CMSRN Certification Exam Practice Test Bank – Medical-
Surgical Nursing Certification Board (MSNCB) | Complete
Questions and Answers Study Guide
INTRODUCTION:
This comprehensive practice test bank is designed for medical-surgical registered nurses
preparing for the Certified Medical-Surgical Registered Nurse (CMSRN) certification
examination. Based on the 2025/2026 Medical-Surgical Nursing Certification Board (MSNCB)
exam blueprint and current evidence-based nursing practice, this resource covers all four major
exam domains including physiological integrity, health promotion and maintenance,
psychosocial integrity, and safe and effective care environment. Whether you are seeking initial
certification or recertification, these 150 questions will help you assess your knowledge and
readiness for the examination.
DOMAIN 1A: PHYSIOLOGICAL INTEGRITY - GASTROINTESTINAL (Questions 1-15)
Question 1: A patient presents with severe epigastric pain radiating to the back, nausea, and
vomiting. Serum lipase is 450 U/L (normal <60). What is the priority nursing intervention?
A. Administer oral pain medication
B. Place patient on NPO status
C. Encourage clear liquids
D. Apply heat to the abdomen
Answer: B
Rationale: Elevated lipase indicates acute pancreatitis. The priority is to rest the pancreas by
placing the patient NPO, which reduces pancreatic stimulation. IV fluids and pain management
are initiated. Oral intake is withheld until symptoms improve.
Question 2: A patient with ulcerative colitis reports 10 bloody stools per day and severe
abdominal cramping. Which assessment finding requires immediate provider notification?
A. Temperature 99.8°F (37.7°C)
B. Heart rate 110 bpm
C. Abdominal distention with decreased bowel sounds
D. Hemoglobin 11.5 g/dL
,Answer: C
Rationale: Abdominal distention with decreased or absent bowel sounds in a patient with UC
may indicate toxic megacolon, a life-threatening complication requiring immediate surgical
evaluation. The abdomen becomes tender and tympanic, with risk of perforation.
Question 3: A patient had a right hemicolectomy with anastomosis 3 days ago. The patient
reports sudden abdominal pain and has a temperature of 102°F (38.9°C) and heart rate of 120
bpm. What complication should the nurse suspect?
A. Paralytic ileus
B. Anastomotic leak
C. Wound dehiscence
D. Urinary tract infection
Answer: B
Rationale: Anastomotic leak typically occurs 5-7 days post-operatively but can occur earlier.
Signs include fever, tachycardia, abdominal pain, peritoneal signs, and leukocytosis. This is a
surgical emergency requiring immediate intervention.
Question 4: A patient with cirrhosis has new-onset confusion, asterixis, and elevated ammonia
levels. Which medication should the nurse expect to administer?
A. Lactulose
B. Furosemide
C. Spironolactone
D. Pantoprazole
Answer: A
Rationale: Lactulose promotes excretion of ammonia through the GI tract by acidifying the
colon, converting NH3 to NH4+ (which cannot be absorbed). This treats hepatic
encephalopathy. Neomycin is an alternative.
Question 5: A patient with an ileostomy reports output of 1500 mL over 8 hours and complains
of dizziness. What is the priority assessment?
A. Stoma color
B. Fluid volume status
,C. Dietary intake
D. Medication list
Answer: B
Rationale: High ileostomy output (normal 500-1500 mL/day) can lead to dehydration and
electrolyte imbalances (especially sodium and potassium). The priority is assessing for
hypovolemia (orthostatic hypotension, tachycardia, dry mucous membranes, decreased urine
output).
Question 6: A patient with appendicitis reports pain that started periumbilical and has now
localized to the right lower quadrant. What clinical sign is associated with this progression?
A. McBurney's point tenderness
B. Murphy's sign
C. Blumberg sign
D. Grey Turner's sign
Answer: A
Rationale: McBurney's point is located one-third of the distance from the anterior superior iliac
spine to the umbilicus and is the classic location of maximal tenderness in appendicitis.
Murphy's sign is for cholecystitis, Blumberg sign indicates peritoneal irritation (rebound
tenderness), and Grey Turner's sign indicates retroperitoneal hemorrhage.
Question 7: A patient post-operative bowel obstruction has a nasogastric tube placed to low
intermittent suction. Which assessment finding indicates the tube is functioning effectively?
A. Patient reports decreased nausea
B. Suction chamber shows 50 mL over 8 hours
C. Abdominal distention is decreasing
D. Bowel sounds are hyperactive
Answer: C
Rationale: Decreasing abdominal distention indicates successful decompression of the bowel by
the NG tube. While decreased nausea is positive, the physical finding of reduced distention is
the most objective indicator of effective gastric decompression in bowel obstruction.
, Question 8: A patient with peptic ulcer disease reports burning epigastric pain 1-3 hours after
meals that is relieved by antacids. Which type of ulcer does this describe?
A. Duodenal ulcer
B. Gastric ulcer
C. Stress ulcer
D. Marginal ulcer
Answer: B
Rationale: Gastric ulcers typically cause pain 1-3 hours after meals (when acid is secreted in
response to food) and are relieved by antacids. Duodenal ulcers typically cause pain 2-3 hours
after meals or at night and are relieved by food.
Question 9: A patient is receiving enteral nutrition via PEG tube. Before administering
medications, what is the priority nursing action?
A. Flush with 30 mL water
B. Check gastric residual
C. Verify tube placement by pH testing
D. Elevate head of bed to 45 degrees
Answer: C
Rationale: Tube placement must be verified before each feeding or medication administration.
Gastric aspirate pH ≤5.5 confirms gastric placement. While head elevation and flushing are
important, verifying placement is the priority safety measure to prevent aspiration.
Question 10: A patient with hepatitis B asks about transmission prevention. Which statement by
the patient indicates understanding?
A. "I should avoid sharing needles but can share razors"
B. "My family should get vaccinated against hepatitis B"
C. "I need to use separate bathroom facilities"
D. "I cannot work in food service anymore"
Answer: B
Surgical Nursing Certification Board (MSNCB) | Complete
Questions and Answers Study Guide
INTRODUCTION:
This comprehensive practice test bank is designed for medical-surgical registered nurses
preparing for the Certified Medical-Surgical Registered Nurse (CMSRN) certification
examination. Based on the 2025/2026 Medical-Surgical Nursing Certification Board (MSNCB)
exam blueprint and current evidence-based nursing practice, this resource covers all four major
exam domains including physiological integrity, health promotion and maintenance,
psychosocial integrity, and safe and effective care environment. Whether you are seeking initial
certification or recertification, these 150 questions will help you assess your knowledge and
readiness for the examination.
DOMAIN 1A: PHYSIOLOGICAL INTEGRITY - GASTROINTESTINAL (Questions 1-15)
Question 1: A patient presents with severe epigastric pain radiating to the back, nausea, and
vomiting. Serum lipase is 450 U/L (normal <60). What is the priority nursing intervention?
A. Administer oral pain medication
B. Place patient on NPO status
C. Encourage clear liquids
D. Apply heat to the abdomen
Answer: B
Rationale: Elevated lipase indicates acute pancreatitis. The priority is to rest the pancreas by
placing the patient NPO, which reduces pancreatic stimulation. IV fluids and pain management
are initiated. Oral intake is withheld until symptoms improve.
Question 2: A patient with ulcerative colitis reports 10 bloody stools per day and severe
abdominal cramping. Which assessment finding requires immediate provider notification?
A. Temperature 99.8°F (37.7°C)
B. Heart rate 110 bpm
C. Abdominal distention with decreased bowel sounds
D. Hemoglobin 11.5 g/dL
,Answer: C
Rationale: Abdominal distention with decreased or absent bowel sounds in a patient with UC
may indicate toxic megacolon, a life-threatening complication requiring immediate surgical
evaluation. The abdomen becomes tender and tympanic, with risk of perforation.
Question 3: A patient had a right hemicolectomy with anastomosis 3 days ago. The patient
reports sudden abdominal pain and has a temperature of 102°F (38.9°C) and heart rate of 120
bpm. What complication should the nurse suspect?
A. Paralytic ileus
B. Anastomotic leak
C. Wound dehiscence
D. Urinary tract infection
Answer: B
Rationale: Anastomotic leak typically occurs 5-7 days post-operatively but can occur earlier.
Signs include fever, tachycardia, abdominal pain, peritoneal signs, and leukocytosis. This is a
surgical emergency requiring immediate intervention.
Question 4: A patient with cirrhosis has new-onset confusion, asterixis, and elevated ammonia
levels. Which medication should the nurse expect to administer?
A. Lactulose
B. Furosemide
C. Spironolactone
D. Pantoprazole
Answer: A
Rationale: Lactulose promotes excretion of ammonia through the GI tract by acidifying the
colon, converting NH3 to NH4+ (which cannot be absorbed). This treats hepatic
encephalopathy. Neomycin is an alternative.
Question 5: A patient with an ileostomy reports output of 1500 mL over 8 hours and complains
of dizziness. What is the priority assessment?
A. Stoma color
B. Fluid volume status
,C. Dietary intake
D. Medication list
Answer: B
Rationale: High ileostomy output (normal 500-1500 mL/day) can lead to dehydration and
electrolyte imbalances (especially sodium and potassium). The priority is assessing for
hypovolemia (orthostatic hypotension, tachycardia, dry mucous membranes, decreased urine
output).
Question 6: A patient with appendicitis reports pain that started periumbilical and has now
localized to the right lower quadrant. What clinical sign is associated with this progression?
A. McBurney's point tenderness
B. Murphy's sign
C. Blumberg sign
D. Grey Turner's sign
Answer: A
Rationale: McBurney's point is located one-third of the distance from the anterior superior iliac
spine to the umbilicus and is the classic location of maximal tenderness in appendicitis.
Murphy's sign is for cholecystitis, Blumberg sign indicates peritoneal irritation (rebound
tenderness), and Grey Turner's sign indicates retroperitoneal hemorrhage.
Question 7: A patient post-operative bowel obstruction has a nasogastric tube placed to low
intermittent suction. Which assessment finding indicates the tube is functioning effectively?
A. Patient reports decreased nausea
B. Suction chamber shows 50 mL over 8 hours
C. Abdominal distention is decreasing
D. Bowel sounds are hyperactive
Answer: C
Rationale: Decreasing abdominal distention indicates successful decompression of the bowel by
the NG tube. While decreased nausea is positive, the physical finding of reduced distention is
the most objective indicator of effective gastric decompression in bowel obstruction.
, Question 8: A patient with peptic ulcer disease reports burning epigastric pain 1-3 hours after
meals that is relieved by antacids. Which type of ulcer does this describe?
A. Duodenal ulcer
B. Gastric ulcer
C. Stress ulcer
D. Marginal ulcer
Answer: B
Rationale: Gastric ulcers typically cause pain 1-3 hours after meals (when acid is secreted in
response to food) and are relieved by antacids. Duodenal ulcers typically cause pain 2-3 hours
after meals or at night and are relieved by food.
Question 9: A patient is receiving enteral nutrition via PEG tube. Before administering
medications, what is the priority nursing action?
A. Flush with 30 mL water
B. Check gastric residual
C. Verify tube placement by pH testing
D. Elevate head of bed to 45 degrees
Answer: C
Rationale: Tube placement must be verified before each feeding or medication administration.
Gastric aspirate pH ≤5.5 confirms gastric placement. While head elevation and flushing are
important, verifying placement is the priority safety measure to prevent aspiration.
Question 10: A patient with hepatitis B asks about transmission prevention. Which statement by
the patient indicates understanding?
A. "I should avoid sharing needles but can share razors"
B. "My family should get vaccinated against hepatitis B"
C. "I need to use separate bathroom facilities"
D. "I cannot work in food service anymore"
Answer: B
