CMSRN Certification Exam New 2026 Version with
All the 150 Multiple choice Questions, 100% Correct
Answers and Rationale
Section 1: Caring Practices – Assessment and Care Interventions (Questions 1–41)
1. A 65-year-old patient with type 2 diabetes presents with a fasting blood glucose of 180
mg/dL and reports polyuria. What is the priority nursing intervention?
A) Administer insulin as ordered and educate on diet.
B) Encourage immediate exercise.
C) Ignore if asymptomatic.
D) Order a CT scan. Correct Answer: A) Administer insulin as ordered and educate on
diet.
Rationale: Hyperglycemia requires pharmacologic management and patient education to
prevent complications. Blueprint: Caring Practices – Endocrine assessment and
interventions.
2. During assessment of a 55-year-old postoperative patient, the nurse notes tachycardia
(HR 110 bpm) and cool, clammy skin. What is the most likely cause?
A) Hypovolemic shock from bleeding.
B) Normal postoperative response.
C) Hyperglycemia.
D) Medication side effect. Correct Answer: A) Hypovolemic shock from bleeding.
Rationale: Signs indicate compensatory shock; assess for bleeding. Blueprint: Caring
Practices – Cardiovascular assessment.
3. A 70-year-old patient with COPD exacerbation has SpO2 88% on room air and crackles.
What oxygen therapy is appropriate?
A) Titrate nasal cannula to maintain SpO2 88–92%.
B) High-flow 100% oxygen.
C) No oxygen.
D) Ventilator. Correct Answer: A) Titrate nasal cannula to maintain SpO2 88–92%.
Rationale: Avoids CO2 retention in COPD. Blueprint: Caring Practices – Pulmonary
interventions.
4. A patient with a CVA has left-sided weakness. What nursing assessment is priority?
A) Swallow screen before oral intake.
B) No assessment.
C) Vital signs only.
D) Pain level. Correct Answer: A) Swallow screen before oral intake.
Rationale: Prevents aspiration. Blueprint: Caring Practices – Neurological assessment.
5. A 60-year-old with GI bleed has melena and hemoglobin 9 g/dL. What intervention?
A) Transfuse PRBCs if symptomatic.
B) No transfusion.
C) IV fluids only.
D) Discharge. Correct Answer: A) Transfuse PRBCs if symptomatic.
Rationale: Restrictive transfusion strategy. Blueprint: Caring Practices – Gastrointestinal
interventions.
,6. A patient with AKI has serum creatinine 2.5 mg/dL. What monitoring?
A) Daily weights and I&O.
B) No monitoring.
C) BP only.
D) Labs weekly. Correct Answer: A) Daily weights and I&O.
Rationale: Tracks fluid balance. Blueprint: Caring Practices – Renal assessment.
7. A patient with anemia has Hb 8 g/dL. What intervention?
A) Iron supplementation if iron deficiency.
B) No supplement.
C) Transfusion.
D) Steroids. Correct Answer: A) Iron supplementation if iron deficiency.
Rationale: Treats cause. Blueprint: Caring Practices – Hematology interventions.
8. A patient with sepsis has fever and tachycardia. What bundle?
A) Surviving Sepsis Campaign hour-1 bundle.
B) No bundle.
C) Antibiotics only.
D) Fluids only. Correct Answer: A) Surviving Sepsis Campaign hour-1 bundle.
Rationale: Includes lactate, cultures, fluids. Blueprint: Caring Practices – Multisystem
interventions.
9. A postoperative patient has atelectasis. What intervention?
A) Incentive spirometry.
B) No intervention.
C) Cough suppression.
D) Bed rest. Correct Answer: A) Incentive spirometry.
Rationale: Expands lungs. Blueprint: Caring Practices – Pulmonary care.
10. A patient with CHF has edema. What assessment?
A) Daily weights and lung sounds.
B) No assessment.
C) BP only.
D) Pulse only. Correct Answer: A) Daily weights and lung sounds.
Rationale: Monitors fluid status. Blueprint: Caring Practices – Cardiovascular
assessment.
11. A patient with pneumonia has productive cough. What intervention?
A) Chest physiotherapy.
B) No intervention.
C) Antitussives.
D) Sedation. Correct Answer: A) Chest physiotherapy.
Rationale: Clears secretions. Blueprint: Caring Practices – Pulmonary interventions.
12. A patient with Parkinson's has tremors. What intervention?
A) Administer levodopa as ordered.
B) No medication.
C) Restraints.
D) Ignore tremors. Correct Answer: A) Administer levodopa as ordered.
Rationale: Controls symptoms. Blueprint: Caring Practices – Neurological interventions.
13. A patient with pancreatitis has pain. What intervention?
A) NPO and analgesics.
, B) No NPO.
C) Oral diet.
D) Antibiotics. Correct Answer: A) NPO and analgesics.
Rationale: Reduces pancreatic stimulation. Blueprint: Caring Practices – Gastrointestinal
interventions.
14. A patient with UTI has dysuria. What intervention?
A) Increase fluids and phenazopyridine.
B) No fluids.
C) Antibiotics only.
D) Bed rest. Correct Answer: A) Increase fluids and phenazopyridine.
Rationale: Relieves symptoms. Blueprint: Caring Practices – Renal interventions.
15. A patient with sickle cell crisis has pain. What intervention?
A) Hydration and opioids.
B) No hydration.
C) NSAIDs only.
D) Restraints. Correct Answer: A) Hydration and opioids.
Rationale: Treats vaso-occlusion. Blueprint: Caring Practices – Hematology
interventions.
16. A patient with delirium has confusion. What intervention?
A) Reorient and reduce sedatives.
B) No intervention.
C) Restraints.
D) Sedation. Correct Answer: A) Reorient and reduce sedatives.
Rationale: Non-pharmacologic first. Blueprint: Caring Practices – Behavioral
interventions.
17. A patient with multiple trauma has pain. What intervention?
A) Multimodal analgesia.
B) No pain control.
C) Opioids only.
D) Ignore pain. Correct Answer: A) Multimodal analgesia.
Rationale: Reduces opioid use. Blueprint: Caring Practices – Multisystem interventions.
18. A patient with MI has chest pain. What intervention?
A) MONA (morphine, oxygen, nitroglycerin, aspirin).
B) No MONA.
C) Oxygen only.
D) Discharge. Correct Answer: A) MONA (morphine, oxygen, nitroglycerin, aspirin).
Rationale: Standard ACS protocol. Blueprint: Caring Practices – Cardiovascular
interventions.
19. A patient with asthma has wheezes. What intervention?
A) Albuterol nebulizer.
B) No medication.
C) Steroids PO.
D) Intubation. Correct Answer: A) Albuterol nebulizer.
Rationale: Bronchodilator. Blueprint: Caring Practices – Pulmonary interventions.
20. A patient with DKA has glucose 400 mg/dL. What intervention?
A) Insulin infusion and fluids.
All the 150 Multiple choice Questions, 100% Correct
Answers and Rationale
Section 1: Caring Practices – Assessment and Care Interventions (Questions 1–41)
1. A 65-year-old patient with type 2 diabetes presents with a fasting blood glucose of 180
mg/dL and reports polyuria. What is the priority nursing intervention?
A) Administer insulin as ordered and educate on diet.
B) Encourage immediate exercise.
C) Ignore if asymptomatic.
D) Order a CT scan. Correct Answer: A) Administer insulin as ordered and educate on
diet.
Rationale: Hyperglycemia requires pharmacologic management and patient education to
prevent complications. Blueprint: Caring Practices – Endocrine assessment and
interventions.
2. During assessment of a 55-year-old postoperative patient, the nurse notes tachycardia
(HR 110 bpm) and cool, clammy skin. What is the most likely cause?
A) Hypovolemic shock from bleeding.
B) Normal postoperative response.
C) Hyperglycemia.
D) Medication side effect. Correct Answer: A) Hypovolemic shock from bleeding.
Rationale: Signs indicate compensatory shock; assess for bleeding. Blueprint: Caring
Practices – Cardiovascular assessment.
3. A 70-year-old patient with COPD exacerbation has SpO2 88% on room air and crackles.
What oxygen therapy is appropriate?
A) Titrate nasal cannula to maintain SpO2 88–92%.
B) High-flow 100% oxygen.
C) No oxygen.
D) Ventilator. Correct Answer: A) Titrate nasal cannula to maintain SpO2 88–92%.
Rationale: Avoids CO2 retention in COPD. Blueprint: Caring Practices – Pulmonary
interventions.
4. A patient with a CVA has left-sided weakness. What nursing assessment is priority?
A) Swallow screen before oral intake.
B) No assessment.
C) Vital signs only.
D) Pain level. Correct Answer: A) Swallow screen before oral intake.
Rationale: Prevents aspiration. Blueprint: Caring Practices – Neurological assessment.
5. A 60-year-old with GI bleed has melena and hemoglobin 9 g/dL. What intervention?
A) Transfuse PRBCs if symptomatic.
B) No transfusion.
C) IV fluids only.
D) Discharge. Correct Answer: A) Transfuse PRBCs if symptomatic.
Rationale: Restrictive transfusion strategy. Blueprint: Caring Practices – Gastrointestinal
interventions.
,6. A patient with AKI has serum creatinine 2.5 mg/dL. What monitoring?
A) Daily weights and I&O.
B) No monitoring.
C) BP only.
D) Labs weekly. Correct Answer: A) Daily weights and I&O.
Rationale: Tracks fluid balance. Blueprint: Caring Practices – Renal assessment.
7. A patient with anemia has Hb 8 g/dL. What intervention?
A) Iron supplementation if iron deficiency.
B) No supplement.
C) Transfusion.
D) Steroids. Correct Answer: A) Iron supplementation if iron deficiency.
Rationale: Treats cause. Blueprint: Caring Practices – Hematology interventions.
8. A patient with sepsis has fever and tachycardia. What bundle?
A) Surviving Sepsis Campaign hour-1 bundle.
B) No bundle.
C) Antibiotics only.
D) Fluids only. Correct Answer: A) Surviving Sepsis Campaign hour-1 bundle.
Rationale: Includes lactate, cultures, fluids. Blueprint: Caring Practices – Multisystem
interventions.
9. A postoperative patient has atelectasis. What intervention?
A) Incentive spirometry.
B) No intervention.
C) Cough suppression.
D) Bed rest. Correct Answer: A) Incentive spirometry.
Rationale: Expands lungs. Blueprint: Caring Practices – Pulmonary care.
10. A patient with CHF has edema. What assessment?
A) Daily weights and lung sounds.
B) No assessment.
C) BP only.
D) Pulse only. Correct Answer: A) Daily weights and lung sounds.
Rationale: Monitors fluid status. Blueprint: Caring Practices – Cardiovascular
assessment.
11. A patient with pneumonia has productive cough. What intervention?
A) Chest physiotherapy.
B) No intervention.
C) Antitussives.
D) Sedation. Correct Answer: A) Chest physiotherapy.
Rationale: Clears secretions. Blueprint: Caring Practices – Pulmonary interventions.
12. A patient with Parkinson's has tremors. What intervention?
A) Administer levodopa as ordered.
B) No medication.
C) Restraints.
D) Ignore tremors. Correct Answer: A) Administer levodopa as ordered.
Rationale: Controls symptoms. Blueprint: Caring Practices – Neurological interventions.
13. A patient with pancreatitis has pain. What intervention?
A) NPO and analgesics.
, B) No NPO.
C) Oral diet.
D) Antibiotics. Correct Answer: A) NPO and analgesics.
Rationale: Reduces pancreatic stimulation. Blueprint: Caring Practices – Gastrointestinal
interventions.
14. A patient with UTI has dysuria. What intervention?
A) Increase fluids and phenazopyridine.
B) No fluids.
C) Antibiotics only.
D) Bed rest. Correct Answer: A) Increase fluids and phenazopyridine.
Rationale: Relieves symptoms. Blueprint: Caring Practices – Renal interventions.
15. A patient with sickle cell crisis has pain. What intervention?
A) Hydration and opioids.
B) No hydration.
C) NSAIDs only.
D) Restraints. Correct Answer: A) Hydration and opioids.
Rationale: Treats vaso-occlusion. Blueprint: Caring Practices – Hematology
interventions.
16. A patient with delirium has confusion. What intervention?
A) Reorient and reduce sedatives.
B) No intervention.
C) Restraints.
D) Sedation. Correct Answer: A) Reorient and reduce sedatives.
Rationale: Non-pharmacologic first. Blueprint: Caring Practices – Behavioral
interventions.
17. A patient with multiple trauma has pain. What intervention?
A) Multimodal analgesia.
B) No pain control.
C) Opioids only.
D) Ignore pain. Correct Answer: A) Multimodal analgesia.
Rationale: Reduces opioid use. Blueprint: Caring Practices – Multisystem interventions.
18. A patient with MI has chest pain. What intervention?
A) MONA (morphine, oxygen, nitroglycerin, aspirin).
B) No MONA.
C) Oxygen only.
D) Discharge. Correct Answer: A) MONA (morphine, oxygen, nitroglycerin, aspirin).
Rationale: Standard ACS protocol. Blueprint: Caring Practices – Cardiovascular
interventions.
19. A patient with asthma has wheezes. What intervention?
A) Albuterol nebulizer.
B) No medication.
C) Steroids PO.
D) Intubation. Correct Answer: A) Albuterol nebulizer.
Rationale: Bronchodilator. Blueprint: Caring Practices – Pulmonary interventions.
20. A patient with DKA has glucose 400 mg/dL. What intervention?
A) Insulin infusion and fluids.
