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

Question 1: Which symptom cluster in a post-thyroidectomy patient should prompt the nurse to assess for laryngeal nerve damage?

Tachycardia, fever, and extreme agitation
Perioral tingling and carpopedal spasm
Neck swelling, pain, and difficulty swallowing
Hoarse voice, difficulty speaking, and stridor (Correct answer)

Correct answer: Hoarse voice, difficulty speaking, and stridor

Hoarseness, weak voice, and stridor after thyroidectomy suggest recurrent laryngeal nerve injury, which can compromise the airway.

Question 2: What should be considered when managing medications for elderly patients?

They should avoid taking medications altogether
Only their primary condition needs to be treated with medication
Potential drug interactions, metabolism changes, and organ function should be considered (Correct answer)
Medication doses should always be increased in elderly patients

Correct answer: Potential drug interactions, metabolism changes, and organ function should be considered

When managing medications for elderly patients, it is crucial to consider potential drug interactions, changes in metabolism, and organ function. Elderly individuals often have multiple comorbidities and physiological changes that affect how drugs are processed, increasing the risk of adverse drug reactions. Careful review and dosage adjustments are necessary to ensure safety and efficacy.

Question 3: Which Glasgow Coma Scale score indicates severe traumatic brain injury?

8 or below (Correct answer)
13-15
6 or below
9-12

Correct answer: 8 or below

A GCS score of 8 or below classifies a traumatic brain injury as severe and typically requires intubation to protect the airway.

Question 4: Which clinical manifestation differentiates hyperosmolar hyperglycemic state (HHS) from diabetic ketoacidosis (DKA)?

Serum glucose is typically above 600 mg/dL in HHS with minimal or no ketosis (Correct answer)
HHS presents with marked ketosis and Kussmaul respirations
DKA occurs only in type 2 diabetes patients
Severe dehydration is present only in HHS

Correct answer: Serum glucose is typically above 600 mg/dL in HHS with minimal or no ketosis

HHS features extreme hyperglycemia (often >600 mg/dL) and hyperosmolarity with minimal ketosis, because residual insulin prevents ketogenesis.

Question 5: What is the most important factor in effective communication with patients regarding gastrointestinal nursing?

Speaking quickly to save time
Using clear, understandable language and confirming understanding (Correct answer)
Providing written instructions only
Using medical jargon to appear professional

Correct answer: Using clear, understandable language and confirming understanding

Clear communication in understandable language, with confirmation of understanding, improves patient compliance and outcomes.

Question 6: A nurse is caring for a patient post-Whipple procedure (pancreaticoduodenectomy). Which early complication requires immediate reporting to the surgeon?

Blood glucose of 180 mg/dL
Amylase-rich drain output exceeding 3× normal serum amylase (Correct answer)
Delayed gastric emptying with nausea
Mild abdominal distension on post-op day 2

Correct answer: Amylase-rich drain output exceeding 3× normal serum amylase

Drain amylase >3× the upper limit of normal serum amylase on post-op day 3 or later indicates a clinically relevant pancreatic fistula.

Question 7: What is the role of informed consent in renal nursing?

It is a mere formality
It protects only the provider
It ensures the patient understands and agrees to the plan (Correct answer)
It is only needed for surgery

Correct answer: It ensures the patient understands and agrees to the plan

Informed consent ensures patients understand the proposed interventions, alternatives, risks, and benefits before agreeing to proceed.

Question 8: A nurse is preparing a patient for a renal biopsy. Which post-procedure instruction is most critical?

Apply heat to the biopsy site to reduce discomfort
Monitor urine for hematuria and report persistent bleeding (Correct answer)
Restrict all fluid intake for 24 hours
Encourage vigorous ambulation within 1 hour

Correct answer: Monitor urine for hematuria and report persistent bleeding

Renal biopsy carries a risk of hemorrhage; monitoring urine for hematuria and reporting persistent or worsening bleeding is the priority post-procedure intervention.

Question 9: What is the role of informed consent in musculoskeletal care?

It protects only the provider
It is a mere formality
It ensures the patient understands and agrees to the plan (Correct answer)
It is only needed for surgery

Correct answer: It ensures the patient understands and agrees to the plan

Informed consent ensures patients understand the proposed interventions, alternatives, risks, and benefits before agreeing to proceed.

Question 10: Which documentation practice BEST demonstrates regulatory compliance for MSNCB certified professionals?

Relying on memory for routine procedures
Maintaining organized, dated, and signed records of all activities, training, and incidents (Correct answer)
Keeping informal handwritten notes
Filing documents only when audited

Correct answer: Maintaining organized, dated, and signed records of all activities, training, and incidents

Organized, dated, and signed records demonstrate systematic compliance with regulatory requirements. Proper documentation serves as evidence during audits, protects against liability, and shows a pattern of consistent adherence to standards.

Question 11: Why is screening for chronic diseases important in health promotion?

To reduce the number of chronic disease cases
To eliminate the need for lifestyle changes
To monitor the effectiveness of medications only
To detect diseases early, allowing for early intervention and better management (Correct answer)

Correct answer: To detect diseases early, allowing for early intervention and better management

Screening for chronic diseases is a vital aspect of health promotion because it enables early detection. Identifying diseases like hypertension, diabetes, or cancer in their initial stages allows for timely intervention and treatment. This early management can slow disease progression, prevent severe complications, and significantly improve long-term patient outcomes.

Question 12: A patient is diagnosed with carpal tunnel syndrome. Which conservative treatment should the nurse reinforce first?

Surgical decompression
Strengthening exercises for the wrist flexors
Hot compresses applied continuously
Wrist splinting in neutral position, especially at night (Correct answer)

Correct answer: Wrist splinting in neutral position, especially at night

Wrist splinting in neutral position reduces median nerve compression and is first-line conservative management for carpal tunnel syndrome.

Question 13: A nurse notes CSF leaking from a patient's nose after a basilar skull fracture. The most appropriate nursing action is to:

Apply ice packs to the nasal bridge
Suction the nasal passage to prevent aspiration
Pack the nares with gauze and notify the physician
Test the drainage with a glucose oxidase strip and keep HOB elevated (Correct answer)

Correct answer: Test the drainage with a glucose oxidase strip and keep HOB elevated

CSF rhinorrhea is confirmed by testing for glucose; the HOB is elevated to reduce CSF pressure, and nasal packing is contraindicated due to infection risk.

Question 14: What is the priority nursing intervention for a patient experiencing status epilepticus?

Restrain the patient to prevent injury
Protect the airway and administer IV benzodiazepine (Correct answer)
Administer oral diazepam
Place a tongue blade between the teeth

Correct answer: Protect the airway and administer IV benzodiazepine

Airway protection and rapid administration of IV benzodiazepines (such as lorazepam) are the immediate priorities in status epilepticus.

Question 15: A patient post-thyroidectomy develops perioral tingling and a positive Chvostek's sign. The nurse should anticipate administering:

Sodium bicarbonate IV
Potassium chloride IV
Calcium gluconate IV (Correct answer)
Magnesium sulfate IV

Correct answer: Calcium gluconate IV

Positive Chvostek's sign with perioral tingling indicates hypocalcemia, a common complication after thyroidectomy due to inadvertent parathyroid removal.

Question 16: Which factor MOST significantly affects the quality of technical outcomes in MSNCB practice?

The practitioner's training, preparation, and attention to detail (Correct answer)
The speed at which procedures are completed
The brand of equipment being used
The time of day the procedure is performed

Correct answer: The practitioner's training, preparation, and attention to detail

The quality of technical outcomes depends primarily on the practitioner's level of training, thorough preparation, and careful attention to detail. While equipment matters, the professional's competence is the most significant factor.

Question 17: A nurse is caring for a patient with obstructive sleep apnea (OSA) who was just extubated. Which is the most important nursing intervention in the first two hours post-extubation?

Administer supplemental oxygen at 4 L/min via nasal cannula indefinitely
Position the patient supine to prevent aspiration
Apply continuous pulse oximetry and keep CPAP device at bedside (Correct answer)
Restrict oral intake for 4 hours to prevent nausea

Correct answer: Apply continuous pulse oximetry and keep CPAP device at bedside

Patients with OSA are at high risk for upper airway obstruction after extubation; continuous SpO2 monitoring and bedside CPAP allow rapid intervention if obstruction occurs.

Question 18: A nurse is educating a patient on crutch walking using the three-point gait. Which statement by the patient indicates correct understanding?

I will advance each crutch and leg alternately in a walking pattern
I will keep full weight on my injured leg while the crutches support balance
I will move my good leg first, then swing the crutches through
I will move both crutches and my injured leg together, then step through with my good leg (Correct answer)

Correct answer: I will move both crutches and my injured leg together, then step through with my good leg

In the three-point gait, both crutches and the non-weight-bearing limb advance together, then the good leg follows.

Question 19: Which laboratory result would most likely require postponement of an elective surgical procedure?

INR of 3.8 (Correct answer)
Hemoglobin of 11.5 g/dL
Platelet count of 175,000/μL
Serum creatinine of 1.1 mg/dL

Correct answer: INR of 3.8

An INR of 3.8 indicates excessive anticoagulation, significantly increasing intraoperative hemorrhage risk and requiring correction before elective surgery.

Question 20: Which sign/symptom is MOST specific to a pheochromocytoma?

Orthostatic hypotension with tachycardia
Persistent hypertension unresponsive to medication
Hypertension with bilateral leg edema
Episodic hypertension with headache, diaphoresis, and palpitations (Correct answer)

Correct answer: Episodic hypertension with headache, diaphoresis, and palpitations

Pheochromocytoma classically presents with paroxysmal episodes of hypertension, severe headache, diaphoresis, and palpitations due to catecholamine surges.

Question 21: A patient with a spinal cord injury at T4 suddenly develops severe hypertension (BP 210/120), bradycardia, and profuse sweating above the injury level. The nurse's first action is to:

Place the patient in Trendelenburg position
Apply a cooling blanket for hyperthermia management
Sit the patient upright and identify the noxious stimulus (Correct answer)
Administer an antihypertensive medication immediately

Correct answer: Sit the patient upright and identify the noxious stimulus

Autonomic dysreflexia requires sitting the patient upright to lower BP and then identifying and removing the triggering noxious stimulus, most commonly a full bladder.

Question 22: What should be assessed in the postoperative patient’s wound?

To ensure the patient is not aware of the wound
To evaluate the size of the wound for cosmetic purposes
To check for infection, bleeding, and proper healing of the wound (Correct answer)
Only to monitor for blood clots

Correct answer: To check for infection, bleeding, and proper healing of the wound

Postoperative wound assessment is essential for preventing complications and promoting optimal healing. Nurses meticulously inspect the wound for signs of infection (redness, swelling, discharge), excessive bleeding, dehiscence, or evisceration. Identifying and addressing any issues promptly ensures proper healing and minimizes the risk of adverse outcomes for the patient.

Question 23: A nurse is caring for a patient in Buck's traction. Which action is correct?

Position the head of bed at 90 degrees
Ensure the rope moves freely in the pulley with weights hanging freely (Correct answer)
Remove traction for two hours every shift
Allow weights to rest on the floor during repositioning

Correct answer: Ensure the rope moves freely in the pulley with weights hanging freely

Effective skin traction requires that weights hang freely without touching the floor and that the rope moves unobstructed through the pulley.

Question 24: A patient is admitted with suspected sepsis. Which combination of findings meets the Sepsis-3 quick SOFA (qSOFA) criteria?

Positive blood cultures, fever, and altered consciousness
Altered mentation, RR ≥ 22/min, systolic BP ≤ 100 mmHg (Correct answer)
Temperature > 38.3°C, WBC > 12,000, HR > 90 bpm
Lactate > 2 mmol/L, BP < 90/60, urine output < 0.5 mL/kg/hr

Correct answer: Altered mentation, RR ≥ 22/min, systolic BP ≤ 100 mmHg

The qSOFA score uses altered mentation, respiratory rate ≥ 22/min, and systolic BP ≤ 100 mmHg—each scoring 1 point; a score ≥ 2 suggests sepsis.

Question 25: What is the most important factor in effective communication with patients regarding endocrine nursing?

Speaking quickly to save time
Using clear, understandable language and confirming understanding (Correct answer)
Using medical jargon to appear professional
Providing written instructions only

Correct answer: Using clear, understandable language and confirming understanding

Clear communication in understandable language, with confirmation of understanding, improves patient compliance and outcomes.

Question 26: What is the role of informed consent in gastrointestinal nursing?

It protects only the provider
It ensures the patient understands and agrees to the plan (Correct answer)
It is only needed for surgery
It is a mere formality

Correct answer: It ensures the patient understands and agrees to the plan

Informed consent ensures patients understand the proposed interventions, alternatives, risks, and benefits before agreeing to proceed.

Question 27: Which clinical sign differentiates Parkinson's disease tremor from essential tremor?

Tremor is bilateral in Parkinson's disease
Tremor worsens with caffeine in Parkinson's disease
Tremor is present at rest in Parkinson's disease (Correct answer)
Tremor improves with alcohol in Parkinson's disease

Correct answer: Tremor is present at rest in Parkinson's disease

Parkinson's tremor is a resting tremor that diminishes with intentional movement, while essential tremor occurs with action or posture.

Question 28: A postoperative patient reports sudden onset of chest pain and shortness of breath on the first day after hip replacement surgery. Which complication should the nurse suspect first?

Postoperative pneumonia
Pulmonary embolism (Correct answer)
Myocardial infarction
Pleural effusion

Correct answer: Pulmonary embolism

Sudden chest pain and dyspnea in a postoperative orthopedic patient are classic signs of pulmonary embolism, a life-threatening complication of DVT.

Question 29: A patient with prolonged vomiting and nasogastric suction is at greatest risk for which acid-base imbalance?

Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis (Correct answer)
Respiratory acidosis

Correct answer: Metabolic alkalosis

Loss of hydrochloric acid through vomiting or NG suction removes hydrogen ions from the body, resulting in metabolic alkalosis.

Question 30: A patient recovering from a partial gastrectomy develops diaphoresis, palpitations, and dizziness 20 minutes after eating. The nurse recognizes this as:

Early dumping syndrome (Correct answer)
Marginal ulcer formation
Late dumping syndrome
Anastomotic leak

Correct answer: Early dumping syndrome

Early dumping syndrome occurs within 15–30 minutes of eating due to rapid emptying of hyperosmolar chyme into the small intestine.

Question 31: What role does critical thinking play in clinical decision-making?

It limits the scope of patient care
It focuses on quick decision-making without data analysis
It ignores patient preferences in favor of clinical protocols
It helps nurses evaluate data, consider alternatives, and make informed decisions (Correct answer)

Correct answer: It helps nurses evaluate data, consider alternatives, and make informed decisions

Critical thinking is an essential cognitive process in nursing that enables professionals to analyze information objectively, identify underlying assumptions, and evaluate different perspectives. This skill allows nurses to interpret complex patient data, anticipate potential problems, and make sound, well-reasoned clinical judgments. It is fundamental for making informed and effective decisions in dynamic healthcare environments.

Question 32: Which medication is used to reduce cerebral edema in patients with brain tumors?

Furosemide
Hypertonic saline bolus
Dexamethasone (Correct answer)
Mannitol infusion

Correct answer: Dexamethasone

Dexamethasone (a corticosteroid) is the first-line treatment for vasogenic cerebral edema surrounding brain tumors.

Question 33: A patient receiving phenytoin (Dilantin) for seizure control should be monitored for which serious adverse effect?

Hepatic encephalopathy
Pulmonary fibrosis
Cardiac dysrhythmias during rapid IV infusion (Correct answer)
Nephrotoxicity

Correct answer: Cardiac dysrhythmias during rapid IV infusion

Rapid IV infusion of phenytoin can cause severe hypotension and cardiac dysrhythmias; it must be administered no faster than 50 mg/min.

Question 34: A patient with renal artery stenosis is started on an ACE inhibitor. Which laboratory change requires immediate attention?

Increase in hemoglobin
Decrease in serum potassium below 3.5 mEq/L
Acute rise in serum creatinine >30% from baseline (Correct answer)
Decrease in serum sodium

Correct answer: Acute rise in serum creatinine >30% from baseline

A creatinine rise of >30% after starting an ACE inhibitor in renal artery stenosis suggests significant reduction in glomerular filtration pressure, warranting dose adjustment or discontinuation.

Question 35: A patient with Guillain-Barré syndrome is admitted. Which assessment finding is most critical to monitor?

Blood pressure variability
Respiratory rate and tidal volume (Correct answer)
Deep tendon reflexes
Muscle pain level

Correct answer: Respiratory rate and tidal volume

Ascending paralysis in Guillain-Barré syndrome can involve respiratory muscles, making respiratory function the most critical assessment.

Question 36: A patient with AKI is receiving kayexalate (sodium polystyrene sulfonate) for hyperkalemia. Which adverse effect requires monitoring?

Hypercalcemia
Intestinal necrosis (Correct answer)
Hypermagnesemia
Respiratory depression

Correct answer: Intestinal necrosis

Sodium polystyrene sulfonate (Kayexalate) carries a risk of intestinal necrosis, particularly in post-operative patients or those with reduced gut motility.

Question 37: Which finding in a patient with a cervical spinal cord injury indicates the development of neurogenic shock?

Hypotension and bradycardia (Correct answer)
Hypertension and tachycardia
Hypertension and bradycardia
Hypotension and tachycardia

Correct answer: Hypotension and bradycardia

Neurogenic shock results from disrupted sympathetic pathways, causing hypotension and paradoxical bradycardia without compensatory tachycardia.

Question 38: A patient in the cardiac ICU has a pulmonary artery catheter. The nurse notes a PCWP of 22 mmHg. This finding indicates:

Normal left heart filling pressure
Hypovolemia requiring fluid resuscitation
Right ventricular failure with elevated preload
Elevated left ventricular end-diastolic pressure (Correct answer)

Correct answer: Elevated left ventricular end-diastolic pressure

A PCWP above 18 mmHg reflects elevated left ventricular end-diastolic pressure, indicating left heart congestion and volume overload.

Question 39: Which ethical principle requires MSNCB professionals to act in the patient's best interest?

Autonomy
Justice
Beneficence (Correct answer)
Fidelity

Correct answer: Beneficence

Beneficence is the ethical principle that obligates healthcare professionals to act in ways that promote the well-being and best interests of the patient.

Question 40: What is the role of informed consent in endocrine nursing?

It ensures the patient understands and agrees to the plan (Correct answer)
It protects only the provider
It is a mere formality
It is only needed for surgery

Correct answer: It ensures the patient understands and agrees to the plan

Informed consent ensures patients understand the proposed interventions, alternatives, risks, and benefits before agreeing to proceed.

Question 41: What is the role of disease prevention in nursing care?

To reduce the risk of diseases through preventive care and education (Correct answer)
To increase the risk of infectious diseases
To increase the number of medications prescribed
To eliminate the need for medical treatment

Correct answer: To reduce the risk of diseases through preventive care and education

Disease prevention is a core component of nursing care, aiming to reduce the incidence and impact of illnesses. Through preventive care strategies like screenings, immunizations, and patient education, nurses help individuals avoid developing diseases or detect them early. This proactive approach improves public health outcomes and reduces the need for more intensive medical treatments.

Question 42: Which assessment tool is most appropriate for evaluating pressure injury risk in a hospitalized medical-surgical patient?

Braden Scale (Correct answer)
AUDIT-C
Morse Fall Scale
Pittsburgh Sleep Quality Index

Correct answer: Braden Scale

The Braden Scale assesses six risk factors for pressure injury development and is the standard tool used in acute care settings.

Question 43: Which laboratory finding is most consistent with a diagnosis of acute pancreatitis?

Elevated serum alkaline phosphatase
Serum lipase >3× upper limit of normal (Correct answer)
Decreased serum albumin
Elevated direct bilirubin

Correct answer: Serum lipase >3× upper limit of normal

Serum lipase elevated more than three times the upper limit of normal is the most sensitive and specific marker for acute pancreatitis.

Question 44: A patient with type 2 diabetes is preparing for a long-haul flight. Which health promotion advice is most important related to deep vein thrombosis (DVT) prevention?

Wear compression stockings only if symptoms develop
Take aspirin 24 hours before the flight as prophylaxis
Perform calf exercises, walk periodically, and stay well hydrated (Correct answer)
Avoid all fluids during the flight to reduce edema

Correct answer: Perform calf exercises, walk periodically, and stay well hydrated

DVT prevention during prolonged travel includes regular calf muscle exercises, periodic ambulation, and adequate hydration to promote venous return.

Question 45: A patient with Paget's disease of bone asks why their serum alkaline phosphatase is elevated. The best nursing response is:

It means you are developing bone cancer
It indicates liver damage from your medications
It reflects increased osteoblastic activity due to abnormal bone remodeling (Correct answer)
It shows your kidneys are not filtering waste properly

Correct answer: It reflects increased osteoblastic activity due to abnormal bone remodeling

In Paget's disease, markedly elevated alkaline phosphatase reflects excessive, disorganized osteoblastic bone remodeling activity.

Question 46: When teaching a patient with celiac disease, the nurse emphasizes avoiding which grain?

Rice
Corn
Quinoa
Barley (Correct answer)

Correct answer: Barley

Barley contains hordein, a gluten protein that triggers the autoimmune response in celiac disease.

Question 47: A patient 2 days post-total knee arthroplasty (TKA) has a temperature of 38.6°C, wound erythema, and purulent drainage. The priority nursing action is:

Administer acetaminophen and reassess in 2 hours
Notify the surgeon and obtain wound cultures before starting antibiotics (Correct answer)
Apply warm soaks to the wound
Increase the patient's fluid intake and monitor urine output

Correct answer: Notify the surgeon and obtain wound cultures before starting antibiotics

Signs of surgical site infection require wound cultures before antibiotics to identify the causative organism and guide treatment.

Question 48: A nurse is reviewing a patient's medication administration record and notes that metformin 1,000 mg was due 2 hours ago but not given. The patient is scheduled for a CT scan with IV contrast today. What is the priority nursing action?

Proceed with the scan and administer metformin after
Administer the missed dose immediately before the scan
Document the missed dose and reschedule the scan
Hold metformin and notify the radiologist and ordering physician before the scan (Correct answer)

Correct answer: Hold metformin and notify the radiologist and ordering physician before the scan

Metformin must be held before and after IV contrast administration due to risk of contrast-induced nephropathy leading to lactic acidosis.

Question 49: A surgical patient with a latex allergy is scheduled for the first case of the day. What is the most appropriate accommodation?

Schedule the patient as the last case of the day
Premedicate with diphenhydramine and proceed normally
Schedule the patient as the first case of the day in a latex-free environment (Correct answer)
Use only sterile gloves during the procedure

Correct answer: Schedule the patient as the first case of the day in a latex-free environment

Scheduling a latex-allergic patient first minimizes latex particle accumulation in the OR environment, reducing the risk of an allergic reaction.

Question 50: A patient with hyperparathyroidism would MOST likely exhibit which set of findings?

Hypocalcemia, hypomagnesemia, and bone pain
Hypercalcemia, hypophosphatemia, and nephrolithiasis (Correct answer)
Hypocalcemia, hyperphosphatemia, and tetany
Hypercalcemia, hyperkalemia, and muscle weakness

Correct answer: Hypercalcemia, hypophosphatemia, and nephrolithiasis

Excess PTH causes calcium release from bones and phosphate wasting by kidneys, leading to hypercalcemia, hypophosphatemia, and renal stones.

Question 51: Which positioning is most appropriate for a patient after a right-sided pneumonectomy to facilitate lung expansion?

Trendelenburg
Right lateral decubitus or semi-Fowler's (Correct answer)
Left lateral decubitus
Prone

Correct answer: Right lateral decubitus or semi-Fowler's

Positioning on the operative side (right) or semi-Fowler's prevents mediastinal shift and supports the remaining lung.

Question 52: Which position is most appropriate for a patient with increased intracranial pressure (ICP)?

Head of bed elevated 30 degrees, neck midline (Correct answer)
Prone position
Lateral decubitus with knees flexed
Trendelenburg position

Correct answer: Head of bed elevated 30 degrees, neck midline

Elevating the HOB to 30 degrees with the neck in midline promotes venous drainage from the brain, helping to reduce ICP.

Question 53: Which nursing assessment finding is most consistent with a epidural hematoma?

Bilateral arm weakness with preserved leg strength
Slow progressive headache over weeks with personality changes
Gradual onset of neurological deterioration over days
Brief loss of consciousness, lucid interval, then rapid deterioration (Correct answer)

Correct answer: Brief loss of consciousness, lucid interval, then rapid deterioration

Epidural hematoma classically presents with a lucid interval between initial loss of consciousness and rapid neurological deterioration due to arterial bleeding.

Question 54: In Medical-Surgical Nursing Certification Board, what is the PRIMARY purpose of conducting regular safety drills and exercises?

To ensure personnel can respond effectively in emergencies (Correct answer)
To satisfy insurance requirements only
To evaluate employee performance reviews
To reduce daily workload

Correct answer: To ensure personnel can respond effectively in emergencies

Regular safety drills ensure that all personnel are prepared to respond effectively during actual emergencies. Practice builds muscle memory, identifies gaps in emergency procedures, and improves overall response times.

Question 55: A patient with type 1 diabetes presents with blood glucose of 42 mg/dL, diaphoresis, and confusion. Which intervention should the nurse perform FIRST?

Start an IV and administer 50% dextrose
Give 15-20g of fast-acting carbohydrate orally (Correct answer)
Notify the physician immediately
Administer 1 mg glucagon IM

Correct answer: Give 15-20g of fast-acting carbohydrate orally

If the patient can swallow safely, oral fast-acting carbohydrates (15-20g) are the first-line treatment for mild-to-moderate hypoglycemia.

Question 56: A nurse is planning health education for a group of men aged 55–69. Which cancer screening should the nurse include based on USPSTF recommendations?

Prostate MRI every 3 years
Annual digital rectal exam for prostate cancer
Annual PSA testing regardless of risk factors
One-time PSA screening with informed decision-making (Correct answer)

Correct answer: One-time PSA screening with informed decision-making

USPSTF recommends that men aged 55–69 engage in shared decision-making about PSA-based prostate cancer screening rather than routine universal testing.

Question 57: A post-operative patient refuses to perform deep breathing exercises. Which is the nurse's best initial response?

Explain that atelectasis and pneumonia are serious risks of not breathing deeply
Document the refusal and notify the physician
Apply a nasal cannula at 2 L/min as an alternative measure
Administer prescribed pain medication and then reteach the technique (Correct answer)

Correct answer: Administer prescribed pain medication and then reteach the technique

Adequate pain control is the most common barrier to deep breathing post-operatively; managing pain first enables effective patient participation.

Question 58: A nurse is caring for a patient with hypernatremia (serum sodium 158 mEq/L). Which intervention is most appropriate?

Restrict all fluid intake
Encourage free water intake or administer hypotonic fluids (Correct answer)
Administer sodium bicarbonate
Administer 3% NaCl IV

Correct answer: Encourage free water intake or administer hypotonic fluids

Hypernatremia is treated by replacing the free water deficit using hypotonic fluids or encouraging oral water intake to dilute the elevated serum sodium level.

Question 59: A patient with acromegaly would MOST likely present with which assessment findings?

Short stature, delayed puberty, and small hands
Coarsened facial features, enlarged hands and feet, and prognathism (Correct answer)
Exophthalmos, heat intolerance, and weight loss
Central obesity, moon face, and proximal muscle weakness

Correct answer: Coarsened facial features, enlarged hands and feet, and prognathism

Acromegaly results from excess GH in adults, causing coarsening of facial features, prognathism (jaw protrusion), and enlargement of hands and feet.

Question 60: A patient with hepatitis B asks the nurse how the infection is most commonly transmitted. The correct response is:

Fecal-oral route via contaminated food or water
Contact with infected blood, sexual contact, and perinatal transmission (Correct answer)
Insect vectors such as mosquitoes
Airborne droplets from coughing or sneezing

Correct answer: Contact with infected blood, sexual contact, and perinatal transmission

Hepatitis B is a bloodborne pathogen transmitted through blood, sexual contact, and from mother to infant at birth.

Question 61: A post-op patient is prescribed ketorolac (Toradol). The nurse should assess which organ system most closely during therapy?

Liver function
Pulmonary function
Renal function (Correct answer)
Neurological function

Correct answer: Renal function

Ketorolac is an NSAID that can cause renal vasoconstriction and acute kidney injury, particularly in hypovolemic or older patients.

Question 62: The nurse is preparing to administer regular insulin IV for a patient in DKA. Which action is MOST important before beginning the infusion?

Administer sodium bicarbonate to correct acidosis first
Ensure the patient has eaten a full meal
Check serum potassium level and correct if below 3.5 mEq/L (Correct answer)
Obtain a 12-lead ECG before starting any insulin

Correct answer: Check serum potassium level and correct if below 3.5 mEq/L

Insulin drives potassium intracellularly; if potassium is already low (<3.5 mEq/L), insulin administration can cause life-threatening hypokalemia.

Question 63: A patient with aortic stenosis develops syncope, angina, and dyspnea. The nurse recognizes these symptoms indicate:

Early disease that can be managed with medication alone
Progression to critical stenosis requiring urgent valve intervention (Correct answer)
Concurrent mitral valve disease complicating treatment
Fluid overload requiring aggressive diuresis

Correct answer: Progression to critical stenosis requiring urgent valve intervention

The classic triad of syncope, angina, and dyspnea in aortic stenosis signals critical disease with significantly reduced survival if valve replacement is not performed.

Question 64: Which clinical manifestation differentiates osteomyelitis from a simple soft tissue infection?

Low-grade fever
Localized redness and warmth
Mild leukocytosis
Persistent bone pain with point tenderness and elevated ESR/CRP (Correct answer)

Correct answer: Persistent bone pain with point tenderness and elevated ESR/CRP

Osteomyelitis typically presents with bone point tenderness, marked elevation of inflammatory markers (ESR, CRP), and often a positive bone scan.

Question 65: In MSNCB practice, when should a patient's condition be reassessed?

At regular intervals and when status changes (Correct answer)
Once per week
Only when the patient requests it
Only at admission and discharge

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 66: A patient receiving epidural analgesia postoperatively develops a blood pressure of 85/50 mmHg and heart rate of 55 bpm. The nurse's priority action is to:

Discontinue the epidural and notify the anesthesiologist (Correct answer)
Administer an antiemetic for vagal response
Increase the epidural infusion rate
Place the patient in Trendelenburg position only

Correct answer: Discontinue the epidural and notify the anesthesiologist

Hypotension and bradycardia with epidural analgesia suggest sympathetic blockade; the epidural must be stopped and the anesthesiologist notified immediately.

Question 67: A patient with a long leg cast reports severe pain unrelieved by opioids and paresthesia in the toes. What is the priority nursing action?

Elevate the extremity higher
Apply ice over the cast
Bivalve or remove the cast immediately (Correct answer)
Administer additional analgesic

Correct answer: Bivalve or remove the cast immediately

Unrelieved pain and paresthesia indicate compartment syndrome, requiring immediate cast removal to relieve pressure.

Question 68: A patient is being evaluated for brain death. Which finding is INCONSISTENT with a brain death determination?

Intact oculovestibular (cold caloric) reflex (Correct answer)
Positive apnea test
Fixed, dilated pupils bilaterally
Absent corneal reflexes bilaterally

Correct answer: Intact oculovestibular (cold caloric) reflex

An intact oculovestibular (cold caloric) reflex indicates brainstem activity, which is incompatible with a brain death determination.

Question 69: Which clinical indicator most reliably signals that weaning from mechanical ventilation should proceed?

Patient can open eyes to voice commands
SpO2 of 88% on FiO2 0.60
Rapid shallow breathing index (RSBI) of 80 or less with hemodynamic stability (Correct answer)
Patient has been on the ventilator for at least 48 hours

Correct answer: Rapid shallow breathing index (RSBI) of 80 or less with hemodynamic stability

An RSBI (respiratory rate / tidal volume in liters) ≤105, especially ≤80, combined with hemodynamic stability and adequate oxygenation, predicts successful extubation.

Question 70: Which arterial blood gas result is consistent with metabolic alkalosis with respiratory compensation?

pH 7.35, PaCO2 40, HCO3 24
pH 7.48, PaCO2 30, HCO3 22
pH 7.50, PaCO2 50, HCO3 38 (Correct answer)
pH 7.30, PaCO2 28, HCO3 13

Correct answer: pH 7.50, PaCO2 50, HCO3 38

Metabolic alkalosis shows elevated pH and HCO3; the body compensates by hypoventilating (retaining CO2), raising PaCO2.

Question 71: What is the MOST important factor to consider when selecting assessment tools for MSNCB certification work?

Validity, reliability, and appropriateness for the specific context (Correct answer)
The cost of the assessment tool
Personal familiarity with the tool
How quickly the tool can be administered

Correct answer: Validity, reliability, and appropriateness for the specific context

Assessment tools must be valid (measuring what they claim to measure), reliable (producing consistent results), and appropriate for the specific context and population. These psychometric properties ensure the quality of assessment outcomes.

Question 72: A patient returns from the OR after open reduction internal fixation (ORIF) of the radius. What is the priority neurovascular assessment?

Check pulses, sensation, and movement of the fingers distal to the injury (Correct answer)
Assess respiratory rate and oxygen saturation
Monitor blood glucose every 4 hours
Assess the patient's ability to move the shoulder

Correct answer: Check pulses, sensation, and movement of the fingers distal to the injury

Neurovascular assessment distal to a fracture or surgical site detects early compartment syndrome or vascular injury.

Question 73: While assessing a patient post-thyroidectomy, the nurse notes carpopedal spasm when inflating the blood pressure cuff. This finding is known as:

Chvostek's sign, indicating hypocalcemia
Trousseau's sign, indicating hypocalcemia (Correct answer)
Homans' sign, indicating thrombosis
Kernig's sign, indicating meningeal irritation

Correct answer: Trousseau's sign, indicating hypocalcemia

Trousseau's sign is carpal spasm elicited by inflating a BP cuff above systolic pressure for 3 minutes, indicating hypocalcemia from parathyroid injury.

Question 74: A patient presents with severe hyponatremia (sodium 118 mEq/L) and altered mental status. Which nursing intervention is the highest priority?

Encourage increased dietary sodium intake
Administer oral sodium supplements
Increase the IV infusion rate of 0.9% NaCl
Restrict free water and notify the physician for possible hypertonic saline administration (Correct answer)

Correct answer: Restrict free water and notify the physician for possible hypertonic saline administration

Severe symptomatic hyponatremia requires immediate free water restriction and urgent physician notification for potential hypertonic saline to prevent progressive cerebral edema and brainstem herniation.

Question 75: A nurse notes that a patient's morning potassium is 3.0 mEq/L. The patient is also taking digoxin. The nurse should:

Administer the digoxin with orange juice to boost potassium
Hold the digoxin and notify the provider of the potassium level (Correct answer)
Administer the digoxin and recheck potassium in 4 hours
Administer the digoxin since 3.0 mEq/L is only mildly low

Correct answer: Hold the digoxin and notify the provider of the potassium level

Hypokalemia increases sensitivity to digoxin toxicity; the medication should be withheld and the provider notified for potassium correction orders.

Question 76: Which finding in a 24-hour urine collection indicates nephrotic-range proteinuria?

Protein excretion of 1.0 g/day
Protein excretion of 2.5 g/day
Protein excretion >3.5 g/day (Correct answer)
Protein excretion of 150 mg/day

Correct answer: Protein excretion >3.5 g/day

Nephrotic syndrome is defined by proteinuria exceeding 3.5 g/day in adults, reflecting significant glomerular damage.

Question 77: Which ethical principle requires MSNCB professionals to act in the patient's best interest?

Beneficence (Correct answer)
Justice
Autonomy
Fidelity

Correct answer: Beneficence

Beneficence is the ethical principle that obligates healthcare professionals to act in ways that promote the well-being and best interests of the patient.

Question 78: A patient on a ventilator has a sudden high-pressure alarm with decreased breath sounds on the left. The nurse's immediate action is to:

Increase the FiO2 to 1.0
Increase the tidal volume setting
Silence the alarm and continue monitoring
Assess for right mainstem bronchus intubation or pneumothorax (Correct answer)

Correct answer: Assess for right mainstem bronchus intubation or pneumothorax

High-pressure alarm with unilateral absent breath sounds indicates either ET tube migration into the right mainstem bronchus or left-sided pneumothorax, both requiring urgent assessment.

Question 79: Which finding on CT scan would CONTRAINDICATE administration of tPA for acute stroke?

Absence of hemorrhage
Large hyperdense area indicating intracranial hemorrhage (Correct answer)
Small area of hypodensity in basal ganglia
Subtle loss of gray-white matter differentiation

Correct answer: Large hyperdense area indicating intracranial hemorrhage

Intracranial hemorrhage on CT is an absolute contraindication to tPA because the thrombolytic would worsen the bleeding.

Question 80: A patient with osteoporosis is prescribed alendronate (Fosamax). Which teaching point is essential?

Take the medication at bedtime with a full glass of milk
Remain upright for at least 30 minutes after taking the medication (Correct answer)
Take the medication with food to avoid GI upset
Crush the tablet and mix with juice for better absorption

Correct answer: Remain upright for at least 30 minutes after taking the medication

Bisphosphonates must be taken with plain water on an empty stomach, and the patient must remain upright for 30 minutes to prevent esophageal erosion.

Question 81: Which electrolyte imbalance is MOST commonly associated with hyperaldosteronism (Conn's syndrome)?

Hypokalemia and hypernatremia (Correct answer)
Hypomagnesemia and hyperchloremia
Hyperphosphatemia and hypocalcemia
Hyperkalemia and hyponatremia

Correct answer: Hypokalemia and hypernatremia

Excess aldosterone promotes sodium retention and potassium excretion, resulting in hypokalemia and hypernatremia with resultant hypertension.

Question 82: In MSNCB practice, when should a patient's condition be reassessed?

At regular intervals and when status changes (Correct answer)
Only at admission and discharge
Only when the patient requests it
Once per week

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 83: A post-operative patient is prescribed patient-controlled analgesia (PCA) with morphine. Which nursing action is essential for safe PCA management?

Encourage the patient to press the button before pain becomes severe
Assess pain and sedation level every 1–2 hours (Correct answer)
Set the lockout interval to 5 minutes for adequate pain control
Allow family members to press the PCA button if the patient is sleeping

Correct answer: Assess pain and sedation level every 1–2 hours

Regular assessment of pain and sedation level every 1–2 hours is essential to detect early signs of opioid-induced respiratory depression with PCA therapy.

Question 84: Which approach to respiratory care is considered best practice in current MSNCB standards?

Traditional methods exclusively
The least expensive option
Evidence-based, individualized interventions (Correct answer)
One-size-fits-all protocols

Correct answer: Evidence-based, individualized interventions

Evidence-based, individualized interventions combine the best available research with patient-specific factors for optimal outcomes.

Question 85: Which laboratory value best reflects the adequacy of hemodialysis treatment?

Serum albumin level
Urine specific gravity
Kt/V ratio (Correct answer)
Serum creatinine level

Correct answer: Kt/V ratio

The Kt/V ratio (dialyzer clearance × time / urea volume of distribution) is the standard measure of hemodialysis adequacy; a target of ≥1.2 is recommended.

Question 86: A nurse is educating a patient about modifiable risk factors for cardiovascular disease. Which factor is classified as non-modifiable?

Physical inactivity
Hyperlipidemia
Family history of heart disease (Correct answer)
Hypertension

Correct answer: Family history of heart disease

Family history (genetics) is a non-modifiable cardiovascular risk factor, unlike hypertension, hyperlipidemia, and inactivity, which can be changed.

Question 87: A patient refuses a blood transfusion for religious reasons but consents to the scheduled surgery. How should the perioperative nurse respond?

Obtain consent from the patient's next of kin to override the refusal
Document the refusal, notify the team, and respect the patient's decision (Correct answer)
Contact hospital administration to seek a court order
Administer blood only if the patient becomes hemodynamically unstable

Correct answer: Document the refusal, notify the team, and respect the patient's decision

Competent adult patients have the right to refuse treatment, including blood transfusions; this decision must be respected and clearly documented.

Question 88: When applying electrosurgical unit (ESU) grounding pad to a patient, which site is most appropriate?

Over a site with a tattoo for better conductivity
Over well-vascularized muscle mass close to the operative site (Correct answer)
On the patient's back regardless of the surgical site
Over a bony prominence such as the hip

Correct answer: Over well-vascularized muscle mass close to the operative site

The ESU grounding pad should be placed on a well-vascularized, fleshy area close to the operative site to ensure even current distribution and prevent burns.

Question 89: What role does calibration play in maintaining technical accuracy for Medical-Surgical Nursing Certification Board professionals?

It only matters during formal inspections
It is only necessary for new equipment
It is an optional best practice for advanced professionals
It ensures instruments and methods produce accurate, consistent results over time (Correct answer)

Correct answer: It ensures instruments and methods produce accurate, consistent results over time

Regular calibration ensures that instruments, tools, and methods continue to produce accurate and consistent results over time. Without calibration, measurement drift and equipment wear can lead to unreliable outcomes.

Question 90: A nurse is assessing fall risk in a hospitalized 78-year-old patient. Which intervention is considered primary prevention of fall-related injury in this population?

Placing a fall alert bracelet after the patient falls
Administering calcium supplements only after a fracture
Non-slip footwear, bed alarms, and hourly rounding before any fall occurs (Correct answer)
Completing a bone density scan post-fall

Correct answer: Non-slip footwear, bed alarms, and hourly rounding before any fall occurs

Primary prevention of falls involves implementing measures—such as non-slip footwear, bed alarms, and rounding—before a fall event occurs.

Question 91: A patient with GERD is prescribed omeprazole. The nurse should instruct the patient to take this medication:

At bedtime with a full glass of water
30–60 minutes before the first meal of the day (Correct answer)
With food to reduce GI upset
As needed when heartburn symptoms occur

Correct answer: 30–60 minutes before the first meal of the day

Proton pump inhibitors are most effective when taken 30–60 minutes before a meal so the drug is active when acid pumps are stimulated.

Question 92: A patient post-ischemic stroke develops unilateral neglect. Which nursing intervention best addresses this deficit?

Approach the patient only from the unaffected side
Place objects on the affected side and teach the patient to scan toward it (Correct answer)
Place all objects on the unaffected side to ensure patient can see them
Patch the eye on the affected side to encourage use of the other eye

Correct answer: Place objects on the affected side and teach the patient to scan toward it

Rehabilitation for unilateral neglect focuses on training the patient to consciously scan toward the affected side, placing items there to encourage awareness.

Question 93: Which nursing action is essential before drawing blood from the arm with an AV fistula?

Apply a tourniquet above the fistula to enhance venous access
Use the fistula as a preferred site for IV access
Draw blood slowly through the fistula needle
Avoid all venipuncture and blood pressure measurements in that arm (Correct answer)

Correct answer: Avoid all venipuncture and blood pressure measurements in that arm

The arm with an AV fistula must be protected from venipuncture, BP cuffs, and IVs to preserve the access site and prevent damage or thrombosis.

Question 94: Which approach to renal nursing is considered best practice in current MSNCB standards?

Traditional methods exclusively
The least expensive option
Evidence-based, individualized interventions (Correct answer)
One-size-fits-all protocols

Correct answer: Evidence-based, individualized interventions

Evidence-based, individualized interventions combine the best available research with patient-specific factors for optimal outcomes.

Question 95: When educating a patient newly prescribed lisinopril, the nurse should instruct the patient to report which adverse effect?

Peripheral edema
Dry, persistent cough (Correct answer)
Increased urination
Photosensitivity

Correct answer: Dry, persistent cough

ACE inhibitors like lisinopril commonly cause a dry, nonproductive cough due to bradykinin accumulation in the lungs.

Question 96: Why is medication management important in nursing care?

To reduce the time spent on patient assessments
To ensure patients receive the correct medications and dosages for effective treatment (Correct answer)
To increase the number of medications prescribed
To limit patient involvement in treatment decisions

Correct answer: To ensure patients receive the correct medications and dosages for effective treatment

Medication management is a critical aspect of nursing care focused on patient safety and therapeutic efficacy. It involves ensuring the 'five rights' of medication administration (right patient, drug, dose, route, time) to prevent errors, optimize treatment outcomes, and minimize adverse drug events. Proper management ensures patients receive the correct medications for effective treatment.

Question 97: A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L. Which dietary instruction is the priority?

Avoid high-potassium foods such as bananas and oranges (Correct answer)
Limit sodium to 2 g/day
Increase fluid intake to flush excess potassium
Restrict phosphorus-containing foods

Correct answer: Avoid high-potassium foods such as bananas and oranges

Hyperkalemia (K+ >5.5 mEq/L) is life-threatening; dietary restriction of high-potassium foods is the priority nursing intervention.

Question 98: Why is health promotion essential in nursing?

To encourage healthier behaviors and prevent disease (Correct answer)
To limit the need for patient education
To increase healthcare costs
To reduce the number of hospital admissions

Correct answer: To encourage healthier behaviors and prevent disease

Health promotion is essential in nursing because it focuses on empowering individuals and communities to take control over their health. By encouraging healthier behaviors, such as good nutrition, regular exercise, and stress management, nurses can help prevent the onset of diseases. This proactive approach leads to improved quality of life and reduced healthcare burdens.

Question 99: Which oxygen delivery system provides the most precise FiO2 for a patient with chronic hypercapnia?

Venturi mask (Correct answer)
Nasal cannula at 4 L/min
Non-rebreather mask at 15 L/min
Simple face mask at 8 L/min

Correct answer: Venturi mask

The Venturi mask delivers a precise, controlled FiO2 regardless of patient breathing pattern, essential for patients with chronic CO2 retention.

Question 100: Which diet modification is most appropriate for a patient with diverticulosis (no active diverticulitis)?

Low-fiber, low-residue diet
Clear liquid diet long-term
High-fiber diet with adequate fluid intake (Correct answer)
High-protein, low-carbohydrate diet

Correct answer: High-fiber diet with adequate fluid intake

A high-fiber diet softens stool and reduces intraluminal pressure, decreasing the risk of diverticular inflammation.

Question 101: Which stool characteristic is most associated with an upper GI bleed?

Tarry, black, malodorous stool (Correct answer)
Clay-colored stool
Ribbon-shaped stool
Bright red blood per rectum

Correct answer: Tarry, black, malodorous stool

Melena (tarry, black, malodorous stool) results from digestion of blood as it transits the GI tract from an upper source.

Question 102: A patient is receiving continuous passive motion (CPM) therapy after TKA. The patient requests to stop due to pain. The nurse should:

Stop CPM, administer prescribed analgesic, and restart after pain is controlled (Correct answer)
Discontinue CPM permanently and notify the surgeon
Increase CPM speed to complete the session faster
Ignore the request because CPM is essential for recovery

Correct answer: Stop CPM, administer prescribed analgesic, and restart after pain is controlled

Pain during CPM should be managed with analgesics before resuming; adequate pain control improves tolerance and outcomes.

Question 103: A patient with cirrhosis develops asterixis and confusion. The nurse anticipates which intervention as the priority?

Place a Salem sump tube for gastric decompression
Initiate lactulose therapy (Correct answer)
Restrict dietary sodium to 2 g/day
Administer furosemide IV

Correct answer: Initiate lactulose therapy

Lactulose reduces intestinal ammonia absorption and is the first-line treatment for hepatic encephalopathy.

Question 104: The six rights of medication administration include the right patient, drug, dose, route, time, and which sixth right?

Right diagnosis
Right documentation (Correct answer)
Right practitioner
Right indication

Correct answer: Right documentation

The sixth right of medication administration is right documentation, which ensures accurate recording after administration to prevent duplicate dosing.

Question 105: A patient taking glucocorticoids long-term should be monitored for which common adverse effect related to glucose metabolism?

Improved glycemic control in existing diabetics
Steroid-induced hyperglycemia or diabetes (Correct answer)
Hypoglycemia due to increased insulin sensitivity
Hypoglycemia due to suppressed glucagon secretion

Correct answer: Steroid-induced hyperglycemia or diabetes

Glucocorticoids antagonize insulin action and stimulate hepatic gluconeogenesis, causing hyperglycemia and potentially steroid-induced diabetes.

Question 106: Which documentation practice BEST demonstrates regulatory compliance for MSNCB certified professionals?

Maintaining organized, dated, and signed records of all activities, training, and incidents (Correct answer)
Keeping informal handwritten notes
Filing documents only when audited
Relying on memory for routine procedures

Correct answer: Maintaining organized, dated, and signed records of all activities, training, and incidents

Question 107: A patient on skeletal traction asks why weights cannot be removed for comfort. The correct nursing explanation is:

Weights can be temporarily removed during meals only
Removing weights prevents nerve damage
Weights are removed only during physical therapy
Weights must remain continuous to maintain bone alignment and prevent muscle spasm (Correct answer)

Correct answer: Weights must remain continuous to maintain bone alignment and prevent muscle spasm

Continuous traction is essential; interruption allows bone fragments to override and muscle spasm to recur, negating the therapeutic effect.

Question 108: A patient is scheduled for a barium enema. Which pre-procedure instruction is most important?

Complete a bowel prep with laxatives and clear liquid diet (Correct answer)
Fast for 12 hours with nothing by mouth after midnight
Avoid aspirin and NSAIDs for one week prior
Maintain a full liquid diet for 48 hours before the procedure

Correct answer: Complete a bowel prep with laxatives and clear liquid diet

Thorough bowel cleansing is essential for a barium enema to ensure adequate visualization of the colon.

Question 109: A nurse is teaching a patient about taking oral iron supplements. Which instruction will maximize iron absorption?

Take iron with milk to reduce gastrointestinal irritation
Take iron with coffee or tea to improve tolerability
Take iron with calcium-rich foods to enhance bioavailability
Take iron with a glass of orange juice on an empty stomach (Correct answer)

Correct answer: Take iron with a glass of orange juice on an empty stomach

Vitamin C in orange juice enhances non-heme iron absorption, and taking iron on an empty stomach maximizes gastrointestinal uptake despite potential GI upset.

Question 110: A patient with Cushing's syndrome would be expected to exhibit which combination of findings?

Hypoglycemia, muscle weakness, and bronze skin
Hypertension, central obesity, and purple striae (Correct answer)
Hypotension, weight loss, and hyperpigmentation
Bradycardia, hair loss, and dry skin

Correct answer: Hypertension, central obesity, and purple striae

Cushing's syndrome is caused by excess cortisol and presents with hypertension, central obesity, moon face, buffalo hump, and purple striae.

Question 111: Which instruction is MOST important for a patient newly diagnosed with diabetes insipidus being discharged on desmopressin (DDAVP)?

Take the medication with a full glass of orange juice
Avoid all physical activity while on this medication
Monitor daily weight and report gains of more than 2 lbs (Correct answer)
Increase sodium intake to compensate for urinary losses

Correct answer: Monitor daily weight and report gains of more than 2 lbs

DDAVP can cause fluid retention and dilutional hyponatremia; daily weight monitoring helps detect early signs of water intoxication.

Question 112: A patient's HbA1c is reported as 9.2%. Which average blood glucose level does this BEST correspond to?

Approximately 180 mg/dL
Approximately 212 mg/dL (Correct answer)
Approximately 154 mg/dL
Approximately 126 mg/dL

Correct answer: Approximately 212 mg/dL

An HbA1c of 9.2% corresponds to an estimated average glucose (eAG) of approximately 212 mg/dL over the prior 2-3 months.

Question 113: A nurse is caring for a patient 6 hours post-appendectomy who develops a rigid, board-like abdomen and reports pain rated 9/10. Temperature is 38.7°C. Which complication does the nurse MOST suspect?

Anastomotic leak
Wound dehiscence
Paralytic ileus
Peritonitis from bowel perforation (Correct answer)

Correct answer: Peritonitis from bowel perforation

A board-like rigid abdomen with fever and severe pain post-appendectomy suggests peritonitis, a surgical emergency requiring immediate physician notification.

Question 114: When using the CIWA-Ar scale to assess alcohol withdrawal, which symptom is included in the scoring?

Bradycardia, hypothermia, and lethargy
Tremor, diaphoresis, and perceptual disturbances (Correct answer)
Hypoglycemia, seizures, and urinary retention
Tachypnea, chest pain, and diaphoresis

Correct answer: Tremor, diaphoresis, and perceptual disturbances

CIWA-Ar assesses 10 withdrawal signs including tremor, diaphoresis, anxiety, agitation, nausea/vomiting, headache, and perceptual disturbances.

Question 115: Which nursing intervention is highest priority when caring for a patient in the immediate postoperative period following a hemorrhoidectomy?

Apply a rectal tube to minimize pressure on the surgical site
Assess pain level and administer analgesics before bowel movements (Correct answer)
Encourage ambulation every 2 hours
Administer a Fleet enema to cleanse the operative area

Correct answer: Assess pain level and administer analgesics before bowel movements

Pain management prior to bowel movements is critical to prevent fecal retention, constipation, and wound dehiscence after hemorrhoidectomy.

Question 116: A patient with a C5 spinal cord injury is at greatest risk for which complication during the acute phase?

Deep vein thrombosis
Urinary tract infection
Pressure ulcer formation
Respiratory failure (Correct answer)

Correct answer: Respiratory failure

A C5 injury affects the phrenic nerve (C3-C5), significantly impairing diaphragm function and placing the patient at high risk for respiratory failure.

Question 117: A patient with a cervical spine injury is placed in halo traction. Which nursing action is the priority?

Ensure a wrench is taped to the halo vest at all times for emergency vest removal (Correct answer)
Remove the vest daily for skin inspection
Encourage the patient to rotate their neck slowly for range of motion
Pad the halo ring for patient comfort

Correct answer: Ensure a wrench is taped to the halo vest at all times for emergency vest removal

A wrench must be immediately accessible to remove the halo vest during cardiopulmonary resuscitation.

Question 118: Which ethical principle requires MSNCB professionals to act in the patient's best interest?

Autonomy
Fidelity
Beneficence (Correct answer)
Justice

Correct answer: Beneficence

Beneficence is the ethical principle that obligates healthcare professionals to act in ways that promote the well-being and best interests of the patient.

Question 119: A patient 2 days post-open appendectomy reports the urge to defecate but passes only flatus. The nurse's best response is:

Administer a prescribed laxative immediately
Insert a rectal tube to facilitate gas expulsion
Report to the surgeon as this suggests anastomotic failure
Reassure the patient that flatus indicates return of bowel function (Correct answer)

Correct answer: Reassure the patient that flatus indicates return of bowel function

Passage of flatus signals the return of peristalsis and is a normal, expected finding that should be encouraged and celebrated in postoperative patients.

Question 120: In MSNCB practice, when should a patient's condition be reassessed?

At regular intervals and when status changes (Correct answer)
Only at admission and discharge
Only when the patient requests it
Once per week

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 121: In MSNCB practice, when should a patient's condition be reassessed?

At regular intervals and when status changes (Correct answer)
Once per week
Only when the patient requests it
Only at admission and discharge

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 122: Which laboratory finding is MOST consistent with primary hypothyroidism?

High TSH and high T4
High TSH and low T4 (Correct answer)
Low TSH and low T4
Low TSH and high T4

Correct answer: High TSH and low T4

Primary hypothyroidism is characterized by elevated TSH (pituitary compensation) and low T4 due to inadequate thyroid gland function.

Question 123: A nurse is screening a 45-year-old female patient for depression in the outpatient med-surg setting. Which tool is the most widely validated and recommended for adult depression screening?

Hamilton Depression Rating Scale (HAM-D)
Beck Depression Inventory (BDI-II) clinician version
Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
Center for Epidemiologic Studies Depression Scale (CES-D)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is the most widely validated, brief, and recommended screening tool for depression in adult primary and outpatient care settings.

Question 124: A patient with type 2 diabetes is ordered a fasting lipid panel. The nurse knows the patient's LDL target should be less than:

160 mg/dL
100 mg/dL (Correct answer)
200 mg/dL
130 mg/dL

Correct answer: 100 mg/dL

ADA guidelines recommend LDL <100 mg/dL for most patients with diabetes, or <70 mg/dL for those with cardiovascular disease.

Question 125: A patient with a new ileostomy reports watery output of 2,500 mL in 24 hours. The nurse's priority action is to:

Assess for signs of dehydration and electrolyte imbalance (Correct answer)
Apply a larger ostomy pouch
Administer a bulk-forming laxative
Increase dietary fiber intake

Correct answer: Assess for signs of dehydration and electrolyte imbalance

High ileostomy output >2,000 mL/day places the patient at risk for dehydration, hyponatremia, and hypokalemia.

Question 126: A patient with chronic kidney disease has a serum potassium of 5.8 mEq/L. Which dietary instruction is the most important priority?

Avoid high-potassium foods such as bananas, oranges, and potatoes (Correct answer)
Increase intake of bananas and oranges
Increase sodium intake to balance potassium levels
Restrict protein intake only

Correct answer: Avoid high-potassium foods such as bananas, oranges, and potatoes

CKD impairs renal potassium excretion; restricting high-potassium foods is essential to prevent hyperkalemia from rising to levels that cause fatal cardiac arrhythmias.

Question 127: A nurse assesses a patient post-liver transplant who is receiving tacrolimus. Which finding requires immediate notification of the provider?

Mild hand tremors
Headache rated 3/10
Serum creatinine rising from 0.9 to 2.4 mg/dL over 48 hours (Correct answer)
Blood glucose of 130 mg/dL

Correct answer: Serum creatinine rising from 0.9 to 2.4 mg/dL over 48 hours

A rapid rise in serum creatinine indicates tacrolimus nephrotoxicity or acute rejection, both requiring urgent evaluation.

Question 128: Which acid-base disturbance is most characteristic of ESRD?

Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis with elevated anion gap (Correct answer)
Metabolic alkalosis

Correct answer: Metabolic acidosis with elevated anion gap

ESRD impairs renal acid excretion and bicarbonate regeneration, resulting in high anion gap metabolic acidosis.

Question 129: Which sign or symptom indicates uremic encephalopathy in a patient with ESRD?

Polydipsia
Pruritus without neurological changes
Asterixis and confusion (Correct answer)
Peripheral neuropathy only

Correct answer: Asterixis and confusion

Asterixis (flapping tremor) and altered mental status are classic neurological manifestations of uremia affecting the central nervous system.

Question 130: A nurse is assessing a patient with suspected appendicitis. Which finding is described as Rovsing's sign?

RLQ pain elicited by elevation of the right leg against resistance
Pain in the RLQ when the left lower quadrant is palpated (Correct answer)
Tenderness at McBurney's point on direct palpation
Increased RLQ pain with internal rotation of the right hip

Correct answer: Pain in the RLQ when the left lower quadrant is palpated

Rovsing's sign is RLQ pain that occurs when pressure is applied to the left lower quadrant, suggesting peritoneal irritation.

Question 131: A patient with chronic liver disease has a serum albumin of 2.0 g/dL. The nurse understands this contributes to ascites primarily because:

Decreased albumin reduces osmotic pressure, allowing fluid to shift into the peritoneal cavity (Correct answer)
Low albumin directly stimulates aldosterone release
Albumin deficiency impairs bile acid synthesis
Decreased albumin increases portal venous resistance

Correct answer: Decreased albumin reduces osmotic pressure, allowing fluid to shift into the peritoneal cavity

Low serum albumin decreases oncotic pressure, shifting fluid from the vascular space into the peritoneal cavity.

Question 132: The nurse notes fat globules in the urine of a patient with a long bone fracture. This finding is associated with:

Fat embolism syndrome (Correct answer)
Deep vein thrombosis
Pulmonary edema
Rhabdomyolysis

Correct answer: Fat embolism syndrome

Lipuria (fat in urine) along with petechiae and neurological changes are classic signs of fat embolism syndrome after long bone fractures.

Question 133: Which fluid assessment technique is most appropriate to monitor fluid status in a hemodialysis patient between sessions?

Daily weight measurement (Correct answer)
Central venous pressure monitoring
Serum sodium levels every 6 hours
Daily urine output measurement

Correct answer: Daily weight measurement

Daily weight is the most reliable and practical method to assess fluid accumulation between hemodialysis sessions in anuric or oliguric patients.

Question 134: What is the BEST way for a Medical-Surgical Nursing Certification Board professional to stay current with regulatory changes?

Actively monitor regulatory bodies, attend continuing education, and participate in professional associations (Correct answer)
Depend on colleagues to share updates informally
Check regulations only during certification renewal
Rely solely on employer notifications

Correct answer: Actively monitor regulatory bodies, attend continuing education, and participate in professional associations

Staying current requires a multi-faceted approach: monitoring regulatory agencies directly, attending relevant continuing education programs, and participating in professional associations that disseminate regulatory updates.

Question 135: Which finding in a patient receiving mechanical ventilation indicates ventilator-associated pneumonia (VAP)?

New infiltrate on chest X-ray with purulent secretions and fever >38.3°C (Correct answer)
Respiratory rate of 18 breaths per minute
PEEP requirement of 5 cmH2O
SpO2 of 94% on FiO2 0.40

Correct answer: New infiltrate on chest X-ray with purulent secretions and fever >38.3°C

VAP is diagnosed by new or worsening radiographic infiltrate plus at least two of: fever, leukocytosis, and purulent secretions.

Question 136: A patient with esophageal varices undergoes endoscopic band ligation. In the immediate post-procedure period, the nurse should prioritize monitoring for:

Aspiration pneumonia
Re-bleeding and hematemesis (Correct answer)
Esophageal stricture formation
Spontaneous bacterial peritonitis

Correct answer: Re-bleeding and hematemesis

Re-bleeding is the most immediate life-threatening complication following esophageal variceal banding.

Question 137: A patient with nephrotic syndrome presents with pitting edema, proteinuria >3.5 g/day, and hypoalbuminemia. Which mechanism best explains the edema?

Increased oncotic pressure from excess albumin
Decreased oncotic pressure due to protein loss in urine (Correct answer)
Elevated hydrostatic pressure from hypertension
Lymphatic obstruction caused by renal inflammation

Correct answer: Decreased oncotic pressure due to protein loss in urine

Massive proteinuria depletes serum albumin, reducing oncotic pressure and allowing fluid to shift into the interstitial space.

Question 138: A patient with a subarachnoid hemorrhage suddenly develops worsening headache, photophobia, and neck stiffness. Which complication is most likely occurring?

Rebleeding (Correct answer)
Hydrocephalus
Cerebral vasospasm
Hyponatremia

Correct answer: Rebleeding

Sudden worsening of headache after subarachnoid hemorrhage is the classic sign of rebleeding, the most dangerous early complication.

Question 139: What is the first priority in gastrointestinal nursing for MSNCB practitioners?

Completing documentation
Following insurance requirements
Ensuring patient safety and well-being (Correct answer)
Meeting productivity targets

Correct answer: Ensuring patient safety and well-being

Patient safety and well-being must always be the first priority in clinical practice, taking precedence over administrative concerns.

Question 140: A nurse assesses paradoxical breathing in a trauma patient. This pattern is MOST consistent with which condition?

Pulmonary embolism
Flail chest (Correct answer)
Spontaneous pneumothorax
Pleural effusion

Correct answer: Flail chest

Flail chest occurs when multiple rib fractures create a free-floating segment that moves inward during inhalation and outward during exhalation (paradoxical movement).

Question 141: What is the most important factor in effective communication with patients regarding renal nursing?

Using clear, understandable language and confirming understanding (Correct answer)
Speaking quickly to save time
Using medical jargon to appear professional
Providing written instructions only

Correct answer: Using clear, understandable language and confirming understanding

Clear communication in understandable language, with confirmation of understanding, improves patient compliance and outcomes.

Question 142: A scrub nurse accidentally contaminates a glove during surgery. What is the correct immediate response?

Wipe the glove with a sterile gauze and continue
Request a glove change and re-establish sterility before continuing (Correct answer)
Notify the surgeon and wait for their instruction
Apply a sterile drape over the contaminated hand

Correct answer: Request a glove change and re-establish sterility before continuing

Any break in sterile technique requires immediate correction by changing the contaminated glove to prevent introducing microorganisms to the surgical field.

Question 143: When performing endotracheal suctioning, the nurse should limit each suction pass to a maximum of how many seconds?

20–25 seconds
10–15 seconds (Correct answer)
5 seconds
30 seconds

Correct answer: 10–15 seconds

Suctioning beyond 10–15 seconds risks hypoxemia, dysrhythmias, and mucosal trauma; pre- and post-oxygenation with 100% O2 is also required.

Question 144: A patient with acute kidney injury (AKI) has a urine output of 25 mL/hour for the past 3 hours. How should the nurse classify this finding?

Oliguria requiring evaluation (Correct answer)
Normal urine output
Polyuria suggesting recovery phase
Anuria requiring urgent intervention

Correct answer: Oliguria requiring evaluation

Oliguria is defined as urine output <0.5 mL/kg/hr or <30 mL/hr in adults, warranting prompt clinical evaluation.

Question 145: Which intervention best prevents aspiration when administering a tube feeding via nasogastric tube?

Clamp the tube for 30 minutes after each intermittent feeding
Administer feedings in the supine position to promote gastric emptying
Use a large-bore tube to allow for rapid delivery
Verify tube placement with pH testing of aspirate before each feeding (Correct answer)

Correct answer: Verify tube placement with pH testing of aspirate before each feeding

Confirming tube placement by measuring the pH of gastric aspirate (pH ≤5.5) helps ensure the tube is in the stomach before feeding.

Question 146: A nurse is caring for a patient with liver cirrhosis who becomes increasingly confused and drowsy. Which assessment finding would MOST support the development of hepatic encephalopathy?

Bilateral pitting edema in lower extremities
Caput medusae on the abdomen
Asterixis (flapping tremor) on hand extension (Correct answer)
Spider angiomata on the chest wall

Correct answer: Asterixis (flapping tremor) on hand extension

Asterixis is a hallmark sign of hepatic encephalopathy caused by impaired ammonia metabolism affecting the brain.

Question 147: A patient's telemetry shows P waves that are upright in lead II, a PR interval of 0.24 seconds, and a QRS of 0.08 seconds. This rhythm is best described as:

Second-degree AV block, Mobitz type I
Bundle branch block with prolonged conduction
Junctional rhythm with retrograde P waves
First-degree atrioventricular block (Correct answer)

Correct answer: First-degree atrioventricular block

A PR interval greater than 0.20 seconds with consistent 1:1 AV conduction and normal QRS indicates first-degree AV block.

Question 148: A nurse is assessing a patient's alcohol consumption. The patient reports drinking 5 or more standard drinks on a single occasion at least once per week. How should the nurse classify this behavior?

Binge drinking (Correct answer)
Moderate drinking
Social drinking within safe limits
Heavy alcohol use disorder

Correct answer: Binge drinking

Binge drinking is defined by NIAAA as consuming 4+ drinks (women) or 5+ drinks (men) on a single occasion, bringing blood alcohol to ≥0.08 g/dL.

Question 149: Which intervention is the PRIORITY for a patient in thyroid storm (thyrotoxic crisis)?

Administer radioactive iodine therapy
Apply warming blankets to treat hypothermia
Administer propylthiouracil (PTU) and propranolol (Correct answer)
Prepare patient for immediate thyroidectomy

Correct answer: Administer propylthiouracil (PTU) and propranolol

Thyroid storm treatment prioritizes blocking new thyroid hormone synthesis with PTU and controlling sympathetic symptoms with propranolol.

Question 150: A nurse is assessing mental status using the MMSE. A patient with a score of 18/30 would be classified as having:

Moderate-to-severe cognitive impairment
Mild cognitive impairment (Correct answer)
Normal cognitive function
Severe cognitive impairment

Correct answer: Mild cognitive impairment

MMSE scores of 18–23 indicate mild cognitive impairment; scores below 18 suggest moderate-to-severe impairment.

Question 151: A nurse notes that a patient's pulse oximetry reads 98% but the patient appears cyanotic and confused. Which condition best explains this discrepancy?

Sensor malfunction due to nail polish
Carbon monoxide poisoning falsely elevating SpO2 (Correct answer)
Methemoglobinemia causing actual hypoxia
Peripheral arterial disease causing poor perfusion

Correct answer: Carbon monoxide poisoning falsely elevating SpO2

Standard pulse oximetry cannot differentiate carboxyhemoglobin from oxyhemoglobin, so CO poisoning reads falsely normal while the patient is actually hypoxic.

CMSRN® Certification Exam (Certified Medical-Surgical Registered Nurse)

The CMSRN® certification validates the clinical knowledge and expertise of registered nurses working in medical-surgical settings.

150

Questions

180 min

Time Limit

95%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds