10 free, exam-style Certified Medical-Surgical Registered Nurse (CMSRN) practice questions with answers and explanations. No signup required. Work through them below, then take the full free CMSRN practice test to study every exam domain.
A patient with type 2 diabetes is admitted with a blood glucose of 740 mg/dL, serum osmolality of 342 mOsm/kg, and arterial pH of 7.36. The patient is lethargic with no fruity breath odor and is receiving aggressive IV fluid resuscitation. As the nurse prepares to initiate the ordered insulin infusion, the PRIORITY action is:
Correct answer: B - Check the patient's serum potassium level
A patient recovering from a left-sided pleural effusion has a chest tube connected to a water-seal drainage system. During routine assessment, the nurse notes that tidaling in the water-seal chamber has completely stopped over the past hour. The patient's breathing is unlabored and SpO2 is 97%. The nurse should FIRST:
Correct answer: A - Have the patient take a deep breath and cough
A patient with end-stage renal disease missed their scheduled hemodialysis session and is admitted to the medical-surgical unit. The serum potassium level is 6.4 mEq/L. Which cardiac monitor finding is MOST consistent with this laboratory result?
Correct answer: C - Tall, peaked, narrow T waves
A registered nurse begins a shift with a team that includes an LPN and a UAP. Which task is MOST appropriate to delegate to the UAP?
Correct answer: A - Collect and record urine output from a stable patient's indwelling catheter
A nurse is caring for a terminally ill patient whose family insists on continuing aggressive life-sustaining interventions. The patient had clearly expressed a wish for comfort-focused care, documented in a valid advance directive. The nurse feels unable to stop treatments that appear to be causing the patient harm. This situation BEST represents:
Correct answer: C - Moral distress from being unable to act on one's ethical beliefs
A nurse completes discharge education with a patient newly diagnosed with heart failure, reviewing the purpose and technique for daily weights. The patient nods throughout and says, 'Yes, I understand all of that.' Which action by the nurse is MOST appropriate NEXT?
Correct answer: C - Ask the patient to explain in their own words when to call the provider about weight changes
A 61-year-old patient is 20 hours post-transsphenoidal resection of a pituitary adenoma. The nurse notes a urine output of 680 mL in the past hour. Urine specific gravity is 1.001 and serum sodium is 152 mEq/L. The nurse's BEST interpretation of these findings is:
Correct answer: B - Arginine vasopressin deficiency (AVP-D)
A nurse on a medical-surgical unit receives morning report on four patients. Which patient requires assessment FIRST?
Correct answer: B - A patient 8 hours post-total knee replacement reporting numbness and inability to dorsiflex the right foot
A nurse manager introduces an evidence-based protocol requiring staff to conduct bedside shift report. During the first two weeks, experienced nurses consistently describe the process as 'a waste of time' and revert to conducting report at the nurses' station. Using the ADKAR model, this resistance MOST likely indicates a deficit in which component?
Correct answer: D - Desire - staff understand the change but are not motivated to adopt it
A nurse is planning discharge for a 74-year-old patient hospitalized with decompensated heart failure. The patient lives alone on a fixed income in a second-floor apartment with no elevator, has no reliable transportation, and has been filling prescriptions only every other month due to cost. The factor MOST likely to increase this patient's risk for 30-day readmission is:
Correct answer: D - The patient's social and environmental circumstances
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