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

Question 1: An autoimmune condition known as Hashimoto's disease has been identified in Ms. JMM. Which of the following descriptions of the client's indications and symptoms most likely contributed to the diagnosis?

Decreased appetite, weight gain, constipation (Correct answer)
Increased urination, weight gain, and purplish red striae
Increased urination, weight loss, increased thirst
Increased appetite, weight loss, hyperdefecation

Correct answer: Decreased appetite, weight gain, constipation

Constipation, weight gain, and decreased appetite are signs of Hashimoto's disease, the most prevalent cause of hypothyroidism among clients. Additionally, fatigue, brittle nails, coarse hair, cramping in the muscles, weakness, and apnea are symptoms to be aware of. Choice A exhibits hyperthyroidism symptoms. Choice B's symptoms are indicative of uncontrolled diabetic mellitus. The symptoms listed in option D are indicative of hypercortisolism.

Question 2: A patient with acute respiratory distress syndrome (ARDS) is on a ventilator. Which ventilation strategy is recommended to prevent ventilator-induced lung injury?

CPAP only without mechanical ventilation
Volume-controlled ventilation at 500 mL regardless of weight
Low tidal volumes of 6 mL/kg ideal body weight (Correct answer)
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 3: A patient with a pacemaker has a paced rhythm on the monitor, but the nurse notes the patient's heart rate is 38 bpm and symptoms of dizziness. What does this indicate?

Normal pacemaker function
Appropriate rate-response pacing
Pacemaker failure to capture (Correct answer)
Pacemaker oversensing

Correct answer: Pacemaker failure to capture

Failure to capture occurs when the pacemaker delivers a stimulus but the myocardium does not depolarize, resulting in bradycardia despite paced spikes.

Question 4: Which is the MOST important nursing action when a patient with a history of latex allergy is scheduled for a procedure?

Obtain informed consent documenting the allergy
Schedule the patient as the first case of the day and use latex-free equipment (Correct answer)
Keep epinephrine available but proceed normally
Premedicate with diphenhydramine only

Correct answer: Schedule the patient as the first case of the day and use latex-free equipment

Scheduling first case of the day minimizes airborne latex particles from previous cases, and using a fully latex-free environment is essential to prevent anaphylaxis.

Question 5: Which positioning complication is a patient undergoing a lengthy procedure in the lithotomy position most at risk for?

Brachial plexus injury
Compartment syndrome of the lower extremities (Correct answer)
Radial nerve compression
Cervical spine flexion injury

Correct answer: Compartment syndrome of the lower extremities

Extended lithotomy positioning compresses lower extremity compartments, increasing risk of compartment syndrome due to elevated pressure and reduced perfusion.

Question 6: In the early postoperative phase, a client feels confused. Which of the following evaluations is necessary to identify the confusion's cause?

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

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 7: Which laboratory value is most critical for the nurse to monitor in a patient receiving a continuous heparin infusion for deep vein thrombosis?

Platelet count and fibrinogen level
Activated partial thromboplastin time (aPTT) (Correct answer)
Prothrombin time (PT)
International normalized ratio (INR)

Correct answer: Activated partial thromboplastin time (aPTT)

The aPTT is the primary lab value used to monitor therapeutic effectiveness and dosing of unfractionated heparin infusions.

Question 8: A patient with a history of obstructive sleep apnea is ordered opioid analgesia postoperatively. Which nursing action is most appropriate?

Use continuous pulse oximetry and capnography monitoring (Correct answer)
Position the patient flat to prevent orthostatic hypotension
Administer the full prescribed opioid dose on schedule
Discontinue supplemental oxygen to improve respiratory drive

Correct answer: Use continuous pulse oximetry and capnography monitoring

Patients with obstructive sleep apnea are at increased risk for opioid-induced respiratory depression and require continuous monitoring of oxygenation and ventilation.

Question 9: Which nursing intervention is most appropriate for a patient experiencing autonomic dysreflexia?

Place the patient in a supine position and elevate the legs
Immediately sit the patient upright and identify the triggering stimulus (Correct answer)
Administer a bolus of IV fluids
Apply sequential compression devices

Correct answer: Immediately sit the patient upright and identify the triggering stimulus

Sitting the patient upright lowers blood pressure using gravity, and identifying the trigger (often a full bladder or bowel) is the priority intervention.

Question 10: In deceased-donor organ allocation, which criterion gives highest priority for kidney offers to a recipient on the waiting list?

Recipient body weight closest to donor
Zero HLA mismatch with the donor (Correct answer)
Geographic proximity to donor hospital
Longest time on dialysis

Correct answer: Zero HLA mismatch with the donor

Zero HLA antigen mismatch (full-house match) confers mandatory sharing across UNOS regions due to superior long-term outcomes.

Question 11: A patient with Crohn's disease involving the terminal ileum is at highest risk for deficiency of which nutrient?

Vitamin B12 (Correct answer)
Iron
Folate
Thiamine

Correct answer: Vitamin B12

The terminal ileum is the exclusive absorption site for vitamin B12, so Crohn's disease affecting this region causes B12 deficiency.

Question 12: 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 13: What is a potential postoperative concern regarding a patient who has already resumed a solid diet?

Patient reports a decreased appetite
Passage of excessive flatus
Failure to pass stool within 48 hours of eating solid foods (Correct answer)
Failure to pass stool within 12 hours of eating solid foods

Correct answer: Failure to pass stool within 48 hours of eating solid foods

After resuming a solid diet post-surgery, the return of normal bowel function is expected. Failure to pass stool within 48 hours of eating solid foods indicates a potential complication such as ileus, constipation, or obstruction. This warrants nursing intervention and further assessment, as prolonged absence of bowel movements can lead to discomfort and more serious issues.

Question 14: A nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which finding does the nurse expect?

Hyponatremia and decreased urine specific gravity
Hyponatremia and decreased urine output (Correct answer)
Hypernatremia and increased urine output
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 15: A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which ECG change should the nurse anticipate?

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

Correct answer: Peaked T waves

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

Question 16: A nurse is teaching a patient newly diagnosed with myasthenia gravis. Which statement by the patient indicates correct understanding of the disease?

I can safely stop my medication once my symptoms improve
My muscle weakness will be worst in the morning when I first wake up
I should take my pyridostigmine after meals to reduce nausea
I need to plan activities early in the day when I have the most strength (Correct answer)

Correct answer: I need to plan activities early in the day when I have the most strength

Myasthenia gravis causes progressive muscle fatigue throughout the day, so patients typically have more strength in the morning and should schedule demanding activities accordingly.

Question 17: A patient with a pulmonary embolism suddenly becomes restless with a SpO2 of 84%. Which intervention takes priority?

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

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 18: Which Glasgow Coma Scale score indicates severe brain injury?

13-15
3-8 (Correct answer)
9-12
6-8

Correct answer: 3-8

A GCS score of 3-8 indicates severe brain injury and is commonly associated with coma.

Question 19: Which sign is a late indicator of increased intracranial pressure?

Projectile vomiting
Pupillary changes
Headache
Cushing's triad (hypertension, bradycardia, irregular respirations) (Correct answer)

Correct answer: Cushing's triad (hypertension, bradycardia, irregular respirations)

Cushing's triad is an ominous late sign of severely elevated ICP indicating brainstem herniation is imminent.

Question 20: During postoperative assessment, a nurse notes serosanguineous drainage saturating the surgical dressing. The patient's heart rate is 110 bpm and blood pressure is 94/60 mmHg. What is the priority action?

Administer an oral analgesic to reduce the patient's anxiety
Reinforce the dressing and continue monitoring
Notify the surgeon immediately and prepare for possible return to the OR (Correct answer)
Apply an abdominal binder to reduce drainage

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

Excessive serosanguineous drainage combined with tachycardia and hypotension suggests active postoperative hemorrhage, requiring immediate surgeon notification and potential surgical re-exploration.

Question 21: Which laboratory value requires the nurse to hold a scheduled dose of digoxin and contact the provider?

BUN of 18 mg/dL
Serum potassium of 4.2 mEq/L
Serum digoxin level of 2.8 ng/mL (Correct answer)
Serum sodium of 138 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 22: Which assessment finding in a postoperative patient most strongly suggests the development of malignant hyperthermia?

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

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

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

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 24: In the operating room (OR), the circulating nurse sets up the sterile field. After fifteen minutes, the nurse gets word that the surgeon is working at another hospital, thus the procedure will be delayed by twenty minutes. What would be the best course of action for the nurse?

Tear down the sterile field until the surgeon arrives in the OR.
Cover the sterile field with a sterile drape until the surgery is about to begin.
Monitor the sterile field while awaiting the surgeon. (Correct answer)
Close and tape the OR doors so that no one may enter.

Correct answer: Monitor the sterile field while awaiting the surgeon.

Maintaining the sterility of the surgical field is paramount to prevent surgical site infections. If a procedure is delayed, the circulating nurse's primary responsibility is to continuously monitor the sterile field to ensure it remains intact and uncontaminated. Covering the field or tearing it down introduces unnecessary risks of contamination or delays in re-establishing sterility when the surgeon arrives.

Question 25: Which arterial blood gas (ABG) result indicates respiratory acidosis?

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

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 26: A patient with hypertension has a blood pressure of 198/114 mmHg with complaints of headache and blurred vision but no end-organ damage. This is classified as which condition?

Hypertensive urgency (Correct answer)
Hypertensive emergency
Malignant hypertension
Orthostatic hypotension

Correct answer: Hypertensive urgency

Hypertensive urgency is severely elevated BP (>180/120 mmHg) without acute end-organ damage; it is managed with oral antihypertensives and gradual BP reduction over 24-48 hours.

Question 27: A renal transplant recipient is started on fluconazole for a fungal infection. The nurse anticipates which medication adjustment?

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

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 28: A patient's arterial blood pressure waveform shows pulsus paradoxus of 18 mmHg. What condition does this suggest?

Pulmonary hypertension
Left ventricular failure
Hypertensive crisis
Cardiac tamponade (Correct answer)

Correct answer: Cardiac tamponade

Pulsus paradoxus greater than 10 mmHg (exaggerated fall in systolic BP during inspiration) is a classic sign of cardiac tamponade.

Question 29: The nurse is caring for a patient with multiple sclerosis (MS) who is experiencing an exacerbation. Which intervention addresses fatigue, the most common MS symptom?

Encourage high-intensity exercise to build endurance
Limit fluid intake to reduce fatigue
Schedule all activities in the late afternoon
Plan rest periods between activities and prioritize energy conservation (Correct answer)

Correct answer: Plan rest periods between activities and prioritize energy conservation

Energy conservation techniques and scheduled rest periods help MS patients manage fatigue, which is exacerbated by overexertion and heat.

Question 30: A patient with myasthenia gravis is experiencing increased weakness. How does the nurse differentiate a myasthenic crisis from a cholinergic crisis?

Assess for bradycardia; its presence confirms myasthenic crisis
Administer edrophonium; improvement indicates myasthenic crisis (Correct answer)
Measure peak expiratory flow; low values confirm cholinergic crisis
Check pupil size; dilated pupils indicate cholinergic crisis

Correct answer: Administer edrophonium; improvement indicates myasthenic crisis

Edrophonium (Tensilon) temporarily improves symptoms in myasthenic crisis but worsens or does not change symptoms in cholinergic crisis.

Question 31: The patient, who underwent surgery 24 hours ago, is being observed by the nurse. Which finding calls for action?

Temperature of 99.3' F
Pain rating of 4 on 1-10 scale
BP 100/80
24-hour urine output of 300 ml (Correct answer)

Correct answer: 24-hour urine output of 300 ml

A 24-hour urine output of 300 ml is significantly below the normal minimum of 0.5 mL/kg/hr or approximately 400-500 mL/day for an adult, indicating oliguria. This finding suggests potential kidney dysfunction, hypovolemia, or urinary obstruction, which requires immediate investigation and intervention in a postoperative patient. Other options like mild pain, slightly low BP (if asymptomatic), or a low-grade fever might be expected post-op and are less immediately concerning.

Question 32: 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)
Avoiding the use of table salt
Measuring abdominal girth daily
Avoiding blood donation

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

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

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 34: During spinal anesthesia, a patient's blood pressure drops from 130/80 to 75/40 mmHg. Which intervention should the nurse anticipate FIRST?

Administer atropine 1 mg IV
Administer ephedrine or phenylephrine and IV fluid bolus (Correct answer)
Administer epinephrine 1 mg IV
Place the patient in Trendelenburg position only

Correct answer: Administer ephedrine or phenylephrine and IV fluid bolus

Hypotension following spinal anesthesia results from sympathetic blockade; vasopressors (ephedrine or phenylephrine) combined with IV fluids are the first-line treatment.

Question 35: Which finding on a chest X-ray is most consistent with pneumothorax?

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

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 36: 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 37: Which assessment finding in a postoperative patient most strongly suggests the development of a pulmonary embolism?

Sudden onset of dyspnea with pleuritic chest pain (Correct answer)
Temperature of 100.2°F on postoperative day two
Bilateral lower extremity edema
Productive cough with yellow sputum

Correct answer: Sudden onset of dyspnea with pleuritic chest pain

Sudden dyspnea accompanied by pleuritic chest pain is the hallmark presentation of a pulmonary embolism.

Question 38: 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
Pleural effusion
Tension pneumothorax (Correct answer)
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 39: Except for the following, all of the following list phosphodiasterase inhibitors:

Increase cAMP bypreventing breakdown
Decrease SVR
Positive inotrope
Vasoconstrictor (Correct answer)

Correct answer: Vasoconstrictor

Phosphodiesterase inhibitors (PDEIs) like milrinone are known for their positive inotropic effects (increasing cardiac contractility) and their ability to cause vasodilation, which decreases systemic vascular resistance (SVR). They achieve this by preventing the breakdown of cyclic AMP (cAMP), leading to increased intracellular calcium in cardiac cells and smooth muscle relaxation in blood vessels. Therefore, 'Vasoconstrictor' is the characteristic that does NOT describe the action of phosphodiesterase inhibitors.

Question 40: A patient post-bilateral lung transplant develops progressive obstructive airflow limitation on spirometry at 14 months, with an FEV1 decline > 20% from baseline. This pattern is consistent with:

Primary graft dysfunction
Acute cellular rejection
Bronchiolitis obliterans syndrome (chronic lung allograft dysfunction) (Correct answer)
Pleural fibrosis

Correct answer: Bronchiolitis obliterans syndrome (chronic lung allograft dysfunction)

Bronchiolitis obliterans syndrome is the hallmark of chronic lung allograft dysfunction, characterized by progressive, irreversible obstructive spirometry changes after the first post-transplant year.

Question 41: A nurse is assessing a patient 24 hours after a thyroidectomy. Which finding is the highest priority to report?

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

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 42: When monitoring a patient under general anesthesia, what does a sustained increase in end-tidal CO2 (EtCO2) MOST likely indicate?

Hypovolemia
Hyperventilation by the ventilator
Inadequate ventilation or increased CO2 production (Correct answer)
Pulmonary embolism

Correct answer: Inadequate ventilation or increased CO2 production

A sustained rise in EtCO2 indicates either hypoventilation (insufficient minute ventilation) or increased metabolic CO2 production such as in malignant hyperthermia.

Question 43: When preparing a patient for general anesthesia who takes daily aspirin, the nurse understands that aspirin is typically:

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

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

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

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 45: Which laboratory finding is most indicative of primary graft non-function immediately after liver transplantation?

Total bilirubin of 4 mg/dL on day 2
Serum creatinine of 2.0 mg/dL
INR > 3.0 unresponsive to vitamin K with persistent encephalopathy (Correct answer)
ALT 1,200 U/L with improving trend

Correct answer: INR > 3.0 unresponsive to vitamin K with persistent encephalopathy

Primary non-function is characterized by failure to produce bile, coagulopathy unresponsive to treatment, encephalopathy, and rapidly rising bilirubin requiring urgent retransplant.

Question 46: A patient develops laryngospasm immediately after extubation. What is the priority nursing intervention?

Place the patient in Trendelenburg position immediately
Reinsert the endotracheal tube without assistance
Apply positive pressure ventilation with jaw thrust and notify the anesthesia team (Correct answer)
Administer oral suctioning and wait for spontaneous resolution

Correct answer: Apply positive pressure ventilation with jaw thrust and notify the anesthesia team

Positive pressure ventilation with jaw thrust can break laryngospasm by forcing the vocal cords open, while the anesthesia team prepares for possible reintubation or succinylcholine administration.

Question 47: Which assessment finding in a patient with peripheral arterial disease (PAD) requires immediate reporting?

Sudden onset of rest pain and pallor of the affected limb (Correct answer)
Thickened toenails
Dependent rubor of the feet
Absent hair on lower legs

Correct answer: Sudden onset of rest pain and pallor of the affected limb

Sudden rest pain with pallor suggests acute arterial occlusion, a vascular emergency requiring immediate intervention to prevent limb loss.

Question 48: 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:

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

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

Begin fresh frozen plasma transfusion
Administer IV vitamin K 10 mg
Administer protamine sulfate
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 50: Twelve-year-old Shane loves skateboarding a lot. On her first attempt at learning the movements, she unintentionally fell. She was subsequently taken to the Emergency Department, where she was in excruciating pain. The left tibia's incomplete fracture was seen on the X-ray film. Her left leg was cast after the doctor prescribed a closed reduction. Which of the following is not the right way to help Shane?

Exercise her toe
Support Shane’s foot with the ankle in 90 degrees of flexion.
Elevate entire extremity higher than the client’s heart for the first 24 to 48 hours.
Create a turning schedule for position changes every 3 hours. (Correct answer)

Correct answer: Create a turning schedule for position changes every 3 hours.

The wrong kind of intervention is to design a turning timetable for position adjustments every three hours. It is recommended to arrange position changes every two hours in order to prevent deep vein thrombosis, pneumonia, and skin disintegration that can occur from immobility. For a client with closed reduction, the remaining options represent appropriate nursing interventions.

Question 51: Which preoperative medication is routinely administered to reduce the risk of pulmonary aspiration of gastric contents in patients with a full stomach?

Diazepam
Sodium citrate (non-particulate antacid) (Correct answer)
Midazolam
Atropine

Correct answer: Sodium citrate (non-particulate antacid)

Sodium citrate neutralizes gastric acid, reducing the risk of aspiration pneumonitis (Mendelson's syndrome) if aspiration occurs during rapid sequence induction.

Question 52: A patient on mechanical ventilation develops high peak airway pressures. What is the priority nursing assessment?

Assess for kinking of the ventilator tubing or ET tube (Correct answer)
Decrease the FiO2
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 53: 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
Do not stop the medication abruptly (Correct answer)
Take the medication on an empty stomach
Increase potassium-rich foods only if potassium is low

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 54: Which finding distinguishes nephrotic syndrome from nephritic syndrome?

Massive proteinuria (>3.5 g/day) and edema (Correct answer)
Hematuria
Hypertension
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 55: Which assessment finding would the nurse expect in a patient with a tension pneumothorax?

Tracheal deviation toward the affected side
Symmetrical chest expansion
Bilateral wheezing
Tracheal deviation away from the affected side with absent breath sounds (Correct answer)

Correct answer: Tracheal deviation away from the affected side with absent breath sounds

In tension pneumothorax, trapped air shifts mediastinal structures away from the affected side, and breath sounds are absent on that side.

Question 56: What is the PRIMARY purpose of the CMSRN exam blueprint provided by the MSNCB?

To outline the percentage of questions allocated to each content domain (Correct answer)
To list all possible exam questions in advance
To certify that a nurse has completed required CE hours
To replace the need for a study guide

Correct answer: To outline the percentage of questions allocated to each content domain

The blueprint shows the proportion of exam questions per domain, helping candidates allocate study time appropriately.

Question 57: The nurse assesses a lung transplant patient on post-op day 7 who has new hypoxemia, bilateral infiltrates, and decreased FEV1. No fever or leukocytosis is present. This presentation suggests:

Pleural effusion
Primary graft dysfunction
Bacterial pneumonia
Acute cellular rejection (Correct answer)

Correct answer: Acute cellular rejection

Acute cellular rejection in lung transplant classically presents with dyspnea, hypoxemia, and radiographic infiltrates without infection markers, typically within days to months post-transplant.

Question 58: Which intervention is the priority for a postoperative patient with a PCA pump who has a respiratory rate of 8 breaths per minute?

Encourage deep breathing exercises
Document the finding and reassess in 15 minutes
Stop the PCA infusion and administer naloxone as ordered (Correct answer)
Reposition the patient to a semi-Fowler's position

Correct answer: Stop the PCA infusion and administer naloxone as ordered

A respiratory rate of 8 indicates opioid-induced respiratory depression requiring immediate cessation of the PCA and naloxone administration.

Question 59: Which immunosuppressive protocol is considered standard induction therapy to prevent early rejection in solid organ transplantation?

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

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 60: A patient with myasthenia gravis develops sudden worsening of weakness and respiratory difficulty. Which assessment helps differentiate myasthenic crisis from cholinergic crisis?

Checking pupil size for bilateral dilation
Administration of edrophonium with monitoring for symptom improvement (Correct answer)
Assessing deep tendon reflexes
Measuring peak expiratory flow rate

Correct answer: Administration of edrophonium with monitoring for symptom improvement

Edrophonium (Tensilon) temporarily improves symptoms in myasthenic crisis but worsens symptoms in cholinergic crisis, differentiating the two.

Question 61: 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?

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

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

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
Increase oxygen to 4L/min immediately

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 63: Which RN licensure requirement must be met BEFORE applying for the CMSRN examination?

Possess a BSN degree
Hold a current, unrestricted RN license (Correct answer)
Complete a CMSRN review course
Have 5 years of total nursing experience

Correct answer: Hold a current, unrestricted RN license

Applicants must hold a current, unrestricted RN license in the U.S. or its territories as a prerequisite for the CMSRN exam.

Question 64: 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 SpO2 is accurate and no further action is needed
The probe may be on a poorly perfused site, leading to inaccurate reading (Correct answer)
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 65: A patient is 6 hours post-abdominal surgery and has not voided. Which assessment is most important before intervening?

Current pain level
Type of anesthesia used
Bladder scan for urinary retention (Correct answer)
Last oral intake time

Correct answer: Bladder scan for urinary retention

A bladder scan should be performed first to determine if urinary retention is present before any urinary intervention is initiated.

Question 66: A nurse planning to sit for the CMSRN must have practiced in medical-surgical nursing for at least how many hours within the past 3 years?

3,000 hours
1,000 hours
500 hours
2,000 hours (Correct answer)

Correct answer: 2,000 hours

Eligibility requires a minimum of 2,000 hours of adult medical-surgical nursing practice within the past 3 years.

Question 67: A patient with a chest tube has continuous bubbling in the water seal chamber. Which action should the nurse take first?

Check all tubing connections for loose fittings or disconnections (Correct answer)
Prepare for immediate chest tube removal
Increase the suction pressure on the drainage system
Clamp the chest tube immediately at the insertion site

Correct answer: Check all tubing connections for loose fittings or disconnections

Continuous bubbling in the water seal chamber may indicate an air leak in the system, so checking all connections from the insertion site to the drainage unit is the first step.

Question 68: A postoperative patient who received neuraxial anesthesia reports a severe headache that worsens when sitting upright. What is the most likely cause?

Post-dural puncture headache from CSF leakage (Correct answer)
Hypertensive crisis from fluid overload
Meningitis from contaminated equipment
Migraine triggered by anesthetic agents

Correct answer: Post-dural puncture headache from CSF leakage

Post-dural puncture headache results from CSF leakage through the dural puncture site, causing intracranial hypotension that worsens with upright positioning.

Question 69: Which intervention is most effective for preventing contrast-induced nephropathy in a patient with CKD undergoing cardiac catheterization?

Administering prophylactic furosemide before the procedure
Restricting all fluids for 12 hours post-procedure
Providing IV hydration with isotonic saline before and after the procedure (Correct answer)
Preloading with oral potassium supplements

Correct answer: Providing IV hydration with isotonic saline before and after the procedure

Adequate IV hydration with isotonic saline before and after contrast administration is the most evidence-based intervention for reducing contrast-induced nephropathy risk.

Question 70: A nurse is caring for a patient post-thyroidectomy. Which assessment finding requires the most immediate intervention?

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

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 71: Which nursing intervention is ESSENTIAL before administering antithymocyte globulin (ATG) to a transplant patient?

Verify a negative tuberculin skin test from the past year
Ensure the patient has fasted for 8 hours
Confirm a baseline echocardiogram is on file
Premedicate with acetaminophen, diphenhydramine, and corticosteroids (Correct answer)

Correct answer: Premedicate with acetaminophen, diphenhydramine, and corticosteroids

ATG is a polyclonal antibody that frequently causes cytokine release syndrome, so premedication with antipyretics, antihistamines, and steroids is essential to reduce infusion reactions.

Question 72: The main ways that nursing diagnoses differ from medical diagnoses are as follows:

Primarily concerned with human response, while medical diagnoses are primarily concerned with pathology (Correct answer)
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
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 73: Which of the following catecholamines DOES NOT occur naturally?

Dobutamine (Correct answer)
Dopamine
Isoproterenol (Correct answer)
Norepinephrine
Epinephrine

Correct answer: Dobutamine

Dopamine, Epinephrine, and Norepinephrine are naturally occurring catecholamines produced by the body. Isoproterenol is a synthetic catecholamine that acts as a beta-adrenergic agonist, primarily used as a bronchodilator and cardiac stimulant. Dobutamine is also a synthetic catecholamine, primarily a beta-1 agonist.

Question 74: A nurse is caring for a patient with a chest tube. Which finding requires immediate intervention?

Tidaling in the water seal chamber during inspiration
Continuous vigorous bubbling in the water seal chamber (Correct answer)
Gentle bubbling in the suction control chamber
Drainage of 50 mL of serosanguineous fluid in one hour

Correct answer: Continuous vigorous bubbling in the water seal chamber

Continuous vigorous bubbling in the water seal chamber indicates an air leak in the system that must be identified and corrected immediately.

Question 75: 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 76: A patient is prescribed incentive spirometry post-operatively. What is the primary goal of this intervention?

Improve cardiac output
Drain pleural effusion
Reduce post-operative pain
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 77: A patient receiving IV vancomycin develops flushing, erythema, and hypotension during the infusion. What is the most likely cause?

Septic shock
Red man syndrome (Correct answer)
Anaphylactic reaction
Phlebitis at the IV site

Correct answer: Red man syndrome

Red man syndrome is a rate-related reaction to rapid vancomycin infusion causing flushing, erythema, and hypotension due to histamine release.

Question 78: Which sign is an early indicator of hypoxemia in an adult patient?

Restlessness and anxiety (Correct answer)
Decreased respiratory rate
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 79: A disparity in the number of sponges is discovered by the scrub tech and the circulating nurse. Which task ought to be completed by the circulating nurse first?

Re-count all sponges. (Correct answer)
Complete an occurrence report.
Contact the surgical manager.
Notify the client’s surgeon.

Correct answer: Re-count all sponges.

A discrepancy in the sponge count during surgery is a serious safety concern, as it indicates a potential retained surgical item. The immediate priority for the circulating nurse is to re-count all sponges to confirm the discrepancy and rule out a counting error. Only after a confirmed discrepancy should other actions, like notifying the surgeon or completing an occurrence report, be taken.

Question 80: A patient with a tracheostomy has thick, tenacious secretions. Which independent nursing intervention is most appropriate?

Perform postural drainage every 4 hours
Administer mucolytic medication
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 81: A patient is ordered to receive adenosine 6 mg IV push for SVT. What is the correct administration technique?

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

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 82: 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
Increased heart rate during exercise causes fluid to shift to the lungs
The narrowed valve limits cardiac output during exertion, reducing cerebral perfusion (Correct answer)
The left ventricle dilates during exercise, reducing ejection fraction

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 83: Which assessment finding in a patient with a long-leg cast warrants immediate intervention?

Mild itching under the cast
Pain relieved by elevation
Slight warmth over the cast site
Capillary refill of 3 seconds in the toes (Correct answer)

Correct answer: Capillary refill of 3 seconds in the toes

Capillary refill greater than 2 seconds indicates compromised circulation and possible compartment syndrome requiring immediate action.

Question 84: 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?

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

Correct answer: Acute rejection

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

Question 85: Which early sign of digoxin toxicity should the nurse assess for?

Decreased urine output
Tachycardia and hypertension
Visual disturbances including yellow-green halos (Correct answer)
Hypokalemia

Correct answer: Visual disturbances including yellow-green halos

Visual disturbances, especially yellow-green halos around lights, are a classic early sign of digoxin toxicity.

Question 86: 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:

acceptance of changed health status.
feelings of loss of control. (Correct answer)
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 87: A patient is receiving epidural analgesia post-operatively and develops sudden onset weakness in both legs with loss of bowel and bladder function. What is the MOST likely complication?

Epidural hematoma compressing the spinal cord (Correct answer)
Opioid-induced urinary retention
Expected dermatomal numbness from epidural
Spinal headache

Correct answer: Epidural hematoma compressing the spinal cord

New neurological deficits (bilateral leg weakness, bowel/bladder dysfunction) after epidural placement are signs of epidural hematoma requiring emergency intervention.

Question 88: A nurse is caring for a patient with acute pancreatitis. Which serum lab value is most specific for confirming this diagnosis?

Lipase (Correct answer)
Amylase
Alkaline phosphatase
Bilirubin

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 89: Which lab value should a nurse monitor most closely in a patient receiving IV vancomycin?

Serum peak level
Urine specific gravity
Erythrocyte sedimentation rate
Serum trough level (Correct answer)

Correct answer: Serum trough level

Vancomycin trough levels are monitored to ensure therapeutic dosing and prevent nephrotoxicity and ototoxicity.

Question 90: When performing post-transplant patient education, the nurse emphasizes sun protection because transplant recipients are at highest risk for which skin cancer?

Malignant melanoma
Merkel cell carcinoma
Squamous cell carcinoma (Correct answer)
Basal 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 91: A patient develops stridor after extubation. What is the priority nursing action?

Notify the physician and prepare for possible reintubation (Correct answer)
Administer oral fluids to soothe the airway
Obtain an arterial blood gas immediately
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 92: When a client needs fluids, the nurse gets ready to place a peripheral intravascular catheter. Which antiseptic is best for cleaning the skin before the catheter is inserted?

Acetone
Iodophor
Alcohol
Chlorhexadine (Correct answer)

Correct answer: Chlorhexadine

Chlorhexidine is the preferred antiseptic for skin preparation before inserting peripheral intravascular catheters. It provides superior and longer-lasting antimicrobial activity compared to alcohol or iodophor, effectively reducing the risk of catheter-related bloodstream infections. Its efficacy and residual activity make it the gold standard for this procedure.

Question 93: A patient with liver cirrhosis develops confusion, asterixis, and elevated ammonia levels. Which dietary modification is most appropriate?

Provide a high-fat, low-carbohydrate diet
Restrict protein to 0.5-1.0 g/kg/day (Correct answer)
Increase protein intake to promote healing
Eliminate all dietary sodium

Correct answer: Restrict protein to 0.5-1.0 g/kg/day

Protein restriction reduces ammonia production from protein metabolism, helping to manage hepatic encephalopathy while maintaining adequate nutrition.

Question 94: 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 95: A patient with heart failure is prescribed furosemide 40 mg IV push. Which electrolyte imbalance should the nurse anticipate?

Hypernatremia
Hyperkalemia
Hypercalcemia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

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

Question 96: When is a CMSRN credential renewal required?

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

Correct answer: Every 5 years

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

Question 97: A nurse is caring for a patient with a serum sodium of 122 mEq/L who is confused and complaining of a headache. Which intervention should the nurse implement first?

Restrict IV fluid administration to prevent further dilution
Encourage oral fluid intake to dilute the sodium concentration
Administer 0.9% normal saline IV bolus at 500 mL over 1 hour
Place the patient on seizure precautions and notify the provider (Correct answer)

Correct answer: Place the patient on seizure precautions and notify the provider

A serum sodium of 122 mEq/L with neurological symptoms (confusion, headache) indicates severe symptomatic hyponatremia with risk of seizures and cerebral edema. The priority is patient safety — implementing seizure precautions and notifying the provider for further orders.

Question 98: A patient with a traumatic brain injury has an intracranial pressure (ICP) reading of 24 mmHg. Which nursing intervention should be implemented first?

Administer acetaminophen for pain management
Encourage the patient to cough and perform deep breathing exercises
Apply sequential compression devices to the lower extremities
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 99: Which intervention is the priority for a patient experiencing autonomic dysreflexia?

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

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 100: When receiving warfarin (Coumadin) medication, excessive alcohol consumption causes:

increased anticoagulation effect. (Correct answer)
increased vitamin K absorption.
decreased international normalized ratio.
decreased anticoagulation effect.

Correct answer: increased anticoagulation effect.

Excessive alcohol consumption can inhibit the metabolism of warfarin in the liver, leading to higher concentrations of the drug in the bloodstream. This increased level of warfarin enhances its anticoagulant effect, resulting in a higher International Normalized Ratio (INR) and an elevated risk of bleeding. Patients on warfarin are advised to consume alcohol in moderation or avoid it entirely to maintain stable anticoagulation.

Question 101: The nurse is caring for a patient with a pleural effusion. Which intervention would the nurse anticipate assisting with to relieve symptoms?

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

Correct answer: Thoracentesis to drain fluid

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

Question 102: A patient with asthma is experiencing an acute exacerbation. What is the first-line medication the nurse should administer?

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

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 103: A patient is being examined for colon cancer. The nurse should: when preparing the patient for a barium enema

Give laxative the night before and a cleansing enema in the morning before the test (Correct answer)
Place the client on CBR a day before the study
Render an oil retention enema and give laxative the night before
Instruct the client to swallow 6 radiopaque tablets the evening before the study

Correct answer: Give laxative the night before and a cleansing enema in the morning before the test

The radiologic imaging of the colon using a die is known as a barium enema. The bowels must be cleared of feces before this technique may produce appropriate findings, necessitating the use of laxatives and enema.

Question 104: Which electrolyte abnormality is MOST dangerous in a patient receiving succinylcholine and should be assessed before administration?

Hypocalcemia
Hyponatremia
Hypomagnesemia
Hyperkalemia (Correct answer)

Correct answer: Hyperkalemia

Succinylcholine causes a transient rise in serum potassium; administering it to a patient with pre-existing hyperkalemia (e.g., burns, crush injuries, renal failure) can cause fatal cardiac arrest.

Question 105: A nurse is providing education to a patient newly diagnosed with deep vein thrombosis (DVT) who is being discharged on enoxaparin. Which statement by the patient indicates a need for further teaching?

"I will report any signs of unusual bleeding or bruising to my doctor right away."
"I need to rotate the injection sites on my abdomen."
"I will have my INR checked weekly to make sure the medication is working." (Correct answer)
"I should use an electric razor to reduce my risk of getting cut."

Correct answer: "I will have my INR checked weekly to make sure the medication is working."

Enoxaparin is a low-molecular-weight heparin (LMWH). Routine coagulation monitoring, such as INR or aPTT, is not required for LMWH as it is for warfarin or unfractionated heparin. This statement indicates a misunderstanding of the medication. The other statements reflect correct understanding of anticoagulant precautions and proper administration technique.

Question 106: Which of the following is the MOST reliable indicator of adequate reversal of neuromuscular blockade in the PACU?

Ability to sustain head lift for 5 seconds (Correct answer)
SpO2 greater than 95%
Respiratory rate of 12 breaths/min
Verbal response to commands

Correct answer: Ability to sustain head lift for 5 seconds

A 5-second head lift demonstrates adequate neuromuscular recovery and respiratory muscle strength needed for safe extubation.

Question 107: Which assessment finding in a patient receiving a blood transfusion requires the nurse to immediately stop the transfusion?

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

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

Administer supplemental oxygen and notify the provider immediately (Correct answer)
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

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 109: 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
Normal PT, elevated fibrinogen, increased platelet count
Elevated fibrinogen, decreased D-dimer, normal PT
Elevated D-dimer, decreased fibrinogen, prolonged PT and aPTT (Correct answer)

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 110: The nurse is positioning a patient following lumbar laminectomy. Which position is most appropriate in the immediate post-operative period?

Log-rolling technique to maintain spinal alignment (Correct answer)
Prone with pillows under abdomen
Trendelenburg to reduce spinal pressure
High Fowler's position

Correct answer: Log-rolling technique to maintain spinal alignment

Log-rolling maintains spinal alignment and prevents twisting or flexion of the operative site following lumbar laminectomy.

Question 111: Which lab value is the most specific marker for myocardial cell damage following an acute MI?

LDH
CK-MB
Myoglobin
Troponin I or T (Correct answer)

Correct answer: Troponin I or T

Cardiac troponin I and T are highly specific for myocardial injury and remain elevated for 7–14 days after an acute MI.

Question 112: 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?

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

Correct answer: Administer naloxone IV

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

Question 113: The client correctly describes how to lower the risk of colon cancer when he says:

“I will exercise daily.”
“I will have an annual chest x-ray.”
“I will include more fresh fruits and vegetables in my diet.” (Correct answer)
“I will include more red meat in my diet.”

Correct answer: “I will include more fresh fruits and vegetables in my diet.”

The development of cancer may be influenced by a variety of dietary and nutritional factors. A low-fiber diet hinders the transit of substances through the gut, which has been associated to colorectal cancer, such as when fresh fruits and vegetables are scarce or absent from the diet.

Question 114: Which laboratory value should the nurse monitor most closely in a patient receiving heparin therapy?

Hemoglobin A1C
Prothrombin time (PT)
Platelet count and aPTT (Correct answer)
Activated partial thromboplastin time (aPTT)

Correct answer: Platelet count and aPTT

Both aPTT for therapeutic effectiveness and platelet count for heparin-induced thrombocytopenia must be monitored during heparin therapy.

Question 115: 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
Increases renal excretion of cyclosporine
Induces CYP3A4, accelerating cyclosporine metabolism (Correct answer)

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

Supine with head of bed flat
Prone position
Good lung down (unaffected side dependent) (Correct answer)
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 117: Before being released, a patient with a fractured left leg must learn the three-point gait. Which directive ought the nurse to deliver to this patient?

“Advance your right crutch, swing the left foot forward, advance the left crutch, and then bring the right foot forward.”
“While partially bearing weight on your left leg, advance both crutches and then bring your right leg forward.”
“Move your right crutch and left foot forward together, and then swing the right foot and left crutch in one movement.”
“Using one movement, advance your left foot and both crutches and then bring right leg forward.” (Correct answer)

Correct answer: “Using one movement, advance your left foot and both crutches and then bring right leg forward.”

Explanation: <br> In the three-point gait, both crutches and the affected “bad” leg and foot moved together, with the unaffected “good” leg and foot following.

Question 118: A patient with type 2 diabetes is admitted with a blood glucose of 748 mg/dL, serum osmolality of 340 mOsm/kg, and minimal ketones. What is the priority nursing intervention?

Initiate aggressive intravenous fluid resuscitation (Correct answer)
Administer a bolus of regular insulin per protocol
Prepare for emergent hemodialysis
Begin a sodium bicarbonate infusion

Correct answer: Initiate aggressive intravenous fluid resuscitation

Hyperosmolar hyperglycemic state causes severe dehydration, and aggressive IV fluid replacement is the initial priority to restore circulating volume before insulin therapy.

Question 119: 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)
Slow the transfusion rate and monitor vital signs
Administer diphenhydramine and continue the transfusion
Obtain a urine sample and continue the transfusion at a slower rate

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 120: A heart transplant recipient presents with dyspnea, fatigue, and an endomyocardial biopsy showing Grade 2R rejection. The most appropriate treatment is:

Plasmapheresis and IVIG
Observation and repeat biopsy in 2 weeks
High-dose IV methylprednisolone pulse therapy (Correct answer)
Immediate retransplantation listing

Correct answer: High-dose IV methylprednisolone pulse therapy

ISHLT Grade 2R moderate acute cellular rejection is treated with high-dose IV corticosteroid pulse therapy.

Question 121: 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
Tension pneumothorax
Normal post-operative breath sounds
Pulmonary edema or early pneumonia (Correct answer)

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 122: Prerenal failure is the diagnosis for the patient. For this patient, the nursing intervention that should be given high priority is to:

administer antibiotics, as prescribed.
reposition frequently.
administer I.V. fluid boluses, as prescribed. (Correct answer)
provide frequent oral hygiene.

Correct answer: administer I.V. fluid boluses, as prescribed.

Reduced blood supply to the kidneys, which can result in ischemia in the nephrons, is what causes prerenal failure. I.V. Boluses of fluid may increase flow and perfusion to the nephrons. Repositioning, dental care, and antibiotics are not top priority in this case.

Question 123: A patient with heart failure has a BNP level of 850 pg/mL. What does this elevated level indicate?

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

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 124: A patient is receiving IV heparin for a pulmonary embolism. The aPTT result is 200 seconds. The therapeutic range is 60-100 seconds. What is the priority nursing action?

Hold the infusion and notify the provider (Correct answer)
Administer vitamin K immediately
Continue monitoring without changes
Increase the heparin infusion rate

Correct answer: Hold the infusion and notify the provider

An aPTT of 200 seconds is supratherapeutic and places the patient at high risk for bleeding; the infusion should be held and the provider notified.

Question 125: A patient with chronic venous insufficiency asks the nurse what causes their leg ulcers. What is the best explanation?

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

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 126: Meditation may be helpful for a patient recovering from a myocardial infarction since this method:

increases the release of catecholamines.
increases sympathetic nervous system activity.
decreases vasodilation.
decreases sympathetic nervous system activity. (Correct answer)

Correct answer: decreases sympathetic nervous system activity.

Meditation promotes relaxation and activates the parasympathetic nervous system, which counteracts the 'fight or flight' response mediated by the sympathetic nervous system. This leads to beneficial physiological changes such as decreased heart rate, reduced blood pressure, and lower levels of stress hormones like catecholamines. For a patient recovering from a myocardial infarction, decreasing sympathetic nervous system activity helps reduce cardiac workload, promote healing, and lower the risk of further cardiac events.

Question 127: 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.
use mild antidiarrheal medications to prevent nutritional losses.
monitor the patient for fluid and electrolyte imbalances. (Correct answer)
administer proteolytic enzymes to aid digestion of fats and proteins.

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

Pericarditis
Aortic dissection (Correct answer)
Esophageal rupture
Pulmonary embolism

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 129: A nurse is caring for a post-operative patient who received general anesthesia 2 hours ago. Which respiratory assessment finding is most concerning?

Oxygen saturation of 88% on 2L nasal cannula (Correct answer)
SpO2 of 94% on room air
Respiratory rate of 14 breaths/min
Productive cough with clear sputum

Correct answer: Oxygen saturation of 88% on 2L nasal cannula

SpO2 of 88% despite supplemental oxygen indicates inadequate oxygenation and potential respiratory compromise requiring immediate intervention.

Question 130: A patient with an acute inferior wall MI is most likely to exhibit which ECG finding?

ST elevation in leads V1-V4
New left bundle branch block
ST depression in leads I and aVL
ST elevation in leads II, III, and aVF (Correct answer)

Correct answer: ST elevation in leads II, III, and aVF

The inferior wall is supplied by the right coronary artery; occlusion causes ST elevation in the inferior leads II, III, and aVF.

Question 131: A patient with a new tracheostomy requires suctioning. What is the maximum recommended suction duration per pass?

20 seconds
10 seconds (Correct answer)
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 132: 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)
Moderate incisional pain rated 5 out of 10
Serosanguineous drainage on the surgical dressing

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 133: A patient returns from a cardiac catheterization via the femoral artery. Which assessment is the highest priority?

Assess blood pressure every hour
Check the puncture site for bleeding or hematoma (Correct answer)
Encourage fluid intake
Monitor for chest pain

Correct answer: Check the puncture site for bleeding or hematoma

The femoral artery puncture site must be monitored closely because arterial bleeding can be rapid and life-threatening.

Question 134: One week prior to a patient's operation. During the patient's physical examination and history, acute bronchitis was identified. The ideal course of action for a perianesthesia nurse is:

Get an order for an antibiotic
Proceed with surgery
Notify the surgeon (Correct answer)
Postpone the surgery

Correct answer: Notify the surgeon

Because acute bronchitis can raise the risk of perioperative complications, alerting the surgeon is essential. Depending on the patient's state, the surgeon must determine whether to perform the surgery now, postpone it, or administer antibiotics.

Question 135: A patient recovering from a sigmoid colectomy on postoperative day 2 reports nausea and abdominal distension. Bowel sounds are hypoactive and the patient has not passed flatus. What is the priority nursing intervention?

Insert a rectal tube to relieve accumulated gas
Administer an antiemetic and advance the diet to clear liquids
Encourage the patient to ambulate in the hallway (Correct answer)
Request an order for a stimulant laxative

Correct answer: Encourage the patient to ambulate in the hallway

Early ambulation is the first-line intervention for postoperative ileus because movement stimulates peristalsis and the return of bowel function. Laxatives and diet advancement are premature before bowel sounds return, and a rectal tube is not indicated for a postoperative ileus.

Question 136: A nurse is preparing to remove a patient's temporary transvenous pacemaker. Which action is essential before removal?

Obtain a 12-lead ECG immediately after removal
Place the patient in Trendelenburg position
Administer a bolus of IV heparin
Confirm the patient has an underlying rhythm that maintains adequate perfusion (Correct answer)

Correct answer: Confirm the patient has an underlying rhythm that maintains adequate perfusion

Before removing a temporary pacemaker, the nurse must confirm the patient has a stable underlying rhythm capable of maintaining adequate cardiac output without pacing support.

Question 137: A patient with peripheral arterial disease (PAD) reports intermittent claudication. Which patient statement indicates a need for further teaching?

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

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 138: 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
Left main coronary artery
Right coronary artery (Correct answer)
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 139: 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
Hyperalcemia
Diabetic Ketoacidosis
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 140: A nurse is caring for a patient in cardiogenic shock. Which hemodynamic finding is expected?

Normal PAWP with elevated mixed venous oxygen saturation
Elevated pulmonary artery wedge pressure (PAWP) and decreased cardiac output (Correct answer)
Decreased PAWP and increased cardiac output
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 141: 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)
Fibrinogen level
Prothrombin time (PT)

Correct answer: Activated partial thromboplastin time (aPTT)

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

Question 142: During CMSRN exam preparation, a nurse should spend the MOST time studying which system-specific content area?

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

Correct answer: Cardiovascular disorders

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

Question 143: How many scored questions appear on the CMSRN examination?

125
175
200
150 (Correct answer)

Correct answer: 150

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

Question 144: When treating acute glomerulonephritis, the primary objective is to:

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

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 145: A patient is admitted with suspected small bowel obstruction. Which assessment finding is most consistent with this diagnosis?

Bright red rectal bleeding with severe lower abdominal pain
Jaundice with right upper quadrant tenderness
High-pitched hyperactive bowel sounds with abdominal distension (Correct answer)
Absent bowel sounds in all four quadrants

Correct answer: High-pitched hyperactive bowel sounds with abdominal distension

High-pitched, hyperactive (borborygmi) bowel sounds with crampy abdominal pain and distension are the classic early findings as the bowel attempts to propel contents past the obstruction.

Question 146: A patient with acute respiratory distress syndrome (ARDS) is mechanically ventilated. Which ventilator strategy is consistent with lung-protective ventilation?

Tidal volume of 10-12 mL/kg ideal body weight
FiO2 maintained at 1.0 continuously
Tidal volume of 4-6 mL/kg ideal body weight (Correct answer)
PEEP of 0-2 cmH2O

Correct answer: Tidal volume of 4-6 mL/kg ideal body weight

Lung-protective ventilation in ARDS uses low tidal volumes (4-6 mL/kg IBW) to minimize ventilator-induced lung injury from barotrauma and volutrauma.

Question 147: A patient post-CABG has a chest tube output of 250 mL in the last hour. What is the priority nursing action?

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

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 148: 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?

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
Administer the metformin dose as scheduled the morning 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 149: A nurse is caring for a patient who received a brachial plexus nerve block. Which finding requires immediate notification of the anesthesia provider?

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

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 150: Which of the patient's statements accurately reflects their knowledge of herbal supplements?

Herbs may interact with prescribed medications but not other herbs."
The Food and Drug Administration regulates herbs and allows advertising.
"Most herbs have been tested and found to be safe and therapeutic."
"There is no standardization among the manufacturers of herbs in this country." (Correct answer)

Correct answer: "There is no standardization among the manufacturers of herbs in this country."

This claim draws attention to a crucial point about herbal supplements: their production techniques aren't standardized. Different brands or sources of herbal items may differ in terms of potency, purity, and general quality as a result of this lack of standardization.

Question 151: A patient receiving general anesthesia develops sudden onset masseter muscle rigidity after succinylcholine administration. Which condition should the nurse immediately suspect?

Serotonin syndrome
Neuroleptic malignant syndrome
Pseudocholinesterase deficiency
Malignant hyperthermia (Correct answer)

Correct answer: Malignant hyperthermia

Masseter muscle rigidity following succinylcholine is a classic early warning sign of malignant hyperthermia, a life-threatening hypermetabolic crisis.

Question 152: A nurse caring for a patient with deep vein thrombosis notes the INR is 4.8 on warfarin. Which action is most appropriate?

Hold warfarin and notify the provider (Correct answer)
Administer protamine sulfate immediately
Give vitamin C to lower the INR
Administer the next scheduled warfarin dose as ordered

Correct answer: Hold warfarin and notify the provider

An INR above the therapeutic range (2–3 for DVT) increases bleeding risk and requires dose withholding and provider notification.

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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