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

Question 1: What is the role of informed consent in neurological nursing?

It ensures the patient understands and agrees to the plan (Correct answer)
It is a mere formality
It protects only the provider
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 2: What is the most important factor in effective communication with patients regarding gastrointestinal nursing?

Providing written instructions only
Speaking quickly to save time
Using clear, understandable language and confirming understanding (Correct answer)
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 3: How does nutrition impact disease prevention?

By reducing the need for exercise
By increasing the need for medications
By supporting overall health and preventing chronic diseases through healthy eating (Correct answer)
By focusing only on weight management

Correct answer: By supporting overall health and preventing chronic diseases through healthy eating

Nutrition profoundly impacts disease prevention by directly influencing overall health and bodily functions. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins provides essential nutrients that support immune function, maintain healthy weight, and reduce inflammation. This healthy eating pattern is crucial in preventing the onset and progression of numerous chronic diseases like heart disease, diabetes, and certain cancers.

Question 4: A patient in the PACU has a respiratory rate of 8 breaths per minute and is difficult to arouse. What is the priority nursing action?

Elevate the head of the bed to 30 degrees
Administer oxygen via nasal cannula and document findings
Stimulate the patient and prepare to administer naloxone (Correct answer)
Notify the family of the patient's condition

Correct answer: Stimulate the patient and prepare to administer naloxone

Signs of opioid-induced respiratory depression require immediate stimulation and readiness to administer naloxone to reverse the effect.

Question 5: Which drug is the FIRST-LINE treatment for an ischemic stroke patient who presents within the thrombolytic window?

Heparin IV infusion
Aspirin 325 mg PO
Clopidogrel 300 mg loading dose
IV alteplase (tPA) (Correct answer)

Correct answer: IV alteplase (tPA)

IV alteplase (tPA) is the only FDA-approved thrombolytic for acute ischemic stroke and must be given within 3-4.5 hours of symptom onset.

Question 6: 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 tidal volume setting
Silence the alarm and continue monitoring
Increase the FiO2 to 1.0
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 7: When administering nimodipine to a patient with subarachnoid hemorrhage, the primary purpose is to:

Control seizure activity
Reduce intracranial pressure
Prevent cerebral vasospasm (Correct answer)
Dissolve the blood clot in the subarachnoid space

Correct answer: Prevent cerebral vasospasm

Nimodipine, a calcium channel blocker, is given after subarachnoid hemorrhage specifically to prevent cerebral vasospasm and reduce neurological deficits.

Question 8: What is the first priority in respiratory care for MSNCB practitioners?

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

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

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

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 10: Which finding in the immediate postoperative period requires the nurse to reposition the patient before anything else?

Blood pressure of 138/88 mmHg
Respiratory rate of 14 breaths/min
SpO2 of 94% on room air
SpO2 of 86% with audible snoring and a relaxed jaw (Correct answer)

Correct answer: SpO2 of 86% with audible snoring and a relaxed jaw

SpO2 of 86% with snoring indicates airway obstruction from a relaxed tongue; immediate jaw-thrust or head-tilt/chin-lift repositioning is the priority.

Question 11: A patient on long-term lithium therapy is at highest risk for which endocrine disorder?

Cushing's syndrome
Hyperparathyroidism and hypothyroidism (Correct answer)
Adrenal insufficiency
Pheochromocytoma

Correct answer: Hyperparathyroidism and hypothyroidism

Lithium commonly causes hypothyroidism by blocking thyroid hormone synthesis and release; it also raises PTH levels, leading to hypercalcemia and hyperparathyroidism.

Question 12: Which approach to perioperative nursing is considered best practice in current MSNCB standards?

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

Correct answer: Evidence-based, individualized interventions

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

Question 13: A patient with hyperparathyroidism would MOST likely exhibit which set of findings?

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

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 14: A patient with stable angina asks about the difference between their condition and unstable angina. The nurse correctly explains that unstable angina:

Occurs only with exertion and resolves with rest
Occurs at rest or with minimal exertion and is unpredictable (Correct answer)
Is characterized by ST elevation on the 12-lead ECG
Always indicates an acute MI is in progress

Correct answer: Occurs at rest or with minimal exertion and is unpredictable

Unstable angina occurs at rest or with minimal exertion, is unpredictable, and represents worsening coronary perfusion without myocardial necrosis.

Question 15: What is the importance of ongoing patient assessment in clinical decision-making?

To reduce the number of assessments needed
To ensure that care plans are adjusted based on the patient’s evolving condition (Correct answer)
To ensure patients follow treatment instructions
To minimize nursing documentation

Correct answer: To ensure that care plans are adjusted based on the patient’s evolving condition

Ongoing patient assessment is crucial because a patient's condition can change rapidly and unexpectedly. Regular reassessment allows nurses to detect subtle changes, evaluate the effectiveness of interventions, and modify care plans promptly. This ensures that care remains responsive and appropriate to the patient's evolving needs, leading to better outcomes.

Question 16: What is the role of informed consent in cardiac 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 17: A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L. Which dietary instruction is the priority?

Limit sodium to 2 g/day
Increase fluid intake to flush excess potassium
Avoid high-potassium foods such as bananas and oranges (Correct answer)
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 18: Which assessment finding would most concern the perioperative nurse during a patient's preoperative evaluation?

Heart rate of 78 beats per minute
Serum potassium of 2.9 mEq/L (Correct answer)
Temperature of 37.1°C
Blood pressure 128/82 mmHg

Correct answer: Serum potassium of 2.9 mEq/L

Hypokalemia (K+ < 3.5 mEq/L) increases the risk of intraoperative dysrhythmias and should be corrected before elective surgery.

Question 19: A patient with CKD develops pruritus. Which intervention is most appropriate to address uremic pruritus?

Administer corticosteroids
Apply ice packs to the affected areas
Increase dietary protein intake
Ensure adequate dialysis and prescribe emollients or antihistamines (Correct answer)

Correct answer: Ensure adequate dialysis and prescribe emollients or antihistamines

Uremic pruritus is managed with optimized dialysis to reduce uremic toxins, combined with topical emollients and antihistamines for symptomatic relief.

Question 20: 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
Trendelenburg position
Lateral decubitus with knees flexed

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 21: Why is evidence-based practice important in clinical decision-making?

To ensure decisions are based on the best available evidence and research (Correct answer)
To provide care that is cost-effective
To reduce the time spent with patients
To focus solely on patient opinions

Correct answer: To ensure decisions are based on the best available evidence and research

Evidence-based practice (EBP) is vital in clinical decision-making because it ensures that care is based on the best available scientific evidence, clinical expertise, and patient values. This approach moves beyond tradition or personal preference, leading to safer, more effective, and higher-quality patient care. EBP helps nurses make informed choices that are supported by research.

Question 22: 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 23: A patient has a serum potassium of 6.2 mEq/L. Which ECG change would the nurse most likely observe?

Flattened T waves
Shortened QT interval only
Prominent U waves
Peaked (tall, narrow) T waves (Correct answer)

Correct answer: Peaked (tall, narrow) T waves

Hyperkalemia classically produces tall, peaked, narrow T waves on ECG, representing one of the earliest electrocardiographic signs of elevated potassium.

Question 24: 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 126 mg/dL
Approximately 154 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 25: Which symptom cluster in a post-thyroidectomy patient should prompt the nurse to assess for laryngeal nerve damage?

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

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

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

Correct answer: Steroid-induced hyperglycemia or diabetes

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

Question 27: Which laboratory value best reflects the adequacy of hemodialysis treatment?

Urine specific gravity
Kt/V ratio (Correct answer)
Serum creatinine level
Serum albumin 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 28: Which ethical principle requires MSNCB professionals to act in the patient's best interest?

Autonomy
Fidelity
Justice
Beneficence (Correct answer)

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 29: A post-operative patient who underwent bowel resection develops third-spacing with hypotension and decreased urine output. Which IV fluid replacement is most appropriate?

D5W to replace free water
Isotonic crystalloid such as 0.9% NaCl or lactated Ringer's (Correct answer)
25% albumin exclusively
3% NaCl to expand plasma volume

Correct answer: Isotonic crystalloid such as 0.9% NaCl or lactated Ringer's

Third-spacing shifts fluid into non-functional spaces, depleting intravascular volume; isotonic crystalloids are first-line to restore functional circulating blood volume.

Question 30: A patient with Guillain-Barré syndrome is admitted. Which assessment finding is most critical to monitor?

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

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 31: A patient receiving warfarin has an INR of 4.8. Which action should the nurse take first?

Recheck the INR in 1 hour
Hold the next warfarin dose
Administer vitamin K as ordered
Notify the provider immediately (Correct answer)

Correct answer: Notify the provider immediately

An INR of 4.8 is supratherapeutic and places the patient at high bleeding risk, requiring immediate provider notification.

Question 32: A nurse teaches a patient about secondary prevention. Which activity is an example of secondary prevention?

Educating school children about hand hygiene
Performing a mammogram to detect early breast cancer (Correct answer)
Administering the influenza vaccine
Providing physical therapy after a stroke

Correct answer: Performing a mammogram to detect early breast cancer

Secondary prevention involves early detection of disease through screening, such as mammography to identify breast cancer before symptoms appear.

Question 33: 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 34: 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 35: When teaching a patient with celiac disease, the nurse emphasizes avoiding which grain?

Quinoa
Corn
Barley (Correct answer)
Rice

Correct answer: Barley

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

Question 36: Which hemodynamic profile is most consistent with cardiogenic shock?

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

Correct answer: High PCWP, low CO, high SVR

Cardiogenic shock presents with elevated PCWP (pulmonary congestion), low cardiac output (pump failure), and elevated SVR (compensatory vasoconstriction).

Question 37: The six rights of medication administration include the right patient, drug, dose, route, time, and which sixth right?

Right practitioner
Right diagnosis
Right documentation (Correct answer)
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 38: A patient with GERD is prescribed omeprazole. The nurse should instruct the patient to take this medication:

With food to reduce GI upset
30–60 minutes before the first meal of the day (Correct answer)
At bedtime with a full glass of water
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 39: A patient's arterial blood gas results show: pH 7.28, PaCO2 52 mmHg, HCO3 24 mEq/L. How should the nurse interpret these findings?

Mixed respiratory and metabolic acidosis
Respiratory acidosis, uncompensated (Correct answer)
Respiratory alkalosis, compensated
Metabolic acidosis, uncompensated

Correct answer: Respiratory acidosis, uncompensated

A low pH with elevated PaCO2 and normal HCO3 indicates primary respiratory acidosis with no metabolic compensation yet.

Question 40: A nurse monitors a patient after surgical removal of a pheochromocytoma. Which postoperative complication is the PRIORITY concern?

Deep vein thrombosis formation
Severe hypotension and hypoglycemia (Correct answer)
Acute respiratory distress syndrome
Hyperthyroidism due to surgical stress

Correct answer: Severe hypotension and hypoglycemia

After pheochromocytoma removal, the sudden drop in catecholamines commonly causes severe hypotension; insulin hypersecretion can also trigger hypoglycemia.

Question 41: Which finding indicates a patient is ready for discharge from Phase I PACU recovery?

Patient reports feeling completely back to normal
Urine output has reached 500 mL since surgery
Patient can walk without assistance to the waiting area
Vital signs stable, patient awake and oriented, pain controlled, no active bleeding (Correct answer)

Correct answer: Vital signs stable, patient awake and oriented, pain controlled, no active bleeding

PACU discharge criteria include stable vital signs, adequate level of consciousness, controlled pain and nausea, and absence of surgical complications such as bleeding.

Question 42: How frequently should ongoing assessments be conducted in Medical-Surgical Nursing Certification Board practice?

Only when required by external auditors
Only when problems are reported
Once annually regardless of circumstances
At regular intervals based on established protocols and as conditions change (Correct answer)

Correct answer: At regular intervals based on established protocols and as conditions change

Ongoing assessments should follow established protocols for regular intervals and also be conducted when conditions change. This balanced approach ensures continuous monitoring while remaining responsive to new developments.

Question 43: Which intervention best prevents contrast-induced nephropathy in a patient with CKD scheduled for a CT scan with contrast?

Administer furosemide before the procedure
Provide IV normal saline hydration before and after the procedure (Correct answer)
Administer mannitol immediately after contrast administration
Withhold all medications for 24 hours prior

Correct answer: Provide IV normal saline hydration before and after the procedure

IV isotonic saline hydration before and after contrast administration is the most evidence-based intervention to reduce contrast-induced nephropathy.

Question 44: A patient with end-stage liver disease is scheduled for a transjugular intrahepatic portosystemic shunt (TIPS) procedure. The primary goal of this intervention is to:

Improve hepatic synthetic function
Eliminate the need for liver transplantation
Reduce portal hypertension to control variceal bleeding and refractory ascites (Correct answer)
Reverse hepatic encephalopathy

Correct answer: Reduce portal hypertension to control variceal bleeding and refractory ascites

TIPS creates a shunt between the portal and hepatic veins to decompress the portal system and reduce portal hypertension.

Question 45: A patient with a new diagnosis of Crohn's disease asks about surgical cure. The nurse's best response is:

A colectomy with ileostomy permanently eliminates Crohn's disease
Surgery controls complications but does not cure Crohn's disease, as it can recur (Correct answer)
Surgery is not an option for Crohn's disease
Surgery cures Crohn's disease by removing the affected bowel segment

Correct answer: Surgery controls complications but does not cure Crohn's disease, as it can recur

Unlike ulcerative colitis, Crohn's disease is not cured by surgery and frequently recurs at or near the anastomosis.

Question 46: A patient with Crohn's disease is admitted with a fistula between the bowel and bladder. Which assessment finding is most characteristic of an enterovesical fistula?

Urinary retention and overflow incontinence
Hematuria and dysuria
Proteinuria and pyuria
Pneumaturia and fecaluria (Correct answer)

Correct answer: Pneumaturia and fecaluria

Pneumaturia (air in urine) and fecaluria (fecal matter in urine) are hallmark signs of an enterovesical fistula.

Question 47: A nurse is assessing a patient who sustained a crush injury to the leg 8 hours ago. Creatine kinase (CK) is 28,000 U/L and urine is dark brown. The priority nursing concern is:

Compartment syndrome in the contralateral leg
Hypernatremia from IV fluid administration
Acute kidney injury from myoglobinuria (Correct answer)
Hypothermia

Correct answer: Acute kidney injury from myoglobinuria

Markedly elevated CK and dark urine indicate rhabdomyolysis; myoglobin precipitates in renal tubules, causing acute kidney injury requiring aggressive IV hydration.

Question 48: Following a colostomy, a patient's stoma appears pale and dusky 12 hours postoperatively. The nurse should:

Notify the surgeon immediately as this indicates ischemia (Correct answer)
Document as a normal finding for the first 24 hours
Apply warm compresses and reassess in 1 hour
Gently massage the stoma to improve circulation

Correct answer: Notify the surgeon immediately as this indicates ischemia

A pale or dusky stoma indicates compromised vascular supply (ischemia), which requires immediate surgical notification.

Question 49: A patient with adrenal insufficiency (Addison's disease) is scheduled for surgery. The nurse should anticipate which perioperative intervention?

Providing stress-dose corticosteroid coverage (Correct answer)
Withholding all steroids to prevent infection risk
Restricting IV fluid administration preoperatively
Administering mineralocorticoid supplements only

Correct answer: Providing stress-dose corticosteroid coverage

Patients with adrenal insufficiency cannot mount a normal cortisol stress response, requiring supraphysiologic 'stress-dose' steroids during surgical stress.

Question 50: Which sign or symptom indicates uremic encephalopathy in a patient with ESRD?

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

Correct answer: Asterixis and confusion

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

Question 51: Why is patient education important after surgery?

To make the patient rest for a longer time
To ensure the patient follows instructions and avoids complications (Correct answer)
To reduce the need for follow-up care
To discourage patient involvement in their recovery

Correct answer: To ensure the patient follows instructions and avoids complications

Patient education after surgery is paramount for ensuring a successful recovery and preventing complications. It empowers patients with the knowledge to understand their care plan, adhere to medication schedules, and recognize warning signs. This active involvement in their recovery journey significantly reduces the risk of readmission and promotes optimal health outcomes.

Question 52: 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
Restrict free water and notify the physician for possible hypertonic saline administration (Correct answer)
Increase the IV infusion rate of 0.9% NaCl
Administer oral sodium supplements

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 53: Which electrolyte imbalance is most commonly associated with end-stage renal disease (ESRD)?

Hyponatremia
Hypocalcemia due to increased calcitonin
Hypokalemia
Hyperphosphatemia (Correct answer)

Correct answer: Hyperphosphatemia

ESRD impairs phosphate excretion, leading to hyperphosphatemia, which secondarily contributes to renal osteodystrophy.

Question 54: A patient is admitted with a small bowel obstruction. Which assessment finding differentiates a complete obstruction from a partial obstruction?

Absence of flatus and bowel sounds (Correct answer)
Elevated white blood cell count
Abdominal distension
Presence of nausea and vomiting

Correct answer: Absence of flatus and bowel sounds

Absence of flatus (obstipation) and absent bowel sounds distal to the obstruction are hallmarks of a complete small bowel obstruction.

Question 55: 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 sodium intake to balance potassium levels
Restrict protein intake only
Increase intake of bananas and oranges

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

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

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 57: A nurse is irrigating a colostomy and notes no return of irrigation fluid after 30 minutes. The most appropriate initial action is to:

Increase irrigation fluid volume to 2,000 mL
Call the provider immediately for a suspected obstruction
Remove the irrigation sleeve and apply a clean pouch
Reposition the patient and gently advance the cone (Correct answer)

Correct answer: Reposition the patient and gently advance the cone

Repositioning and gently repositioning the irrigation cone often resolves a kinked tube or stoma spasm that blocks fluid return.

Question 58: Which finding in a patient receiving peritoneal dialysis (PD) most warrants immediate notification of the physician?

Glucose level of 180 mg/dL
Mild shoulder discomfort after drainage
Weight gain of 0.5 kg between exchanges
Cloudy peritoneal effluent (Correct answer)

Correct answer: Cloudy peritoneal effluent

Cloudy effluent is the hallmark sign of peritoneal dialysis-associated peritonitis requiring immediate medical intervention.

Question 59: A post-operative patient refuses to perform deep breathing exercises. Which is the nurse's best initial response?

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

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 60: A nurse prepares a patient for discharge after a laparoscopic hernia repair. Which instruction is most important for the patient to receive?

Resume full physical activity within 48 hours to speed recovery
Return to the ER if stool is not passed within 24 hours
Change the dressing daily with sterile technique
Avoid lifting more than 10 lbs and report fever, chills, or worsening pain (Correct answer)

Correct answer: Avoid lifting more than 10 lbs and report fever, chills, or worsening pain

Activity restriction and recognizing signs of infection or recurrence are the highest priority discharge instructions after hernia repair.

Question 61: 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
Weights must remain continuous to maintain bone alignment and prevent muscle spasm (Correct answer)
Removing weights prevents nerve damage
Weights are removed only during physical therapy

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 62: A patient is prescribed theophylline for COPD management. Which serum level indicates toxicity risk?

4 mcg/mL
12 mcg/mL
22 mcg/mL (Correct answer)
8 mcg/mL

Correct answer: 22 mcg/mL

The therapeutic range for theophylline is 5–15 mcg/mL; levels above 20 mcg/mL are associated with toxicity including seizures, dysrhythmias, and nausea.

Question 63: Which stool characteristic is most associated with an upper GI bleed?

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

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 64: A patient using an incentive spirometer should be instructed to perform the technique in which way?

Inhale slowly and deeply to raise the piston, hold 3–5 seconds, then exhale (Correct answer)
Breathe rapidly in and out to exercise respiratory muscles
Exhale forcefully into the device 10 times per hour
Use the device only at night to prevent respiratory fatigue

Correct answer: Inhale slowly and deeply to raise the piston, hold 3–5 seconds, then exhale

Slow, sustained maximal inhalation with a 3–5 second breath hold maximizes alveolar recruitment and prevents atelectasis.

Question 65: 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 since 3.0 mEq/L is only mildly low
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 with orange juice to boost potassium

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 66: A patient receiving continuous renal replacement therapy (CRRT) develops hypotension. What is the nurse's priority action?

Administer a diuretic to promote fluid removal
Increase the dialysate flow rate
Decrease or pause ultrafiltration and notify the physician (Correct answer)
Increase the ultrafiltration rate to remove more fluid

Correct answer: Decrease or pause ultrafiltration and notify the physician

Hypotension during CRRT is often caused by excessive fluid removal; decreasing or pausing ultrafiltration and notifying the physician prevents hemodynamic compromise.

Question 67: What is the priority nursing intervention for a patient experiencing status epilepticus?

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

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

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

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

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

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 70: Which assessment finding indicates that treatment for diabetic ketoacidosis (DKA) is effective?

Serum potassium rises from 3.0 to 5.5 mEq/L
Serum glucose drops from 480 to 300 mg/dL within 30 minutes
Blood pressure normalizes and heart rate increases
Urine ketones clear and serum bicarbonate rises above 18 mEq/L (Correct answer)

Correct answer: Urine ketones clear and serum bicarbonate rises above 18 mEq/L

Resolution of DKA is confirmed by closure of the anion gap, clearing ketones, and normalization of serum bicarbonate above 18 mEq/L.

Question 71: A patient with chronic liver disease has a serum albumin of 2.0 g/dL. The nurse understands this contributes to ascites primarily because:

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

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

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

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 73: What is the first priority in neurological nursing for MSNCB practitioners?

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

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 74: When interpreting a 12-lead ECG, which finding is most indicative of left ventricular hypertrophy?

Widened QRS greater than 0.12 seconds with delta waves
Tall R waves in V1 and V2 with right axis deviation
S wave in V1 plus R wave in V5 or V6 greater than 35 mm (Correct answer)
Peaked T waves in precordial leads with short QT interval

Correct answer: S wave in V1 plus R wave in V5 or V6 greater than 35 mm

The Sokolow-Lyon criteria for LVH requires the S wave in V1 plus R wave in V5 or V6 to exceed 35 mm.

Question 75: A patient with acromegaly would MOST likely present with which assessment findings?

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

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 76: A patient recovering from abdominal aortic aneurysm repair suddenly develops mottling of both lower extremities, absent pedal pulses, and severe pain. The nurse recognizes this as:

Acute limb ischemia from thromboembolism or graft occlusion (Correct answer)
Compartment syndrome of the abdomen
Expected vasospasm from hypothermia
Venous thromboembolism bilaterally

Correct answer: Acute limb ischemia from thromboembolism or graft occlusion

Absent pulses, mottling, and acute pain after vascular surgery indicate acute limb ischemia from graft occlusion or thromboembolism, a surgical emergency.

Question 77: A nurse is caring for a patient receiving insulin glargine. Which statement about this insulin is CORRECT?

It has a peak action at 4-6 hours after injection
It provides a steady, peakless 24-hour basal coverage (Correct answer)
It must be administered 30 minutes before meals
It can be mixed with regular insulin in the same syringe

Correct answer: It provides a steady, peakless 24-hour basal coverage

Insulin glargine (Lantus) is a long-acting basal insulin with no pronounced peak, providing approximately 24 hours of steady glucose control.

Question 78: 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 79: A patient with osteoporosis is prescribed alendronate (Fosamax). Which teaching point is essential?

Crush the tablet and mix with juice for better absorption
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

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 80: What is the most important factor in effective communication with patients regarding musculoskeletal care?

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

Correct answer: Using clear, understandable language and confirming understanding

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

Question 81: A patient with a subarachnoid hemorrhage suddenly develops worsening headache, photophobia, and neck stiffness. Which complication is most likely occurring?

Hyponatremia
Cerebral vasospasm
Rebleeding (Correct answer)
Hydrocephalus

Correct answer: Rebleeding

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

Question 82: Which intervention best prevents aspiration when administering a tube feeding via nasogastric tube?

Administer feedings in the supine position to promote gastric emptying
Use a large-bore tube to allow for rapid delivery
Clamp the tube for 30 minutes after each intermittent feeding
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 83: A patient prescribed prednisone long-term should be monitored for which complication?

Thrombocytosis
Bradycardia
Osteoporosis (Correct answer)
Hypoglycemia

Correct answer: Osteoporosis

Long-term corticosteroid use inhibits osteoblast activity and calcium absorption, significantly increasing the risk of osteoporosis and fractures.

Question 84: When teaching a patient about warfarin therapy after mechanical heart valve replacement, the nurse emphasizes which dietary instruction?

Maintain consistent vitamin K intake to stabilize INR (Correct answer)
Increase vitamin K-rich foods to maintain therapeutic levels
Supplement daily with vitamin K to counteract warfarin effects
Eliminate all vitamin K-containing foods from the diet

Correct answer: Maintain consistent vitamin K intake to stabilize INR

Consistent intake of vitamin K-rich foods is recommended because sudden changes in vitamin K consumption cause unpredictable INR fluctuations.

Question 85: A patient with amyotrophic lateral sclerosis (ALS) has a forced vital capacity (FVC) of 48%. The nurse should anticipate discussing:

Non-invasive ventilatory support options (Correct answer)
Immediate surgical tracheostomy
Discontinuation of riluzole therapy
Increased physical therapy to maintain strength

Correct answer: Non-invasive ventilatory support options

An FVC below 50% in ALS indicates significant respiratory compromise and is the threshold for discussing non-invasive ventilation (BiPAP).

Question 86: 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:

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

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

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

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

Hypertension, central obesity, and purple striae (Correct answer)
Hypotension, weight loss, and hyperpigmentation
Hypoglycemia, muscle weakness, and bronze skin
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 89: A nurse is assessing a patient with suspected deep vein thrombosis (DVT) in the right leg. Which assessment finding most supports this diagnosis?

Bilateral leg swelling with pitting edema and varicose veins
Unilateral calf pain, warmth, and edema with a positive Homans' sign (Correct answer)
Cool, pale right foot with diminished dorsal pedal pulse
Right leg muscle cramps that occur at night and resolve with walking

Correct answer: Unilateral calf pain, warmth, and edema with a positive Homans' sign

Unilateral calf erythema, warmth, tenderness, and edema with a positive Homans' sign are classic DVT indicators, though Homans' sign alone is not definitive.

Question 90: A patient with type 1 diabetes presents with blood glucose of 42 mg/dL, diaphoresis, and confusion. Which intervention should the nurse perform FIRST?

Notify the physician immediately
Start an IV and administer 50% dextrose
Give 15-20g of fast-acting carbohydrate orally (Correct answer)
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 91: Which approach to neurological nursing is considered best practice in current MSNCB standards?

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

Correct answer: Evidence-based, individualized interventions

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

Question 92: Which finding in a patient with a cervical spinal cord injury indicates the development of neurogenic shock?

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

Correct answer: Hypotension and bradycardia

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

Question 93: A nurse is teaching a patient about breast self-exam (BSE). According to current evidence-based guidelines, what is the most accurate statement about BSE?

BSE is recommended monthly and replaces clinical breast exams
BSE alone is insufficient for early detection but increases breast health awareness (Correct answer)
BSE should be performed weekly for women over 40
BSE is no longer relevant since mammography was introduced

Correct answer: BSE alone is insufficient for early detection but increases breast health awareness

Current guidelines do not endorse BSE as a standalone screening tool, but it promotes awareness and encourages women to report changes promptly.

Question 94: What role does calibration play in maintaining technical accuracy for Medical-Surgical Nursing Certification Board professionals?

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

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 95: When caring for a patient with an ileal pouch-anal anastomosis (J-pouch), the nurse expects the patient to experience which long-term adaptation?

Permanent ileostomy output requiring pouching
Normal formed stool within 4 weeks post-surgery
Six to eight loose stools per day that decrease over time (Correct answer)
Continuous fecal incontinence requiring pads indefinitely

Correct answer: Six to eight loose stools per day that decrease over time

After J-pouch creation, patients typically have 6–8 stools/day initially, which decreases as the pouch capacity increases over 12–18 months.

Question 96: Which Glasgow Coma Scale score indicates severe traumatic brain injury?

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

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 97: 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?

Caput medusae on the abdomen
Bilateral pitting edema in lower extremities
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 98: A patient with systemic lupus erythematosus (SLE) develops new avascular necrosis of the femoral head. The most likely contributing factor is:

Vitamin C deficiency
Long-term high-dose corticosteroid therapy (Correct answer)
Elevated anti-dsDNA antibodies
Long-term NSAID use

Correct answer: Long-term high-dose corticosteroid therapy

Long-term corticosteroid use is the most common cause of avascular necrosis (osteonecrosis) by impairing blood supply to bone.

Question 99: What is the role of informed consent in respiratory care?

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 100: A patient presents with sudden-onset tearing chest pain radiating to the back. Blood pressure in the right arm is 160/90 mmHg and in the left arm is 110/70 mmHg. The nurse suspects:

Pulmonary embolism with right heart strain
Aortic dissection with involvement of subclavian artery (Correct answer)
Hypertensive urgency with reactive pain
Acute anterior MI with cardiogenic shock

Correct answer: Aortic dissection with involvement of subclavian artery

Tearing chest pain radiating to the back with a blood pressure differential greater than 20 mmHg between arms is classic for aortic dissection.

Question 101: The nurse is preparing to administer regular insulin IV for a patient in DKA. Which action is MOST important before beginning the infusion?

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

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

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

Correct answer: Initiate lactulose therapy

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

Question 103: What is the most important factor in effective communication with patients regarding neurological nursing?

Speaking quickly to save time
Providing written instructions only
Using clear, understandable language and confirming understanding (Correct answer)
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 104: A patient with polycystic kidney disease (PKD) reports severe flank pain and hematuria. Which complication should the nurse suspect first?

Urinary tract infection
Acute tubular necrosis
Cyst hemorrhage or rupture (Correct answer)
Nephrolithiasis

Correct answer: Cyst hemorrhage or rupture

Cyst hemorrhage or rupture is a common complication of PKD that presents with acute flank pain and gross hematuria.

Question 105: A patient is scheduled for a barium enema. Which pre-procedure instruction is most important?

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

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 106: Which laboratory finding is MOST consistent with primary hypothyroidism?

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

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 107: Which intervention best reduces the risk of postoperative deep vein thrombosis (DVT) in a patient who had a total knee replacement?

Elevating both legs on pillows continuously
Bed rest for 48 hours to prevent stress on the surgical site
Applying ice packs to bilateral lower extremities
Early ambulation and sequential compression devices (Correct answer)

Correct answer: Early ambulation and sequential compression devices

Early ambulation combined with SCDs promotes venous return and is the most effective combined approach to DVT prevention after orthopedic surgery.

Question 108: In MSNCB practice, when should a patient's condition be reassessed?

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

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

Protein excretion of 150 mg/day
Protein excretion >3.5 g/day (Correct answer)
Protein excretion of 2.5 g/day
Protein excretion of 1.0 g/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 110: A patient experiences a run of ventricular tachycardia lasting 28 seconds that terminates spontaneously. This is classified as:

Ventricular fibrillation requiring immediate defibrillation
Non-sustained ventricular tachycardia (Correct answer)
Sustained ventricular tachycardia requiring antiarrhythmic therapy
Torsades de pointes from prolonged QT syndrome

Correct answer: Non-sustained ventricular tachycardia

Non-sustained VT is defined as three or more consecutive ventricular beats lasting less than 30 seconds that terminate spontaneously.

Question 111: What documentation is MOST critical to maintain for safety compliance in the Medical-Surgical Nursing Certification Board field?

Annual revenue reports
Employee vacation schedules
Incident reports, training records, and inspection logs (Correct answer)
Client marketing preferences

Correct answer: Incident reports, training records, and inspection logs

Incident reports, training records, and inspection logs are essential safety documentation. They demonstrate compliance with safety regulations, track training completion, and provide evidence of systematic hazard management.

Question 112: In Medical-Surgical Nursing Certification Board practice, what is the CORRECT sequence when performing a technical procedure?

Execute, then plan and review
Execute immediately and document only if issues arise
Plan, prepare, execute, verify, and document (Correct answer)
Document, execute, then plan

Correct answer: Plan, prepare, execute, verify, and document

The correct sequence follows a systematic approach: plan the procedure, prepare necessary resources, execute according to standards, verify results meet specifications, and document the process and outcomes. This ensures quality and accountability.

Question 113: What is the most important factor in effective communication with patients regarding renal nursing?

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

Correct answer: Using clear, understandable language and confirming understanding

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

Question 114: Which ethical principle requires MSNCB professionals to act in the patient's best interest?

Beneficence (Correct answer)
Fidelity
Autonomy
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 115: Which ethical principle requires MSNCB professionals to act in the patient's best interest?

Justice
Beneficence (Correct answer)
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 116: A patient refuses a blood transfusion for religious reasons but consents to the scheduled surgery. How should the perioperative nurse respond?

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

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

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

Correct answer: Using clear, understandable language and confirming understanding

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

Question 118: A patient with a C5 spinal cord injury is at greatest risk for which complication during the acute phase?

Urinary tract infection
Pressure ulcer formation
Deep vein thrombosis
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 119: In MSNCB practice, when should a patient's condition be reassessed?

Once per week
At regular intervals and when status changes (Correct answer)
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 120: A patient with multiple myeloma is at highest risk for which musculoskeletal complication?

Gout from uric acid overproduction
Avascular necrosis of the femoral head
Septic arthritis from immunosuppression
Pathologic fractures due to osteolytic lesions (Correct answer)

Correct answer: Pathologic fractures due to osteolytic lesions

Multiple myeloma causes osteolytic bone lesions that weaken bone structure, placing patients at high risk for pathologic fractures.

Question 121: A patient receiving IV amphotericin B develops rigors and fever during infusion. The most appropriate pre-medication to prevent this reaction is:

Acetaminophen and diphenhydramine (Correct answer)
Ondansetron and lorazepam
Methylprednisolone and epinephrine
Famotidine and cetirizine

Correct answer: Acetaminophen and diphenhydramine

Acetaminophen and diphenhydramine (with or without hydrocortisone) are standard pre-medications used to reduce infusion-related reactions to amphotericin B.

Question 122: A renal transplant patient is prescribed tacrolimus. Which adverse effect requires regular laboratory monitoring?

Nephrotoxicity and neurotoxicity (Correct answer)
Pulmonary fibrosis
Bone marrow stimulation causing polycythemia
Severe hypokalemia

Correct answer: Nephrotoxicity and neurotoxicity

Tacrolimus is a calcineurin inhibitor with dose-dependent nephrotoxicity and neurotoxicity; trough levels and renal function must be monitored closely.

Question 123: A nurse is caring for a patient post-Whipple procedure (pancreaticoduodenectomy). Which early complication requires immediate reporting to the surgeon?

Amylase-rich drain output exceeding 3× normal serum amylase (Correct answer)
Blood glucose of 180 mg/dL
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 124: A patient 24 hours post-total hip replacement reports sudden onset of sharp chest pain and dyspnea. SpO2 drops from 97% to 89%. Which condition does the nurse MOST suspect?

Atelectasis
Acute heart failure
Pneumonia
Pulmonary embolism (Correct answer)

Correct answer: Pulmonary embolism

Sudden pleuritic chest pain, dyspnea, and hypoxia following orthopedic surgery are classic signs of pulmonary embolism due to DVT.

Question 125: When caring for a patient after spinal anesthesia, the nurse monitors for post-dural puncture headache. What characteristic feature differentiates this headache from other postoperative headaches?

It peaks at 72 hours and does not respond to analgesics
It worsens when the patient sits or stands and improves when supine (Correct answer)
It is accompanied by fever and nuchal rigidity
It is unilateral and throbbing

Correct answer: It worsens when the patient sits or stands and improves when supine

Post-dural puncture headache is positional, worsening with upright posture and relieved by lying flat due to CSF pressure changes.

Question 126: Which assessment method provides the MOST reliable data for MSNCB professionals making critical decisions?

Social media reviews and testimonials
Single-source data from one stakeholder
Standardized tools combined with professional observation (Correct answer)
Informal verbal feedback alone

Correct answer: Standardized tools combined with professional observation

Combining standardized assessment tools with professional observation provides the most reliable and comprehensive data. Standardized tools ensure consistency and validity, while professional observation captures nuances that tools might miss.

Question 127: Which serum marker is the most sensitive early indicator of anastomotic leak following colorectal surgery?

Prothrombin time (PT/INR)
Serum amylase
Serum albumin
C-reactive protein (CRP) on postoperative day 3-5 (Correct answer)

Correct answer: C-reactive protein (CRP) on postoperative day 3-5

Elevated CRP on postoperative days 3-5 is the most sensitive laboratory marker for detecting anastomotic leak before clinical signs appear.

Question 128: What is the role of anesthesia in surgical procedures?

To monitor the patient's breathing during surgery
To shorten the duration of the surgery
To provide pain relief and ensure the patient is unconscious during surgery (Correct answer)
To make the patient aware of surgical procedures

Correct answer: To provide pain relief and ensure the patient is unconscious during surgery

Anesthesia is administered to induce a state of controlled temporary loss of sensation or awareness during surgical procedures. Its primary role is to provide effective pain relief and ensure the patient is unconscious or numb in a specific area. This facilitates the surgeon's work by keeping the patient comfortable and still, making the procedure safe and tolerable.

Question 129: A nurse is caring for a patient with bacterial meningitis. Which precaution is required until 24 hours after antibiotics are initiated?

Reverse isolation
Airborne precautions
Droplet precautions (Correct answer)
Contact precautions

Correct answer: Droplet precautions

Droplet precautions are required for bacterial meningitis (especially Neisseria meningitidis) until 24 hours of effective antibiotic therapy have been completed.

Question 130: A patient returns from the OR after open reduction internal fixation (ORIF) of the radius. What is the priority neurovascular assessment?

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

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 131: Which dietary recommendation is appropriate for a CKD patient to slow disease progression?

High-protein diet to prevent muscle wasting
Moderate protein restriction (0.6–0.8 g/kg/day) (Correct answer)
Unrestricted protein with increased caloric intake
Plant-based protein avoided due to phosphorus content

Correct answer: Moderate protein restriction (0.6–0.8 g/kg/day)

Moderate protein restriction (0.6–0.8 g/kg/day) reduces uremic toxin production and glomerular hyperfiltration, slowing CKD progression.

Question 132: A postoperative patient on hydromorphone PCA has a respiratory rate of 8 breaths/min and is difficult to arouse. The nurse should immediately:

Decrease the PCA basal rate by 50%
Request an order for a lower opioid dose for the next PCA refill
Administer naloxone per protocol and apply supplemental oxygen (Correct answer)
Stimulate the patient verbally and recheck in 5 minutes

Correct answer: Administer naloxone per protocol and apply supplemental oxygen

Respiratory rate <10 breaths/min with decreased level of consciousness indicates opioid-induced respiratory depression requiring naloxone reversal.

Question 133: What is the first step in the clinical decision-making process?

Making an intervention plan
Identifying the primary healthcare provider
Evaluating the effectiveness of previous treatments
Gathering patient data through assessment (Correct answer)

Correct answer: Gathering patient data through assessment

The clinical decision-making process begins with gathering patient data through assessment. This initial step provides the necessary information about the patient's condition, symptoms, and history. This comprehensive data collection is essential for identifying problems, formulating hypotheses, and laying the groundwork for all subsequent steps in planning and delivering care.

Question 134: A patient with hepatitis B asks the nurse how the infection is most commonly transmitted. The correct response is:

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

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

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

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 136: Which risk management approach is MOST effective for MSNCB professionals when evaluating potential workplace hazards?

Delegating all safety decisions to management
Relying solely on historical accident data
Reactive analysis after incidents occur
Proactive hazard identification and assessment (Correct answer)

Correct answer: Proactive hazard identification and assessment

Proactive hazard identification and assessment allows professionals to identify and mitigate risks before incidents occur, which is far more effective than reactive approaches that only address problems after they happen.

Question 137: A patient's ABG shows pH 7.28, PaCO2 38 mmHg, HCO3 16 mEq/L. Which acid-base disturbance does this indicate?

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

Correct answer: Metabolic acidosis

A pH below 7.35 with low bicarbonate (<22 mEq/L) and normal PaCO2 indicates uncompensated metabolic acidosis.

Question 138: Which IV solution is classified as isotonic?

D10W
0.45% NaCl
3% NaCl
0.9% NaCl (Correct answer)

Correct answer: 0.9% NaCl

0.9% NaCl (normal saline) has an osmolarity of approximately 308 mOsm/L, matching plasma osmolarity and making it isotonic.

Question 139: A nurse is preparing to give oral medications to a patient with a new nasogastric tube. Which medication should NOT be crushed?

Omeprazole delayed-release capsule (Correct answer)
Metoprolol tartrate immediate-release
Docusate sodium capsule contents
Acetaminophen tablet

Correct answer: Omeprazole delayed-release capsule

Omeprazole is an enteric-coated delayed-release formulation that should not be crushed as this destroys the protective coating and inactivates the drug in the stomach.

Question 140: A patient with ankylosing spondylitis asks what activity best maintains spinal flexibility. The nurse's best response is:

High-impact aerobics
Bed rest during flares only
Sitting in a recliner to maintain lumbar curve
Swimming and prone-lying extension exercises (Correct answer)

Correct answer: Swimming and prone-lying extension exercises

Swimming and prone-lying extension exercises help maintain spinal flexibility and counteract the tendency toward kyphotic fusion in ankylosing spondylitis.

Question 141: A post-renal transplant patient develops oliguria, fever, and graft tenderness on day 5. What does this most likely indicate?

Surgical anastomosis failure unrelated to immunity
Acute rejection requiring immediate evaluation (Correct answer)
Hyperacute rejection occurring in the first minutes
Chronic rejection over months to years

Correct answer: Acute rejection requiring immediate evaluation

Fever, oliguria, and graft tenderness appearing days to weeks post-transplant are classic signs of acute cellular rejection requiring prompt biopsy and treatment.

Question 142: A nurse is caring for a patient in Buck's traction. Which action is correct?

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

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 143: 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
Use only sterile gloves during the procedure
Premedicate with diphenhydramine and proceed normally
Schedule the patient as the first case of the day in a latex-free environment (Correct answer)

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

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

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

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

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 146: How does a nurse prioritize clinical decisions in patient care?

By delegating decisions to other healthcare providers
By focusing on patient preferences only
By prioritizing based on the severity and urgency of patient needs (Correct answer)
By choosing the least invasive treatments first

Correct answer: By prioritizing based on the severity and urgency of patient needs

Nurses prioritize clinical decisions based on the severity and urgency of patient needs, often using frameworks like Maslow's Hierarchy of Needs or the ABCs (Airway, Breathing, Circulation). This approach ensures that life-threatening or immediate physiological needs are addressed first. Prioritizing effectively optimizes patient safety and outcomes by allocating resources to the most critical issues.

Question 147: Which nursing intervention is most effective in preventing deep vein thrombosis (DVT) after hip replacement surgery?

Keeping the patient on strict bed rest for 48 hours postoperatively
Massaging the calf muscles every 4 hours
Early ambulation and sequential compression devices with prescribed anticoagulation (Correct answer)
Applying ice packs to the operative leg for 20 minutes every hour

Correct answer: Early ambulation and sequential compression devices with prescribed anticoagulation

Combined mechanical prophylaxis (SCDs, early ambulation) and pharmacologic anticoagulation is the most effective DVT prevention strategy post-arthroplasty.

Question 148: A patient with DKA has an arterial blood gas showing pH 7.18, PaCO2 28 mmHg, HCO3 10 mEq/L. The nurse recognizes this as:

Metabolic alkalosis with respiratory compensation
Metabolic acidosis with respiratory compensation (Correct answer)
Respiratory acidosis with metabolic compensation
Combined respiratory and metabolic alkalosis

Correct answer: Metabolic acidosis with respiratory compensation

DKA causes metabolic acidosis (low pH, low HCO3); the low PaCO2 reflects respiratory compensation (Kussmaul respirations blowing off CO2).

Question 149: A patient's incentive spirometry goal is 1500 mL but they consistently achieve only 600 mL on postoperative day 1. The nurse's best intervention is to:

Provide pain medication before sessions and coach proper technique (Correct answer)
Discontinue incentive spirometry and use flutter valve instead
Document and accept limited effort as normal postop
Administer a bronchodilator and reassess

Correct answer: Provide pain medication before sessions and coach proper technique

Preemptive analgesia reduces splinting from incisional pain, the primary barrier to deep breathing, and coaching optimizes technique.

Question 150: A patient is receiving IV vancomycin. The nurse notices flushing, erythema, and hypotension during infusion. The priority action is to:

Stop the infusion and administer diphenhydramine
Obtain blood cultures before stopping the infusion
Discontinue vancomycin permanently and notify pharmacy
Slow the infusion rate and monitor the patient (Correct answer)

Correct answer: Slow the infusion rate and monitor the patient

Red Man Syndrome is an infusion rate-related reaction to vancomycin; slowing the infusion rate typically resolves symptoms and is the first intervention.

Question 151: What is the first priority in endocrine nursing for MSNCB practitioners?

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

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.

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

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