CMSRN CERTIFIED MEDICAL-SURGICAL
REGISTERED NURSE PRACTICE EXAMINATION
2026–2027 — STUDY GUIDE | LATEST UPDATE
2026/2027 | PRACTICE QUESTIONS AND ANSWERS |
EXAM REVIEW | 100% CORRECT ANSWERS |
VERIFIED SOLUTIONS | ALREADY GRADED A+
1. A client with heart failure has a brain natriuretic peptide (BNP)
level of 1,200 pg/mL. What does this finding indicate?
A) Normal cardiac function
B) Increased ventricular wall stress and fluid overload
C) Acute kidney injury only
D) Liver failure
Correct Answer: B
BNP is released in response to ventricular stretch and volume overload;
levels >400–500 pg/mL are consistent with heart failure. Normal is
<100. It is not specific to kidney or liver failure.
2. A client with chronic obstructive pulmonary disease is receiving
oxygen at 2 L/min via nasal cannula. The SpO₂ is 94% and the
client is drowsy. What is the best action?
A) Increase oxygen to 4 L/min
B) Decrease oxygen to maintain SpO₂ 88–92% and notify the
provider
C) Administer naloxone
D) Place the client supine
,Correct Answer: B
In COPD with chronic CO₂ retention, excessive oxygen can suppress the
hypoxic drive. Reduce oxygen to target SpO₂ 88–92% and notify
provider. Increasing oxygen worsens hypoventilation. Naloxone is for
opioids. Supine may worsen breathing.
3. A client with type 2 diabetes is prescribed metformin. Which
laboratory value should be monitored periodically?
A) Serum amylase
B) Serum creatinine
C) Serum potassium
D) Serum sodium
Correct Answer: B
Metformin is renally cleared and can cause lactic acidosis if renal
function is impaired; serum creatinine should be monitored regularly.
Amylase, potassium, and sodium are not specifically required for
metformin.
4. A client with a new colostomy is being taught about stoma care.
Which observation indicates a healthy stoma?
A) Dark purple and dry
B) Beefy red and moist
C) Pale pink and dry
D) Blue-tinged and cool
Correct Answer: B
A healthy stoma is moist and beefy red due to adequate blood supply.
Dark purple or blue-tinged indicates ischemia. Pale and dry suggests
poor perfusion.
, 5. A client receiving a continuous heparin infusion has an aPTT of
105 seconds (therapeutic range 60–80 seconds). The client has no
bleeding. What should the nurse do?
A) Stop the heparin and administer protamine sulfate
B) Decrease the infusion rate per protocol and recheck aPTT in 6
hours
C) Continue the current rate
D) Administer vitamin K subcutaneously
Correct Answer: B
A supratherapeutic aPTT without bleeding requires a rate reduction per
protocol. Protamine is for severe hemorrhage. Vitamin K reverses
warfarin, not heparin. Continuing the rate increases bleeding risk.
6. A client with acute pancreatitis has a serum calcium of 6.9 mg/dL.
Which ECG change should the nurse anticipate?
A) Prolonged QT interval
B) Tall, peaked T waves
C) ST-segment elevation
D) Prominent U wave
Correct Answer: A
Hypocalcemia prolongs the QT interval, increasing the risk of torsades
de pointes. Peaked T waves indicate hyperkalemia. ST elevation suggests
myocardial infarction. Prominent U waves indicate hypokalemia.
7. A client with a suspected deep vein thrombosis has a swollen,
warm, tender left calf. Which action is most appropriate?
A) Massage the calf
B) Elevate the leg and notify the provider
, C) Ambulate the client frequently
D) Apply a heating pad to the calf
Correct Answer: B
Elevation and provider notification are appropriate; massage and
ambulation can dislodge the clot. A heating pad may be used after
diagnosis but is not the first action.
8. A client with a new diagnosis of hypertension is prescribed
lisinopril. Which side effect should the nurse instruct the client to
report immediately?
A) Dry, persistent cough
B) Angioedema with swelling of the lips and tongue
C) Dizziness when standing
D) Fatigue
Correct Answer: B
Angioedema is a life-threatening side effect of ACE inhibitors requiring
immediate medical attention. Dry cough is common but not life-
threatening. Dizziness and fatigue are less urgent.
9. A client with a new ileostomy is being discharged. Which
statement indicates a need for further teaching?
A) “I will drink adequate fluids to prevent dehydration.”
B) “I will chew my food thoroughly.”
C) “I will irrigate my ileostomy daily to regulate output.”
D) “I will avoid high-fiber foods that may cause blockage.”
Correct Answer: C
Ileostomies are not irrigated because effluent is liquid and continuous;
irrigation is used for descending or sigmoid colostomies. The other
statements are appropriate.
REGISTERED NURSE PRACTICE EXAMINATION
2026–2027 — STUDY GUIDE | LATEST UPDATE
2026/2027 | PRACTICE QUESTIONS AND ANSWERS |
EXAM REVIEW | 100% CORRECT ANSWERS |
VERIFIED SOLUTIONS | ALREADY GRADED A+
1. A client with heart failure has a brain natriuretic peptide (BNP)
level of 1,200 pg/mL. What does this finding indicate?
A) Normal cardiac function
B) Increased ventricular wall stress and fluid overload
C) Acute kidney injury only
D) Liver failure
Correct Answer: B
BNP is released in response to ventricular stretch and volume overload;
levels >400–500 pg/mL are consistent with heart failure. Normal is
<100. It is not specific to kidney or liver failure.
2. A client with chronic obstructive pulmonary disease is receiving
oxygen at 2 L/min via nasal cannula. The SpO₂ is 94% and the
client is drowsy. What is the best action?
A) Increase oxygen to 4 L/min
B) Decrease oxygen to maintain SpO₂ 88–92% and notify the
provider
C) Administer naloxone
D) Place the client supine
,Correct Answer: B
In COPD with chronic CO₂ retention, excessive oxygen can suppress the
hypoxic drive. Reduce oxygen to target SpO₂ 88–92% and notify
provider. Increasing oxygen worsens hypoventilation. Naloxone is for
opioids. Supine may worsen breathing.
3. A client with type 2 diabetes is prescribed metformin. Which
laboratory value should be monitored periodically?
A) Serum amylase
B) Serum creatinine
C) Serum potassium
D) Serum sodium
Correct Answer: B
Metformin is renally cleared and can cause lactic acidosis if renal
function is impaired; serum creatinine should be monitored regularly.
Amylase, potassium, and sodium are not specifically required for
metformin.
4. A client with a new colostomy is being taught about stoma care.
Which observation indicates a healthy stoma?
A) Dark purple and dry
B) Beefy red and moist
C) Pale pink and dry
D) Blue-tinged and cool
Correct Answer: B
A healthy stoma is moist and beefy red due to adequate blood supply.
Dark purple or blue-tinged indicates ischemia. Pale and dry suggests
poor perfusion.
, 5. A client receiving a continuous heparin infusion has an aPTT of
105 seconds (therapeutic range 60–80 seconds). The client has no
bleeding. What should the nurse do?
A) Stop the heparin and administer protamine sulfate
B) Decrease the infusion rate per protocol and recheck aPTT in 6
hours
C) Continue the current rate
D) Administer vitamin K subcutaneously
Correct Answer: B
A supratherapeutic aPTT without bleeding requires a rate reduction per
protocol. Protamine is for severe hemorrhage. Vitamin K reverses
warfarin, not heparin. Continuing the rate increases bleeding risk.
6. A client with acute pancreatitis has a serum calcium of 6.9 mg/dL.
Which ECG change should the nurse anticipate?
A) Prolonged QT interval
B) Tall, peaked T waves
C) ST-segment elevation
D) Prominent U wave
Correct Answer: A
Hypocalcemia prolongs the QT interval, increasing the risk of torsades
de pointes. Peaked T waves indicate hyperkalemia. ST elevation suggests
myocardial infarction. Prominent U waves indicate hypokalemia.
7. A client with a suspected deep vein thrombosis has a swollen,
warm, tender left calf. Which action is most appropriate?
A) Massage the calf
B) Elevate the leg and notify the provider
, C) Ambulate the client frequently
D) Apply a heating pad to the calf
Correct Answer: B
Elevation and provider notification are appropriate; massage and
ambulation can dislodge the clot. A heating pad may be used after
diagnosis but is not the first action.
8. A client with a new diagnosis of hypertension is prescribed
lisinopril. Which side effect should the nurse instruct the client to
report immediately?
A) Dry, persistent cough
B) Angioedema with swelling of the lips and tongue
C) Dizziness when standing
D) Fatigue
Correct Answer: B
Angioedema is a life-threatening side effect of ACE inhibitors requiring
immediate medical attention. Dry cough is common but not life-
threatening. Dizziness and fatigue are less urgent.
9. A client with a new ileostomy is being discharged. Which
statement indicates a need for further teaching?
A) “I will drink adequate fluids to prevent dehydration.”
B) “I will chew my food thoroughly.”
C) “I will irrigate my ileostomy daily to regulate output.”
D) “I will avoid high-fiber foods that may cause blockage.”
Correct Answer: C
Ileostomies are not irrigated because effluent is liquid and continuous;
irrigation is used for descending or sigmoid colostomies. The other
statements are appropriate.
