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

Question 1: A patient is prescribed heparin infusion. Which antidote should the nurse have readily available?

Phytonadione
Fresh frozen plasma
Vitamin K
Protamine sulfate (Correct answer)

Correct answer: Protamine sulfate

Protamine sulfate is the specific antidote for heparin overdose, neutralizing its anticoagulant effect.

Question 2: During the immediate postoperative period after a lung transplant, which assessment finding requires the MOST urgent nursing intervention?

Pain rating of 6 out of 10
Temperature of 99.2°F (37.3°C)
Urine output of 40 mL/hour
Oxygen saturation dropping to 88% on 2L nasal cannula (Correct answer)

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

A significant drop in oxygen saturation in a new lung transplant patient may indicate primary graft dysfunction or airway complications requiring immediate intervention.

Question 3: Which position is best for a spontaneously breathing patient with unilateral pneumonia to improve oxygenation?

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

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 4: 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?

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

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

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

Correct answer: Factor VIII concentrate

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

Question 6: 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)
Give vitamin C to lower the INR
Administer the next scheduled warfarin dose as ordered
Administer protamine sulfate immediately

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.

Question 7: 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
Bacterial pneumonia
Acute cellular rejection (Correct answer)
Primary graft dysfunction

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 8: A patient with chronic anemia has a hemoglobin of 6.5 g/dL and reports dyspnea on minimal exertion. After transfusion is initiated, which assessment finding indicates a transfusion-related circulatory overload (TACO)?

Fever and rigors
New onset crackles and hypertension (Correct answer)
Wheezing and hypotension
Urticaria and pruritus

Correct answer: New onset crackles and hypertension

TACO presents with pulmonary edema signs including crackles, hypertension, and respiratory distress from fluid volume overload.

Question 9: Which type of allograft rejection occurs within minutes to hours after reperfusion and is caused by preformed donor-specific antibodies?

Chronic rejection
Accelerated acute rejection
Hyperacute rejection (Correct answer)
Acute humoral rejection

Correct answer: Hyperacute rejection

Hyperacute rejection is mediated by preformed anti-donor antibodies that activate complement immediately upon reperfusion, causing irreversible thrombosis.

Question 10: On the day of operation, a patient with type 2 diabetes mellitus is admitted, and their glucose level is 610 mg/dl. The patient may be at risk for the following, according to the perianesthesia nurse:

Hyperkalemia (Correct answer)
Hyperalcemia
Diabetic Inspidu
Diabetic Ketoacidosis

Correct answer: Hyperkalemia

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

Question 11: A patient with a new diagnosis of heart failure has a B-type natriuretic peptide (BNP) level of 1,200 pg/mL. How should the nurse interpret this result?

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

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

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

Question 12: A patient with a chest tube has continuous bubbling in the water seal chamber. What should the nurse do first?

Check all tubing connections for air leaks (Correct answer)
Clamp the chest tube at the insertion site
Notify the healthcare provider immediately
Increase the suction pressure

Correct answer: Check all tubing connections for air leaks

Continuous bubbling in the water seal chamber indicates an air leak, and the nurse should systematically check connections before escalating.

Question 13: Three days ago, the patient under the nurse's care underwent kidney transplant surgery. Urine levels drop suddenly and abruptly, as noted by the nurse. When thrombosis is detected, the nurse notifies the medical professional. Which priority idea is the foundation of this complexity?

Elimination
Cellular regulation
Infection
Perfusion (Correct answer)

Correct answer: Perfusion

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

Question 14: A nurse is preparing to administer a blood transfusion. Which action is essential before starting the infusion?

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

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

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

Question 15: In her health sciences class, 20-year-old Allison Lynn requests you to elaborate on the cause of Type I Diabetes's insulin shortage. You mention that this is the most widely accepted theory:

not enough insulin is made to manage the metabolic needs.
the insulin produced is not effective at the tissue level.
the body's immune system destroyed the cells that make insulin. (Correct answer)
inflammation of the pancreas causes irregular release of insulin.

Correct answer: the body's immune system destroyed the cells that make insulin.

Type 1 Diabetes Mellitus is an autoimmune disease where the body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This destruction leads to an absolute deficiency of insulin, which is essential for glucose uptake by cells. This autoimmune destruction is the most widely accepted theory for the cause of insulin shortage in Type 1 Diabetes.

Question 16: Intern Jane, age 24, was identified as having mitral stenosis. The nurse may discover the following in addition to hearing a murmur during the physical examination:

Angina
Dyspnea upon exertion
Jugular vein distention (Correct answer)
Syncope on exertion

Correct answer: Jugular vein distention

Explanation: The left atrium grows larger as a result of mitral stenosis, which eventually raises pulmonary pressure and causes jugular vein distention. Aortic valve anomalies are linked to dyspnea upon exercise and syncope upon exertion. Aortic stenosis is related to angina.

Question 17: A nurse is monitoring a patient after a cardiac catheterization via the femoral artery. Which finding requires immediate intervention?

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

Correct answer: A rapidly expanding hematoma at the insertion site

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

Question 18: A patient with heart failure is ordered furosemide 40 mg IV. Which laboratory value must be checked before administration?

Serum creatinine
Serum sodium
Serum potassium (Correct answer)
Blood urea nitrogen

Correct answer: Serum potassium

Furosemide is a loop diuretic that causes potassium wasting; baseline potassium must be checked because hypokalemia increases the risk of fatal cardiac dysrhythmias.

Question 19: A nurse who fails the CMSRN exam wishes to retake it. What is the minimum waiting period before retesting?

6 months
1 year
90 days (Correct answer)
30 days

Correct answer: 90 days

Candidates must wait a minimum of 90 days before retaking the CMSRN examination after a failed attempt.

Question 20: A patient with a chest tube has continuous bubbling in the water seal chamber. What does this indicate?

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

Correct answer: There is an air leak in the system

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

Question 21: After extubation in the PACU, a patient develops high-pitched inspiratory stridor and increasing respiratory distress. The MOST likely cause is:

Laryngospasm (Correct answer)
Bronchospasm
Tension pneumothorax
Pulmonary edema

Correct answer: Laryngospasm

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

Question 22: After receiving therapy for a heart illness, a 78-year-old patient is due to be discharged to their home. The patient will receive treatment at home from the patient's spouse, who has chronic obstructive pulmonary disease. The partner claims that their close adult children will lend a hand. Planning for discharge is best done by:

Arrange nursing home placement for the couple
Discuss community resources with the spouse and offer to make referrals (Correct answer)
Consult the spouse's healthcare provider about the spouse's ability to care for the patient
Contact the children to ascertain their commitment to help

Correct answer: Discuss community resources with the spouse and offer to make referrals

Explanation: The best approach to discharge planning in this case would be to discuss community resources with the spouse and offer to make referrals. It is important to assess the spouse's ability to provide care and support considering their own health condition of chronic obstructive pulmonary disease (COPD). Additionally, involving the grown children who live nearby can be beneficial for providing additional support.

Question 23: A patient with chronic kidney disease has a glomerular filtration rate of 12 mL/min. Which clinical manifestation should the nurse anticipate?

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

Correct answer: Uremic frost and pruritus

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

Question 24: Which position should the nurse place a patient in who is experiencing autonomic dysreflexia?

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

Correct answer: Sitting upright with legs dangling

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

Question 25: A patient is receiving epidural analgesia postoperatively. Which assessment finding requires immediate intervention?

Blood pressure 90/58 mmHg (Correct answer)
Pain score of 4/10
Respiratory rate of 14 breaths/min
Urine output of 35 mL/hr

Correct answer: Blood pressure 90/58 mmHg

Hypotension (BP 90/58) is a serious complication of epidural analgesia due to sympathetic blockade and requires immediate intervention.

Question 26: A patient on mechanical ventilation develops high peak airway pressures. What is the priority nursing assessment?

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

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 27: A patient with cirrhosis and esophageal varices should be monitored most closely for which immediate life-threatening complication?

Hepatic coma
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Massive upper GI hemorrhage (Correct answer)

Correct answer: Massive upper GI hemorrhage

Esophageal varices are thin-walled, dilated veins that can rupture suddenly and cause massive, rapidly fatal upper GI hemorrhage.

Question 28: A patient with pulmonary embolism (PE) is being treated with heparin infusion. Which lab value requires immediate dose adjustment?

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

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

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

Question 29: Which laboratory value is the most specific and sensitive marker the nurse would expect to be elevated in acute pancreatitis?

Serum bilirubin
Alkaline phosphatase
Alanine aminotransferase (ALT)
Serum lipase (Correct answer)

Correct answer: Serum lipase

Serum lipase is more specific for pancreatic injury than amylase and remains elevated longer, making it the preferred diagnostic marker for acute pancreatitis.

Question 30: A patient is 6 hours post-abdominal surgery and has not voided. Which assessment is most important before intervening?

Current pain level
Bladder scan for urinary retention (Correct answer)
Type of anesthesia used
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 31: Treatment for acute glomerulonephritis primarily aims to:

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

Correct answer: Maintain fluid balance

Explanation: 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 32: A patient with asthma is experiencing an acute exacerbation. What is the first-line medication the nurse should administer?

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

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

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

Correct answer: MSNCB CMSRN Exam Blueprint and Core Curriculum

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

Question 34: 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 should use an electric razor to reduce my risk of getting cut."
"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)

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

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

Correct answer: The cricoid cartilage to compress the esophagus

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

Question 36: Which finding on a chest X-ray is most consistent with pneumothorax?

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

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

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

Correct answer: Right coronary artery

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

Question 38: A patient with iron-deficiency anemia is started on oral ferrous sulfate. Which teaching point is most important?

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

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

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

Question 39: A medical-surgical nurse is caring for a patient admitted with an acute exacerbation of heart failure. Which of the following nursing diagnoses is the highest priority?

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

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

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

Question 40: A patient in the PACU has a respiratory rate of 6 breaths/min and is unresponsive 30 minutes after receiving fentanyl. What is the priority nursing intervention?

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

Correct answer: Administer naloxone IV

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

Question 41: Which type of wound healing occurs when a wound closes by granulation tissue filling a large tissue defect?

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

Correct answer: Secondary intention

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

Question 42: A patient with cirrhosis develops asterixis. This finding is most associated with which condition?

Portal hypertension
Hypoglycemia
Spontaneous bacterial peritonitis
Hepatic encephalopathy (Correct answer)

Correct answer: Hepatic encephalopathy

Asterixis (flapping tremor of the hands) is a classic sign of hepatic encephalopathy due to ammonia accumulation in the brain.

Question 43: You are watching your patient using the spirometry incentive. What kind of patient demonstration demonstrates to you that the patient knows how to operate the device correctly?

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

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

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

Question 44: A patient awaiting a liver transplant has a MELD score of 32. The nurse understands this score primarily reflects which factors?

AST, ALT, and alkaline phosphatase
Bilirubin, INR, and serum creatinine (Correct answer)
Albumin, ascites severity, and encephalopathy grade
Hemoglobin, platelet count, and ammonia level

Correct answer: Bilirubin, INR, and serum creatinine

The MELD score is calculated using serum bilirubin, INR, and creatinine to predict 90-day mortality and prioritize organ allocation.

Question 45: A patient with peripheral arterial disease reports leg pain that occurs with walking and is relieved by rest. The nurse documents this as:

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

Correct answer: Intermittent claudication

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

Question 46: When assessing level of consciousness using the Glasgow Coma Scale (GCS), which three components are evaluated?

Eye opening, pupillary response, orientation
Orientation, pupil size, reflex response
Eye opening, verbal response, motor response (Correct answer)
Pupil reaction, verbal response, motor response

Correct answer: Eye opening, verbal response, motor response

The GCS assesses eye opening (1–4), verbal response (1–5), and motor response (1–6), with a maximum score of 15 indicating full consciousness.

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

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

Correct answer: Clustering nursing care activities together

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

Question 48: Which parameter is the most accurate indicator of fluid resuscitation adequacy in a patient with burns covering 40% TBSA?

Mean arterial pressure above 65 mmHg
Central venous pressure of 8-12 mmHg
Heart rate below 100 beats/min
Urine output of 0.5-1 mL/kg/hr (Correct answer)

Correct answer: Urine output of 0.5-1 mL/kg/hr

Urine output of 0.5-1 mL/kg/hr is the gold-standard endpoint for Parkland formula fluid resuscitation in major burns, reflecting adequate renal perfusion.

Question 49: 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:

Acute cellular rejection
Bronchiolitis obliterans syndrome (chronic lung allograft dysfunction) (Correct answer)
Primary graft dysfunction
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 50: A patient with an acute MI reports sudden, severe midscapular tearing back pain. What complication should the nurse suspect first?

Aortic dissection (Correct answer)
Pulmonary embolism
Esophageal rupture
Pericarditis

Correct answer: Aortic dissection

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

Question 51: Which assessment finding in a patient 6 hours post-thyroidectomy requires the most urgent nursing intervention?

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

Correct answer: Tingling and numbness around the mouth and fingertips

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

Question 52: During the immediate postoperative period, a patient begins shivering uncontrollably. What is the priority nursing action?

Increase IV fluid rate
Apply warm blankets and active warming measures (Correct answer)
Notify the surgeon immediately
Administer antipyretic medication

Correct answer: Apply warm blankets and active warming measures

Postoperative shivering is commonly caused by hypothermia from operating room exposure; applying warm blankets is the priority intervention.

Question 53: A patient with ulcerative colitis is in a severe flare. Which finding most indicates the need for emergency surgical intervention?

Bloody diarrhea occurring more than 6 times per day
Hemoglobin of 10 g/dL with fatigue
Serum albumin level of 3.0 g/dL
Toxic megacolon with high fever and massive abdominal distension (Correct answer)

Correct answer: Toxic megacolon with high fever and massive abdominal distension

Toxic megacolon is a life-threatening complication requiring emergency colectomy to prevent bowel perforation, peritonitis, and sepsis.

Question 54: A patient with type 2 diabetes presents with blood glucose of 680 mg/dL, serum osmolality of 340 mOsm/kg, and no ketonuria. Which condition does the nurse suspect?

Syndrome of inappropriate ADH secretion
Hyperosmolar hyperglycemic state (Correct answer)
Diabetic ketoacidosis
Addisonian crisis

Correct answer: Hyperosmolar hyperglycemic state

Extremely elevated glucose with high serum osmolality and absent ketones is characteristic of hyperosmolar hyperglycemic state.

Question 55: A patient with a small bowel obstruction has a nasogastric tube in place. Which finding indicates the tube is functioning properly?

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

Correct answer: Abdominal girth decreasing

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

Question 56: A patient develops sudden pleuritic chest pain, dyspnea, and tachycardia 72 hours after a total hip arthroplasty. What is the nurse's priority action?

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

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

Elevated pulmonary artery wedge pressure (PAWP) and decreased cardiac output (Correct answer)
Normal PAWP with elevated mixed venous oxygen saturation
Decreased PAWP and increased cardiac output
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 58: Which CMSRN exam domain addresses infection control, fall prevention, and error-reporting processes?

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

Correct answer: Safe and Effective Care Environment

Safe and Effective Care Environment encompasses safety, management of care, and infection control principles.

Question 59: A patient with type 2 diabetes is scheduled for a CT scan with contrast. Which pre-procedure action is most important?

Encourage oral fluid intake
Check blood glucose every 2 hours
Hold metformin 48 hours before the procedure (Correct answer)
Administer sliding scale insulin

Correct answer: Hold metformin 48 hours before the procedure

Metformin must be held before contrast administration because contrast-induced nephropathy can impair metformin excretion, leading to lactic acidosis.

Question 60: A nurse is reviewing the lab results of a patient with suspected disseminated intravascular coagulation (DIC). Which combination of findings is most consistent with this diagnosis?

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

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

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

Question 61: Which lab value is the most specific marker for myocardial cell damage following an acute MI?

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

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

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

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: A patient reports tearing chest pain that radiates to the back and has unequal blood pressures in both arms. Which condition does the nurse suspect?

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

Correct answer: Aortic dissection

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

Question 64: When receiving warfarin (Coumadin) medication, excessive alcohol consumption causes:

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

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 65: 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)
Measuring peak expiratory flow rate
Assessing deep tendon reflexes

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 66: Except for the following, all of the following list phosphodiasterase inhibitors:

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

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 67: A patient is admitted with an acute exacerbation of COPD and an arterial blood gas showing pH 7.28, PaCO2 62 mmHg, HCO3 26 mEq/L, and PaO2 54 mmHg. How should the nurse interpret these results?

Metabolic acidosis, uncompensated
Respiratory alkalosis, partially compensated
Metabolic alkalosis, compensated
Respiratory acidosis, uncompensated (Correct answer)

Correct answer: Respiratory acidosis, uncompensated

The low pH indicates acidosis; the elevated PaCO2 identifies the cause as respiratory (CO2 retention from hypoventilation). The HCO3 is normal, meaning the kidneys have not yet compensated, making this uncompensated respiratory acidosis.

Question 68: Which intervention is the priority for a postoperative patient with a PCA pump who has a respiratory rate of 8 breaths per minute?

Document the finding and reassess in 15 minutes
Stop the PCA infusion and administer naloxone as ordered (Correct answer)
Encourage deep breathing exercises
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 69: A patient scheduled for a total knee arthroplasty reports taking aspirin 325 mg daily. What is the priority nursing action during the preoperative phase?

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

Correct answer: Notify the surgeon about the aspirin use

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

Question 70: A patient with COPD is admitted with an acute exacerbation. Which oxygen delivery method is most appropriate?

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

Correct answer: Venturi mask at 24-28% FiO2

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

Question 71: 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?

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

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 72: A patient diagnosed with hepatitis B asks how the virus is transmitted. The nurse correctly responds that it spreads through:

Airborne droplets from infected individuals
Blood, sexual contact, and perinatal transmission (Correct answer)
The fecal-oral route via contaminated food and water
Contact with contaminated environmental surfaces

Correct answer: Blood, sexual contact, and perinatal transmission

Hepatitis B is a bloodborne pathogen transmitted via blood and blood products, sexual contact with an infected person, and vertically from infected mother to newborn.

Question 73: Which clinical manifestation most specifically differentiates hepatic encephalopathy from other causes of altered mental status?

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

Correct answer: Asterixis (liver flap tremor)

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

Question 74: Which of the following does barbiturates not treat?

Hypotension (Correct answer)
Seizures
Insomnia
Anxiety

Correct answer: Hypotension

Barbiturates are central nervous system depressants primarily used to treat conditions such as anxiety, seizures, and insomnia due to their sedative and anticonvulsant properties. While they can cause hypotension as a side effect, especially with overdose or rapid intravenous administration, they are not used as a treatment for hypotension. In fact, they would worsen low blood pressure.

Question 75: A patient with a history of obstructive sleep apnea (OSA) is admitted to the PACU. Which postoperative monitoring is most critical for this patient?

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

Correct answer: Continuous pulse oximetry and capnography

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

Question 76: 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?

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

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 77: A patient with peripheral arterial disease (PAD) reports intermittent claudication in the left calf. Which assessment finding would the nurse expect?

Warm, erythematous skin with pitting edema
Diminished or absent pedal pulses in the affected extremity (Correct answer)
Positive Homans sign with dorsiflexion
Distended superficial veins in the lower leg

Correct answer: Diminished or absent pedal pulses in the affected extremity

Intermittent claudication from PAD results from arterial insufficiency, which presents with diminished or absent peripheral pulses distal to the occlusion.

Question 78: A patient receives a final lung cancer diagnosis. The patient accuses his parents of smoking in their house when he was a child after learning the diagnosis. Which of the five stages of mourning according to Kübler-Ross best fits this patient?

Bargaining
Denial
Depression
Anger (Correct answer)

Correct answer: Anger

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

Question 79: A postoperative patient complains of severe pain unrelieved by opioids and the nurse notes a tense, swollen surgical extremity. The nurse's priority concern is:

Surgical site infection with abscess formation
Deep vein thrombosis of the affected extremity
Development of acute compartment syndrome (Correct answer)
Opioid tolerance requiring dose escalation

Correct answer: Development of acute compartment syndrome

Pain disproportionate to injury combined with a tense, swollen extremity are hallmark signs of acute compartment syndrome, a surgical emergency.

Question 80: A patient is prescribed incentive spirometry post-operatively. What is the primary goal of this intervention?

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

Correct answer: Prevent atelectasis and promote lung expansion

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

Question 81: A nurse is assessing a patient 24 hours after a thyroidectomy. Which finding is the highest priority to report?

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

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

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

Correct answer: Thoracentesis to drain fluid

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

Question 83: Propofol infusion syndrome (PRIS) is a rare but fatal complication associated with prolonged high-dose propofol. Which early warning sign should alert the nurse?

Hypernatremia and decreased BUN
Respiratory alkalosis and hypokalemia
Metabolic acidosis, elevated triglycerides, and cardiac arrhythmias (Correct answer)
Metabolic alkalosis and hyperglycemia

Correct answer: Metabolic acidosis, elevated triglycerides, and cardiac arrhythmias

PRIS presents with high anion gap metabolic acidosis, hypertriglyceridemia, rhabdomyolysis, hepatomegaly, and cardiac failure, often after >48 hours of high-dose infusion.

Question 84: When performing a preoperative skin prep, which action by the nurse is INCORRECT?

Allowing the prep solution to dry fully before draping
Using chlorhexidine-alcohol solution for the prep
Scrubbing from the incision site outward in a circular motion
Shaving the surgical site with a razor the night before surgery (Correct answer)

Correct answer: Shaving the surgical site with a razor the night before surgery

Razor shaving the night before surgery increases SSI risk due to skin microabrasions; hair removal should use clippers immediately before surgery if needed.

Question 85: A patient receiving ketamine anesthesia is most likely to experience which unique emergence phenomenon?

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

Correct answer: Dissociative reactions and vivid hallucinations

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

Question 86: Which post-transplant malignancy is most strongly linked to Epstein-Barr virus (EBV) reactivation?

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

Correct answer: Post-transplant lymphoproliferative disorder (PTLD)

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

Question 87: Which precaution is essential for a patient who has undergone a posterior total hip replacement?

Avoid weight bearing on both legs
Do not flex the hip beyond 90 degrees (Correct answer)
Keep the knee fully extended at all times
Avoid abduction of the hip beyond 15 degrees

Correct answer: Do not flex the hip beyond 90 degrees

Posterior hip precautions prohibit hip flexion beyond 90 degrees, adduction past midline, and internal rotation to prevent dislocation of the prosthesis.

Question 88: The nurse is caring for a post-renal transplant patient whose tacrolimus trough level is 18 ng/mL (therapeutic range 8–12 ng/mL). Which assessment finding is most concerning?

Mild hand tremor
Serum creatinine rise from 1.0 to 1.8 mg/dL (Correct answer)
Blood glucose of 140 mg/dL
Blood pressure of 138/86 mmHg

Correct answer: Serum creatinine rise from 1.0 to 1.8 mg/dL

Supratherapeutic tacrolimus causes nephrotoxicity; a rising creatinine indicates calcineurin inhibitor-induced renal injury requiring dose reduction.

Question 89: A patient with type 1 diabetes is found unresponsive with a blood glucose of 28 mg/dL. The patient has no IV access and is unable to swallow. Which intervention should the nurse perform first?

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

Correct answer: Administer 1 mg of glucagon intramuscularly

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

Question 90: A patient with acute respiratory distress syndrome (ARDS) is on a ventilator. Which ventilation strategy is recommended to prevent ventilator-induced lung injury?

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

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

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

Question 91: A patient with a pulmonary embolism is receiving thrombolytic therapy with alteplase. During the infusion, the nurse observes new-onset neurological changes and facial drooping. What is the nurse's priority action?

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

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

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

Question 92: A patient develops sudden severe dyspnea, tracheal deviation to the left, and absent breath sounds on the right. What condition does the nurse suspect?

Pulmonary embolism
Tension pneumothorax (Correct answer)
Pleural effusion
Hemothorax

Correct answer: Tension pneumothorax

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

Question 93: Which intervention is the priority for a patient experiencing a myocardial infarction in the emergency department?

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

Correct answer: Administer aspirin 325 mg

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

Question 94: A postoperative patient who received neuraxial anesthesia reports a severe headache that worsens when sitting upright. What is the most likely cause?

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

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

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

Correct answer: Obtain a 12-lead ECG

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

Question 96: The medical-surgical nurse believes that the following actions will be taken in the patient's immediate care after doing a comprehensive neurological and physical assessment on an admitted patient who is suspected of having had a stroke:

preparing for carotid Doppler ultrasonography.
administering tissue plasminogen activator.
obtaining a computed tomography scan of the head without contrast. (Correct answer)
obtaining a neurosurgical consultation.

Correct answer: obtaining a computed tomography scan of the head without contrast.

When a patient is admitted for suspected stroke, the next proper step in their urgent care is usually to get a computed tomography (CT) scan of their head without contrast. This is essential for determining the kind, extent, and site of the stroke in addition to ruling out other possible explanations for the symptoms. When treating acute ischemic strokes, tissue plasminogen activator (tPA), a drug that breaks up clots, may be recommended for the patient based on the results of the CT scan.

Question 97: A nurse is caring for a patient post-thyroidectomy. Which assessment finding requires the most immediate intervention?

Temperature of 37.5°C
Serum calcium of 8.8 mg/dL
Positive Chvostek's sign (Correct answer)
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 98: A patient taking warfarin has an INR of 5.8 and is not bleeding. Which action should the nurse anticipate?

Administer protamine sulfate
Begin fresh frozen plasma transfusion
Administer IV vitamin K 10 mg
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 99: In the early postoperative phase, a client feels confused. Which of the following evaluations is necessary to identify the confusion's cause?

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

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

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

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

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

Question 101: A nurse is teaching a patient newly diagnosed with type 2 diabetes about sick-day management. Which statement by the patient indicates correct understanding?

I only need to call my doctor if my temperature exceeds 103 degrees
I need to check my blood glucose more frequently when I am ill (Correct answer)
I should stop taking my diabetes medication when I am sick
I should skip meals to keep my blood sugar from going too high

Correct answer: I need to check my blood glucose more frequently when I am ill

During illness, blood glucose levels can fluctuate significantly, so more frequent monitoring is essential to guide medication adjustments and prevent complications.

Question 102: Which is the MOST important nursing action when a patient with a history of latex allergy is scheduled for a procedure?

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

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

Cyanosis
Decreased respiratory rate
Restlessness and anxiety (Correct answer)
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 104: A patient with chronic heart failure is prescribed carvedilol. Which assessment is most important before administering the first dose?

Respiratory rate and oxygen saturation
Baseline heart rate and blood pressure (Correct answer)
Blood glucose level
Serum potassium level

Correct answer: Baseline heart rate and blood pressure

Carvedilol is a beta-blocker that can cause bradycardia and hypotension; baseline heart rate and blood pressure must be assessed to ensure safe administration.

Question 105: A patient is scheduled for a thyroidectomy. Which preoperative assessment is most specific to this procedure?

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

Correct answer: Baseline voice quality and neck range of motion

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

Question 106: A nurse is preparing to remove a patient's temporary transvenous pacemaker. Which action is essential before removal?

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

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 107: A patient with acute pancreatitis has a nasogastric tube connected to low intermittent suction. Which acid-base imbalance is the nurse most likely to observe?

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

Correct answer: Metabolic alkalosis

Nasogastric suction removes hydrochloric acid from the stomach, leading to metabolic alkalosis.

Question 108: Which assessment finding in a post-anesthesia patient most strongly suggests malignant hyperthermia?

Rapidly rising end-tidal CO2 and muscle rigidity (Correct answer)
Mild shivering and cool extremities
Decreased urine output and peripheral edema
Bradycardia with hypertension

Correct answer: Rapidly rising end-tidal CO2 and muscle rigidity

Malignant hyperthermia classically presents with unexplained rise in end-tidal CO2, skeletal muscle rigidity, and rapidly increasing body temperature.

Question 109: A patient with heart failure has a BNP level of 900 pg/mL. What does this finding indicate?

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

Correct answer: Severe ventricular wall stress and volume overload

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

Question 110: What is the most common site for a pulmonary embolism to originate?

Upper extremity veins
Deep veins of the lower extremities (Correct answer)
Renal veins
Pelvic veins

Correct answer: Deep veins of the lower extremities

The majority of pulmonary emboli originate from deep vein thromboses in the lower extremities.

Question 111: A post-operative patient reports numbness and tingling in the fingers and toes, and has a positive Chvostek's sign. What electrolyte imbalance does the nurse suspect?

Hypocalcemia (Correct answer)
Hypernatremia
Hyperkalemia
Hypermagnesemia

Correct answer: Hypocalcemia

Hypocalcemia causes neuromuscular excitability, peripheral paresthesias, and positive Chvostek's sign (facial muscle twitching with cheek tap).

Question 112: Which CMSRN exam domain would most likely contain questions about patient education regarding discharge medications?

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

Correct answer: Health Promotion and Maintenance

Health Promotion and Maintenance covers patient and family education, health teaching, and discharge planning.

Question 113: 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?

Switch the patient to insulin coverage for the day of the procedure
Hold the metformin and notify the provider before the procedure (Correct answer)
Increase the patient's IV fluid rate to prevent dehydration
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 114: One of the main ways to lower a female patient's chance of getting coronary heart disease is to:

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

Correct answer: avoid excessive weight gain during pregnancy.

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

Question 115: A patient is NPO for surgery and asks why they cannot drink clear liquids the morning of their procedure. The best nurse's response is:

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

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

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

Question 116: A postoperative patient receiving PCA morphine has a respiratory rate of 8 breaths/min and is difficult to arouse. The FIRST nursing action is:

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

Correct answer: Administer naloxone and stop the PCA

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

Question 117: A customer who had suffered an amputation is being urged by the nurse to put on a prosthetic right away. The benefit of taking this quick action is

Less chance of phantom limb sensation
Dressing changes are not necessary
Ability to ambulate sooner (Correct answer)
Better fit of the prosthesis

Correct answer: Ability to ambulate sooner

Explanation: When the prosthesis is in place immediately following surgery, the client can stand up several hours postoperatively and walk the next day. The operative site is closed to outside contamination and benefits from improved circulation due to ambulation.

Question 118: A patient receiving IV vancomycin develops sudden flushing, erythema, and hypotension during the infusion. This reaction is most consistent with:

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

Correct answer: Red man syndrome

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

Question 119: A post-operative patient develops a sudden onset of dyspnea, pleuritic chest pain, and tachycardia 3 days after hip replacement surgery. Which condition is most likely?

Pulmonary embolism (Correct answer)
Acute heart failure
Spontaneous pneumothorax
Pericarditis

Correct answer: Pulmonary embolism

Pulmonary embolism is a common post-operative complication, especially after orthopedic surgery, presenting with sudden dyspnea, pleuritic pain, and tachycardia.

Question 120: 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)
Clamp the chest tube immediately at the insertion site
Prepare for immediate chest tube removal
Increase the suction pressure on the drainage system

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 121: A patient with a history of atrial fibrillation is being treated with warfarin. The nurse reviews the patient's morning labs and notes an INR of 4.5. The patient has no active bleeding. Which of the following is the nurse's priority action?

Administer the next scheduled dose of warfarin.
Prepare to administer protamine sulfate.
Notify the healthcare provider and hold the next dose of warfarin. (Correct answer)
Instruct the patient to increase their intake of leafy green vegetables.

Correct answer: Notify the healthcare provider and hold the next dose of warfarin.

An INR of 4.5 is supratherapeutic (target is typically 2.0-3.0 for atrial fibrillation), which places the patient at a significant risk for bleeding. The priority action is to hold the next dose of warfarin to prevent the INR from rising further and to notify the provider for further orders, which may include a dose adjustment or administration of Vitamin K. Protamine sulfate is the antidote for heparin, not warfarin. Instructing the patient to alter their diet is not the immediate priority, and administering the scheduled dose would be unsafe.

Question 122: Activity intolerance is the nursing diagnostic given to a patient who has had a myocardial infarction. The following patient outcome criteria are part of the plan of care:

experiencing no dyspnea on exertion
ambulating 50 feet without experiencing dyspnea. (Correct answer)
agreeing to discontinue smoking.
tolerating activity well.

Correct answer: ambulating 50 feet without experiencing dyspnea.

Outcome criteria for activity intolerance should be specific, measurable, achievable, relevant, and time-bound (SMART). 'Ambulating 50 feet without experiencing dyspnea' is a concrete, measurable goal that directly addresses the nursing diagnosis of activity intolerance in a patient recovering from a myocardial infarction. This provides a clear benchmark for evaluating the patient's progress and the effectiveness of interventions.

Question 123: 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?

Document findings and reassess in 2 hours
Increase FiO2 immediately
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)

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 124: The elderly woman laments her suffering. John saw that the knee was swelled, reddish, and warm to the touch. According to John, these symptoms and indicators are probably connected to:

Thrombophlebitis
Infection
Degenerative disease
Infammation (Correct answer)

Correct answer: Infammation

The symptoms described—swelling, redness, and warmth to the touch—are the cardinal signs of inflammation (tumor, rubor, calor). These physical findings indicate a localized protective response to injury or infection, characterized by increased blood flow and fluid accumulation in the affected area. While infection can cause inflammation, inflammation itself is the direct physiological process manifesting these specific signs.

Question 125: A nurse administers digoxin to a patient with heart failure. Before administration, the apical pulse is 52 bpm. What should the nurse do?

Administer atropine and then the digoxin
Administer the dose since it is within the bradycardic threshold
Hold the dose and notify the provider (Correct answer)
Give half the dose and reassess in 30 minutes

Correct answer: Hold the dose and notify the provider

Digoxin is typically held and the provider notified if the apical pulse is below 60 bpm due to its negative chronotropic effect, which can worsen bradycardia.

Question 126: During emergence from general anesthesia, a patient becomes agitated, thrashing, and attempting to remove the IV line. What is this phenomenon called and how should the nurse respond?

Seizure activity; administer benzodiazepines and call a code
Anaphylaxis; administer epinephrine immediately
Emergence delirium; ensure patient safety, reorient, and administer prescribed short-acting sedative if needed (Correct answer)
Opioid withdrawal; administer naloxone

Correct answer: Emergence delirium; ensure patient safety, reorient, and administer prescribed short-acting sedative if needed

Emergence delirium is a transient state of agitation occurring during recovery from general anesthesia, managed with safety measures, reorientation, and short-acting sedation if necessary.

Question 127: A nurse is preparing to administer a unit of packed red blood cells. Which action is correct regarding transfusion safety?

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

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

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

Question 128: Which assessment technique should the nurse use to evaluate for asterixis in a patient with hepatic encephalopathy?

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

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

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

Question 129: A patient with chronic kidney disease develops normocytic normochromic anemia. Which medication should the nurse anticipate administering?

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

Correct answer: Epoetin alfa (Procrit)

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

Question 130: Which assessment is the nurse's PRIMARY responsibility when monitoring a patient receiving IV moderate sedation per institutional protocol?

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

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

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

Question 131: Continuous ECG monitoring for a patient at a hospital reveals that the rhythm has altered to ventricular tachycardia. What should the nurse do first out of the options below?

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

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

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

Question 132: A patient develops stridor after extubation. What is the priority nursing action?

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

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

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

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 134: Intraoperatively, the scrub technician's gown is splashed with blood. The correct response is to:

Continue the procedure and change the gown after the case
Notify the surgeon; the gown must be changed immediately using sterile technique (Correct answer)
Only change the gown if the blood penetrates to clothing underneath
Cover the soiled area with a sterile towel and continue

Correct answer: Notify the surgeon; the gown must be changed immediately using sterile technique

A contaminated gown compromises sterile technique and must be changed immediately to maintain sterility and prevent infection.

Question 135: A nurse notes a patient's cardiac monitor shows a rhythm with no P waves, irregular RR intervals, and a rate of 110 bpm. What rhythm is this?

Atrial fibrillation (Correct answer)
Sinus tachycardia
Third-degree heart block
Ventricular tachycardia

Correct answer: Atrial fibrillation

Atrial fibrillation is characterized by an absence of distinct P waves, an irregularly irregular ventricular rate, and chaotic atrial activity.

Question 136: The CMSRN exam allows candidates how much total time to complete all questions?

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

Correct answer: 3 hours

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

Question 137: The nurse is caring for a patient with a C5 spinal cord injury. Which complication should be the priority concern?

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

Correct answer: Respiratory compromise due to loss of diaphragmatic function

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

Question 138: A patient with a chest tube has continuous bubbling in the water seal chamber. What does this indicate?

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

Correct answer: An air leak in the system

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

Question 139: Which test result would necessitate the nurse's quick attention for the patient who was supposed to have surgery?

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

Correct answer: Potassium 2.4 mEq/L.

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

Question 140: A patient with neutropenia following chemotherapy develops a fever of 38.5°C (101.3°F). What is the nurse's priority action?

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

Correct answer: Obtain blood cultures and initiate prescribed antibiotics immediately

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

Question 141: Which laboratory finding is most indicative of primary graft non-function immediately after liver transplantation?

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

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

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

Correct answer: IV lorazepam or diazepam

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

Question 143: Which assessment finding is most indicative of a perforated peptic ulcer requiring emergency intervention?

Sudden severe pain with board-like abdominal rigidity (Correct answer)
Epigastric burning that worsens between meals
Melena with gradual onset of epigastric pain
Intermittent cramping relieved by antacids

Correct answer: Sudden severe pain with board-like abdominal rigidity

Sudden severe pain with board-like abdominal rigidity indicates peritonitis from gastric contents leaking into the peritoneal cavity, a surgical emergency.

Question 144: A living-related donor is being evaluated for kidney donation. Which finding would disqualify the donor?

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

Correct answer: Bilateral kidney stones with residual nephrocalcinosis

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

Question 145: A patient's temperature rises to 40.2°C (104.4°F) intraoperatively, along with muscle rigidity, tachycardia, and rising EtCO2. The nurse should anticipate administration of:

Epinephrine and antihistamines
Dantrolene sodium 2.5 mg/kg IV and discontinue volatile anesthetics (Correct answer)
Haloperidol and benzodiazepines
Acetaminophen and cooling blanket only

Correct answer: Dantrolene sodium 2.5 mg/kg IV and discontinue volatile anesthetics

This clinical picture is malignant hyperthermia; dantrolene is the specific antidote and all triggering agents (volatile anesthetics, succinylcholine) must be immediately discontinued.

Question 146: Which arterial blood gas (ABG) result indicates respiratory acidosis?

pH 7.30, PaCO2 55, HCO3 24 (Correct answer)
pH 7.35, PaCO2 40, HCO3 22
pH 7.50, PaCO2 30, HCO3 22
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 147: The nurse cares for a patient diagnosed sickle cell anemia. The patient queries the nurse about signs that might indicate a crisis. Which among the following does not indicate a sickle cell crisis?

Fever
Blurred vision (Correct answer)
Shortness of breath
Pain

Correct answer: Blurred vision

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

Question 148: A patient post-total knee replacement complains of calf pain, warmth, and swelling. The priority nursing action is to:

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

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

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

Question 149: The nurse assesses a patient and hears diminished breath sounds at the bases bilaterally with fine crackles. This finding is most consistent with:

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

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

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

Correct answer: Squamous cell carcinoma

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

Question 151: A patient with a tracheostomy has thick, tenacious secretions. Which independent nursing intervention is most appropriate?

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

Correct answer: Increase humidification of inspired air

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

Question 152: When treating acute glomerulonephritis, the primary objective is to:

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

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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