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CMSRN Exam 2026/2027 Actual Exam |
100% Correct Answers | Verified Updated
| Pass Guaranteed - A+ Graded
Section 1: Assessment and Diagnosis (25 Questions)
Q1: A 65-year-old patient with a 30-pack-year smoking history presents with a new cough that
has persisted for 6 weeks. The cough is non-productive, and the patient denies fever, chest pain,
or dyspnea. Chest x-ray shows a 2 cm solitary pulmonary nodule. Which of the following is the
MOST appropriate next step?
A. Prescribe a course of antibiotics
B. Order a CT scan of the chest [CORRECT]
C. Reassure the patient and schedule follow-up in 6 months
D. Refer for immediate bronchoscopy
Correct Answer: B
Rationale: A solitary pulmonary nodule in a patient with significant smoking history requires
further characterization. A CT scan provides better resolution to determine the probability of
malignancy and guides the need for biopsy or monitoring. Antibiotics are inappropriate without
signs of infection. Delaying follow-up risks progression of potential cancer. Bronchoscopy may
be indicated later but imaging is the first step.
Q2: The nurse is assessing a patient with suspected appendicitis. Which of the following signs is
MOST specific to appendicitis?
A. Rebound tenderness in the RLQ
B. Rovsing's sign [CORRECT]
C. Murphy's sign
D. Cullen's sign
Correct Answer: B
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Rationale: Rovsing's sign (palpation of the LLQ causing pain in the RLQ) is a specific sign for
appendicitis. Rebound tenderness indicates peritoneal irritation but is not specific to appendicitis.
Murphy's sign is associated with cholecystitis. Cullen's sign (periumbilical bruising) indicates
retroperitoneal bleeding or pancreatitis.
Q3: A patient presents with severe chest pain described as "tearing" radiating to the back. Blood
pressure is 180/110 mmHg in the right arm and 140/80 mmHg in the left arm. Which diagnosis
should the nurse suspect?
A. Acute Myocardial Infarction (AMI)
B. Pulmonary Embolism (PE)
C. Aortic Dissection [CORRECT]
D. Tension Pneumothorax
Correct Answer: C
Rationale: Tearing chest pain radiating to the back and a significant blood pressure discrepancy
between arms (>20 mmHg) are classic signs of aortic dissection. AMI pain is typically
crushing/pressure. PE presents with dyspnea and hypoxia. Tension pneumothorax presents with
absent breath sounds and tracheal deviation.
Q4: The nurse is reviewing laboratory results for a patient with chronic kidney disease (CKD)
stage 4. Which finding requires IMMEDIATE notification of the healthcare provider?
A. Potassium of 5.2 mEq/L
B. BUN of 45 mg/dL
C. Potassium of 7.1 mEq/L [CORRECT]
D. Creatinine of 3.8 mg/dL
Correct Answer: C
Rationale: A potassium level of 7.1 mEq/L indicates severe hyperkalemia, which poses an
immediate risk for life-threatening cardiac arrhythmias. While other values are elevated
consistent with CKD, severe hyperkalemia is a medical emergency requiring immediate
intervention (calcium gluconate, insulin/glucose, dialysis).
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Q5: When assessing a patient with a suspected stroke, the nurse uses the NIH Stroke Scale.
Which assessment finding indicates "severe aphasia"?
A. Patient is unable to speak or understand
B. Patient has mild word-finding difficulty
C. Patient is mute or unable to understand commands [CORRECT]
D. Patient speaks clearly but with slurred words
Correct Answer: C
Rationale: Severe aphasia on the NIHSS (Score 3) is defined as the patient being mute or unable
to understand commands. Option A describes global aphasia generally but the scale criteria focus
on the inability to understand or respond. Option B is mild aphasia. Option D describes
dysarthria, not aphasia.
Q6: A patient with liver cirrhosis presents with "milkshake" appearing urine and a serum albumin
of 2.0 g/dL. The nurse recognizes these findings are consistent with:
A. Hepatic encephalopathy
B. Spontaneous bacterial peritonitis
C. Nephrotic syndrome [CORRECT]
D. Hepatorenal syndrome
Correct Answer: C
Rationale: Nephrotic syndrome is characterized by massive proteinuria (causing
frothy/"milkshake" urine), hypoalbuminemia (< 3.0 g/dL), and edema. While often primary, it
can be secondary to systemic diseases. Hepatic encephalopathy involves neuro changes. SBIV
involves infection of ascites fluid. Hepatorenal syndrome involves renal failure in liver disease.
Q7: Which breath sound is characteristic of a pleural effusion?
A. Wheezes
B. Stridor
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C. Pleural friction rub
D. Decreased or absent breath sounds [CORRECT]
Correct Answer: D
Rationale: Pleural effusion involves fluid accumulation in the pleural space, which separates the
lung from the chest wall, causing decreased or absent breath sounds over the affected area.
Wheezes indicate airway narrowing. Stridor indicates upper airway obstruction. A friction rub
indicates pleuritis (inflammation) without significant fluid accumulation.
Q8: The nurse is assessing a patient with diabetes mellitus. Which skin finding is MOST
suggestive of peripheral arterial disease (PAD)?
A. Brownish discoloration of the lower legs
B. Dependent rubor [CORRECT]
C. Pitting edema
D. Warm, dry skin
Correct Answer: B
Rationale: Dependent rubor (redness when legs are dependent, pallor when elevated) is a classic
sign of arterial insufficiency/PAD. Brownish discoloration (stasis dermatitis) and edema suggest
venous insufficiency. Warm, dry skin suggests adequate perfusion or neuropathy.
Q9: A patient presents with sudden onset of severe, "boring" abdominal pain radiating to the
back, nausea, and vomiting. Labs reveal elevated amylase and lipase. Which question is MOST
relevant to the nursing history?
A. "Have you had your gallbladder removed?"
B. "How much alcohol did you drink recently?" [CORRECT]
C. "Do you have a history of irritable bowel syndrome?"
D. "Have you been taking NSAIDs regularly?"
Correct Answer: B
CMSRN Exam 2026/2027 Actual Exam |
100% Correct Answers | Verified Updated
| Pass Guaranteed - A+ Graded
Section 1: Assessment and Diagnosis (25 Questions)
Q1: A 65-year-old patient with a 30-pack-year smoking history presents with a new cough that
has persisted for 6 weeks. The cough is non-productive, and the patient denies fever, chest pain,
or dyspnea. Chest x-ray shows a 2 cm solitary pulmonary nodule. Which of the following is the
MOST appropriate next step?
A. Prescribe a course of antibiotics
B. Order a CT scan of the chest [CORRECT]
C. Reassure the patient and schedule follow-up in 6 months
D. Refer for immediate bronchoscopy
Correct Answer: B
Rationale: A solitary pulmonary nodule in a patient with significant smoking history requires
further characterization. A CT scan provides better resolution to determine the probability of
malignancy and guides the need for biopsy or monitoring. Antibiotics are inappropriate without
signs of infection. Delaying follow-up risks progression of potential cancer. Bronchoscopy may
be indicated later but imaging is the first step.
Q2: The nurse is assessing a patient with suspected appendicitis. Which of the following signs is
MOST specific to appendicitis?
A. Rebound tenderness in the RLQ
B. Rovsing's sign [CORRECT]
C. Murphy's sign
D. Cullen's sign
Correct Answer: B
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Rationale: Rovsing's sign (palpation of the LLQ causing pain in the RLQ) is a specific sign for
appendicitis. Rebound tenderness indicates peritoneal irritation but is not specific to appendicitis.
Murphy's sign is associated with cholecystitis. Cullen's sign (periumbilical bruising) indicates
retroperitoneal bleeding or pancreatitis.
Q3: A patient presents with severe chest pain described as "tearing" radiating to the back. Blood
pressure is 180/110 mmHg in the right arm and 140/80 mmHg in the left arm. Which diagnosis
should the nurse suspect?
A. Acute Myocardial Infarction (AMI)
B. Pulmonary Embolism (PE)
C. Aortic Dissection [CORRECT]
D. Tension Pneumothorax
Correct Answer: C
Rationale: Tearing chest pain radiating to the back and a significant blood pressure discrepancy
between arms (>20 mmHg) are classic signs of aortic dissection. AMI pain is typically
crushing/pressure. PE presents with dyspnea and hypoxia. Tension pneumothorax presents with
absent breath sounds and tracheal deviation.
Q4: The nurse is reviewing laboratory results for a patient with chronic kidney disease (CKD)
stage 4. Which finding requires IMMEDIATE notification of the healthcare provider?
A. Potassium of 5.2 mEq/L
B. BUN of 45 mg/dL
C. Potassium of 7.1 mEq/L [CORRECT]
D. Creatinine of 3.8 mg/dL
Correct Answer: C
Rationale: A potassium level of 7.1 mEq/L indicates severe hyperkalemia, which poses an
immediate risk for life-threatening cardiac arrhythmias. While other values are elevated
consistent with CKD, severe hyperkalemia is a medical emergency requiring immediate
intervention (calcium gluconate, insulin/glucose, dialysis).
,3
Q5: When assessing a patient with a suspected stroke, the nurse uses the NIH Stroke Scale.
Which assessment finding indicates "severe aphasia"?
A. Patient is unable to speak or understand
B. Patient has mild word-finding difficulty
C. Patient is mute or unable to understand commands [CORRECT]
D. Patient speaks clearly but with slurred words
Correct Answer: C
Rationale: Severe aphasia on the NIHSS (Score 3) is defined as the patient being mute or unable
to understand commands. Option A describes global aphasia generally but the scale criteria focus
on the inability to understand or respond. Option B is mild aphasia. Option D describes
dysarthria, not aphasia.
Q6: A patient with liver cirrhosis presents with "milkshake" appearing urine and a serum albumin
of 2.0 g/dL. The nurse recognizes these findings are consistent with:
A. Hepatic encephalopathy
B. Spontaneous bacterial peritonitis
C. Nephrotic syndrome [CORRECT]
D. Hepatorenal syndrome
Correct Answer: C
Rationale: Nephrotic syndrome is characterized by massive proteinuria (causing
frothy/"milkshake" urine), hypoalbuminemia (< 3.0 g/dL), and edema. While often primary, it
can be secondary to systemic diseases. Hepatic encephalopathy involves neuro changes. SBIV
involves infection of ascites fluid. Hepatorenal syndrome involves renal failure in liver disease.
Q7: Which breath sound is characteristic of a pleural effusion?
A. Wheezes
B. Stridor
, 4
C. Pleural friction rub
D. Decreased or absent breath sounds [CORRECT]
Correct Answer: D
Rationale: Pleural effusion involves fluid accumulation in the pleural space, which separates the
lung from the chest wall, causing decreased or absent breath sounds over the affected area.
Wheezes indicate airway narrowing. Stridor indicates upper airway obstruction. A friction rub
indicates pleuritis (inflammation) without significant fluid accumulation.
Q8: The nurse is assessing a patient with diabetes mellitus. Which skin finding is MOST
suggestive of peripheral arterial disease (PAD)?
A. Brownish discoloration of the lower legs
B. Dependent rubor [CORRECT]
C. Pitting edema
D. Warm, dry skin
Correct Answer: B
Rationale: Dependent rubor (redness when legs are dependent, pallor when elevated) is a classic
sign of arterial insufficiency/PAD. Brownish discoloration (stasis dermatitis) and edema suggest
venous insufficiency. Warm, dry skin suggests adequate perfusion or neuropathy.
Q9: A patient presents with sudden onset of severe, "boring" abdominal pain radiating to the
back, nausea, and vomiting. Labs reveal elevated amylase and lipase. Which question is MOST
relevant to the nursing history?
A. "Have you had your gallbladder removed?"
B. "How much alcohol did you drink recently?" [CORRECT]
C. "Do you have a history of irritable bowel syndrome?"
D. "Have you been taking NSAIDs regularly?"
Correct Answer: B
