CMSRN Comprehensive New Practice Exam – Medical-Surgical Nursing (High-Yield Questions & Answers)

This document is a comprehensive practice exam for the Certified Medical-Surgical Registered Nurse (CMSRN) certification, featuring 150 multiple-choice questions with correct answers and detailed rationales. Topics include: Kübler-Ross stages of grief (denial, anger), most common preventable postoperative complication (atelectasis), head injury assessment (notify neurosurgeon for new neurologic changes), chest tube removal instruction (take deep breath and hold it), elderly patient with isolation and hallucinations (rule out delirium, not just psychiatric cause), TB medication refusal (health department can require treatment), discharge planning for elderly couple (discuss community resources), paternalism in ethics, evaluation phase of nursing process (reassessment and audit), risk for disuse syndrome (sedentary patient with COPD), effective feedback from manager (inform staff regularly how they are performing), cost-effective analysis vs cost-benefit analysis, nursing diagnoses vs medical diagnoses (nursing diagnoses focus on patient’s response to health problems), priority action in acute pulmonary edema (elevate HOB and apply oxygen), furosemide hypokalemia (K+ 3.1 mEq/L requires intervention), post-CABG new atrial fibrillation with chest pain (ABC assessment first), ECG peaked T waves (hyperkalemia), normal potassium range (3.5–5.0 mEq/L), normal calcium range (8.5–10.5 mg/dL), normal magnesium range (1.4–2.1 mEq/L), normal chloride range (98–106 mEq/L), lisinopril adverse effect requiring immediate follow-up (angioedema – lip swelling), heart failure daily weight teaching (report gain of 2–3 pounds in a day), heparin monitoring (aPTT), hypokalemia signs (cardiac arrhythmia, leg cramping), hyperkalemia signs (cardiac arrest, muscle weakness), warfarin INR 4.5 (hold dose and notify provider), highest risk for infective endocarditis (prosthetic heart valve), nitroglycerin effectiveness (chest pain relief), heart failure daily weight purpose (detect fluid retention before symptoms), left-sided heart failure sign (pulmonary crackles), hydrochlorothiazide teaching (take in morning to avoid nocturia), digoxin toxicity (visual disturbances with yellow-green halos), aortic dissection (sudden tearing chest pain radiating to back), normal sodium range (135–145 mEq/L), hyponatremia (rapid dehydration and hypotonic states), hypernatremia (older adults who cannot access water), low-sodium meal selection (baked fish with steamed rice and fresh fruit), ABG interpretation: pH 7.30, PaCO2 60, PaO2 65 (uncompensated respiratory acidosis with hypoxemia), normal pH (7.35–7.45), normal PaCO2 (35–45 mm Hg), normal HCO3 (22–26 mEq/L), pH 7.35 (acidosis), pH 7.45 (alkalosis), respiratory acidosis causes (pneumonia, COPD, narcotic overdose), respiratory alkalosis causes (panic attacks, hyperventilation), metabolic acidosis (DKA), metabolic alkalosis (prolonged vomiting/NG suction), COPD initial oxygen (2 L/min nasal cannula), pulmonary embolism (sudden sharp chest pain and dyspnea), pneumonia priority (administer oxygen), chest tube continuous bubbling (air leak), TB precautions (airborne), C. difficile hand hygiene (soap and water), influenza precautions (droplet), acute asthma exacerbation first-line (inhaled albuterol), ventilator right mainstem intubation (absent breath sounds on left), postoperative atelectasis cause (shallow breathing from pain), heparin therapeutic aPTT (1.5–2.5 times control), COPD prevention (annual influenza vaccine), hypoglycemia first action (give 15 g fast-acting carbohydrate), insulin glargine (no peak time), hypoglycemia teaching (carry fast-acting sugar), DKA Kussmaul respirations (compensating for metabolic acidosis), DKA vs HHS (DKA has ketones; HHS has severe hyperglycemia without ketones), PTU agranulocytosis (sore throat and fever – report immediately), hypocalcemia signs (Trousseau and Chvostek signs), hypercalcemia signs (lethargy and bone pain), immunoglobulin IgM (first responder), first line of defense (skin, mucous membranes, gastric juice), second line of defense (inflammation and phagocytosis), third line of defense (B-cells and T-cells), B-cells function (produce antibodies and memory B-cells), helper T-cells function (direct adaptive immune response), passive natural immunity (mother to fetus), preoperative hyperglycemia (notify provider for insulin orders), levothyroxine teaching (take on empty stomach in morning), Cushing’s syndrome (moon face, buffalo hump), Addison’s disease (adrenal crisis with hypotension), low-potassium meal (baked chicken with rice and green beans), IV potassium infiltration (pain and redness – stop infusion), post-stroke dysphagia (NPO until swallowing evaluation), increased ICP sign (sudden headache with vomiting), Parkinson’s carbidopa-levodopa peak timing (schedule PT 1 hour after dose), Buck’s traction priority (assess neurovascular status every hour), post-hip arthroplasty sleep position (non-operative side with abductor pillow), compartment syndrome sign (pain with passive stretch), seizure safety (move furniture away, stay with patient), head injury GCS decrease of 2 points (most concerning – notify provider), fat embolism syndrome (sudden shortness of breath, chest pain), osteoporosis teaching (weight-bearing exercise), herniated disc with bladder incontinence (cauda equina syndrome – notify provider immediately), myasthenia gravis pathophysiology (acetylcholine receptor antibodies), myasthenia gravis contraindicated medication (magnesium sulfate), MS fatigue management (schedule activities during peak energy times, rest when tired), Guillain-Barré complication (respiratory failure from ascending paralysis), autonomic dysreflexia (severe hypertension and bradycardia), C5 spinal cord injury (requires help with eating and dressing), increased ICP priority intervention (keep head in midline position), GCS severe head injury (8 or less), bacterial meningitis precautions (droplet), concussion discharge teaching (return for worsening headache, vomiting, confusion), Parkinson’s mask-like facies (muscle rigidity), severe hyperkalemia ECG (peaked T waves), acute glomerulonephritis main goal (maintain fluid balance), cirrhosis ascites spironolactone (potassium-sparing diuretic counteracting hyperaldosteronism), acute pancreatitis diagnosis (serum amylase and lipase), upper GI bleed priority (start two large-bore IVs and administer fluids), hepatic encephalopathy (confusion and asterixis), ulcerative colitis priority (monitor hemoglobin and hematocrit), new colostomy refusal to look – referral to WOCN, stage 3 pressure injury (full-thickness skin loss with visible subcutaneous fat, no bone/muscle), eschar covering wound (stage as unstageable), highest risk for pressure injury (bedbound patient with incontinence), NG suction complication (metabolic alkalosis), acute kidney injury with K+ 6.2 (life-threatening – immediate intervention), CKD limit foods (bananas, potatoes, tomatoes), bowel obstruction NG tube malfunction (patient reports fullness and nausea), cirrhosis ascites position (semi-Fowler’s), hepatitis A precautions (standard – fecal-oral), C. difficile hand hygiene (soap and water), ileostomy high output risk (fluid volume deficit and electrolyte imbalance), acute pancreatitis pain relief (side-lying with knees bent – fetal position), GERD teaching (avoid eating 2–3 hours before bedtime), omeprazole mechanism (proton pump inhibitor – reduces acid production), GI bleed with Hgb 7.0 (prepare for blood transfusion), pilocarpine eye drops (apply pressure to inner corner of eye for one minute – nasolacrimal occlusion), Meniere’s disease acute vertigo (dark, quiet room), open-angle glaucoma (gradual loss of peripheral vision), macular degeneration (central vision loss), otitis media (warm compresses), delegation to UAP (obtain orthostatic vital signs for stable patient), patient prioritization (new confusion and low oxygen saturation first), DNR order (provide comfort measures only), CMSRN vs MEDSURG-BC (CMSRN from MSNCB, MEDSURG-BC from ANCC), CMSRN eligibility (active RN license and 2,000 hours adult med-surg practice within 3 years), CMSRN exam (150 questions in 3 hours – 125 scored, 25 pretest), HAART effectiveness (increased CD4+ T-cell count), vancomycin red man syndrome (flushing, itching – slow infusion rate), febrile neutropenia priority (obtain cultures and notify provider immediately), thrombocytopenia (bleeding risk), transfusion reaction first action (stop transfusion, keep IV line open with saline), sickle cell crisis priority (opioids and IV fluids), DIC (both thrombosis and bleeding), heparin with sudden severe headache (intracranial hemorrhage – emergency), warfarin monitoring (INR), CMSRN certification validity (5 years). Suitable for CMSRN exam preparation, medical-surgical nursing certification, and nursing students.