmental factors. Nursing diagnoses help nurses identify actual or potential health problems that require nursing interventions to promote the patient's well-being and recovery. Medical diagnoses, on the other hand, focus on identifying and classifying diseases or medical conditions based on their signs, symptoms, and underlying pathology. Medical diagnoses guide the medical management and treatment of the disease or condition.

Question 137: 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:

Preventing platelet aggregation
Increasing iron absorption from the gut
Stimulating bone marrow to produce red blood cells (Correct answer)
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 138: A patient reports tearing chest pain that radiates to the back and has unequal blood pressures in both arms. Which condition does the nurse suspect?

Pulmonary embolism
Cardiac tamponade
Acute MI
Aortic dissection (Correct answer)

Correct answer: Aortic dissection

Aortic dissection classically presents with sudden tearing or ripping chest pain radiating to the back and a blood pressure differential between extremities.

Question 139: Which laboratory value should the nurse verify before a patient is cleared for surgery requiring regional anesthesia with an epidural catheter?

Serum creatinine
Serum potassium level
Platelet count and coagulation studies (Correct answer)
Fasting blood glucose

Correct answer: Platelet count and coagulation studies

Platelet count and coagulation studies must be within acceptable limits before epidural placement to minimize the risk of epidural hematoma, a potentially devastating complication.

Question 140: A CMSRN candidate is reviewing the test blueprint. Which domain carries the HIGHEST percentage of questions on the CMSRN exam?

Physiological Integrity (Correct answer)
Health Promotion and Maintenance
Safe and Effective Care Environment
Psychosocial Integrity

Correct answer: Physiological Integrity

Physiological Integrity is the largest domain on the CMSRN exam, reflecting the clinical complexity of medical-surgical nursing practice.

Question 141: A patient with heart failure is prescribed furosemide. Which electrolyte imbalance should the nurse monitor most closely?

Hypermagnesemia
Hypernatremia
Hypercalcemia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Loop diuretics like furosemide cause urinary potassium wasting, placing patients at risk for hypokalemia, which can precipitate dysrhythmias.

Question 142: Which of the following doesn't result from the sympathoplegic pharmacotherapy?

lethargic behavior
Asthma
Hypertension (Correct answer)
Dry oral cavity

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 143: When a patient receives a kidney transplant and is sent home on maintenance medication, which procedure or intervention should come first?

Monitoring for bacterial and fungal infections (Correct answer)
Measuring abdominal girth daily
Avoiding blood donation
Avoiding the use of table salt

Correct answer: Monitoring for bacterial and fungal infections

Patients who have received a kidney transplant are on lifelong immunosuppressive therapy to prevent organ rejection. This immunosuppression significantly compromises their immune system, making them highly susceptible to various bacterial, viral, and fungal infections. Therefore, monitoring for signs and symptoms of infection is the most critical and immediate post-discharge intervention to ensure patient safety and graft survival.

Question 144: What action sums up a sentinel event alert the best?

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

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 145: Which scenario BEST represents a question that would appear in the CMSRN exam's 'Reduction of Risk Potential' subcategory?

Administering antihypertensives per protocol
Identifying early signs of deep vein thrombosis in a postoperative patient (Correct answer)
Teaching a diabetic patient about foot care
Discussing grief stages with a terminal patient's family

Correct answer: Identifying early signs of deep vein thrombosis in a postoperative patient

Reduction of Risk Potential focuses on preventing complications and monitoring for deterioration, such as DVT in postoperative patients.

Question 146: A patient in atrial fibrillation with a rapid ventricular rate of 148 bpm is hemodynamically stable. Which medication class is typically used for rate control?

Sodium bicarbonate
Thrombolytics
Loop diuretics
Beta-blockers or calcium channel blockers (Correct answer)

Correct answer: Beta-blockers or calcium channel blockers

Beta-blockers (e.g., metoprolol) and non-dihydropyridine calcium channel blockers (e.g., diltiazem) are first-line agents for rate control in hemodynamically stable atrial fibrillation.

Question 147: When performing deep tracheal suctioning, the nurse should limit each suction pass to no more than:

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

Correct answer: 10–15 seconds

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

Question 148: A patient with heart failure has a BNP level of 850 pg/mL. What does this elevated level indicate?

Ventricular wall stress from fluid overload (Correct answer)
Improved myocardial contractility
Increased cardiac output
Adequate diuresis

Correct answer: Ventricular wall stress from fluid overload

BNP (B-type natriuretic peptide) is released by ventricular myocytes in response to wall stress caused by volume and pressure overload.

Question 149: A patient with an acute MI reports sudden, severe midscapular tearing back pain. What complication should the nurse suspect first?

Esophageal rupture
Aortic dissection (Correct answer)
Pulmonary embolism
Pericarditis

Correct answer: Aortic dissection

Tearing or ripping back pain radiating to the interscapular region is the hallmark presentation of aortic dissection, a life-threatening emergency.

Question 150: A patient with type 1 diabetes is found unresponsive with a blood glucose of 28 mg/dL. The patient has no IV access and is unable to swallow. Which intervention should the nurse perform first?

Administer 1 mg of glucagon intramuscularly (Correct answer)
Administer 25 g of 50% dextrose (D50) orally dissolved in water
Apply a glucose gel to the buccal mucosa
Initiate a peripheral IV line and infuse D5W at 125 mL/hr

Correct answer: Administer 1 mg of glucagon intramuscularly

When a patient is unresponsive and has no IV access, intramuscular glucagon is the correct route of administration for severe hypoglycemia. Glucagon stimulates hepatic glycogenolysis to rapidly raise blood glucose. Oral glucose and buccal gel are contraindicated in an unresponsive patient due to aspiration risk.

Question 151: Which sign is an early indicator of hypoxemia in an adult patient?

Decreased respiratory rate
Restlessness and anxiety (Correct answer)
Cyanosis
Bradycardia

Correct answer: Restlessness and anxiety

Restlessness and anxiety are early signs of hypoxemia as the brain is sensitive to decreased oxygen and responds with agitation before cyanosis appears.

Question 152: A nurse is caring for a patient 12 hours after a total hip arthroplasty. Which assessment finding requires immediate intervention?

Mild pain rated 3 out of 10 with movement
Temperature of 99.2°F (37.3°C)
Inability to dorsiflex the affected foot (Correct answer)
Serosanguineous drainage on the surgical dressing

Correct answer: Inability to dorsiflex the affected foot

Inability to dorsiflex the foot may indicate peroneal nerve damage or neurovascular compromise, requiring immediate evaluation.

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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