RN ADULT MEDICAL-SURGICAL
CMS PROCTORED EXAM
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210 EXAM QUESTIONS
with Answer Keys & Detailed Rationales
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COMPREHENSIVE COVERAGE:
✅ Cardiovascular Disorders & Hemodynamic Management
✅ Respiratory Disorders & Critical Care
✅ Neurologic & Musculoskeletal Conditions
✅ Renal, Endocrine & Metabolic Disorders
✅ Gastrointestinal & Hepatic Disorders
✅ Infection, Sepsis & Immune Dysfunction
✅ Oncology, Hematology & Complex Chronic Illness
✅ Pharmacology, Safety, Prioritization & Clinical Judgment
✅ NGN-Style Clinical Decision Making & Patient-Centered Care
,═══════════════════════════════════════════════════════════════
════════════════
PERFECT FOR CMS & NCLEX-RN PREP Page number 1
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════════════════
INSTITUTION: Chamberlain College of Nursing
COURSE: Adult Medical-Surgical Nursing
YEAR:
═══════════════════════════════════════════════════════════════
════════════════
RN Adult Medical-Surgical CMS Proctored Exam – 210
Questions with Answer Keys & Rationales | NGN-Style |
2026/2027
TABLE OF CONTENTS
i. Cardiovascular Disorders and Hemodynamic Management
ii. Respiratory Disorders and Critical Care
iii. Neurologic and Musculoskeletal Conditions
iv. Renal, Endocrine, and Metabolic Disorders
v. Gastrointestinal and Hepatic Disorders
vi. Infection, Sepsis, and Immune Dysfunction
1
,vii. Oncology, Hematology, and Complex Chronic Illness
viii. Pharmacology, Safety, Prioritization, and Clinical Judgment
ix. NGN-Style Clinical Decision Making and Patient-Centered Care Page number 2
INTRODUCTION
This comprehensive RN Adult Medical-Surgical CMS Proctored Exam practice set
evaluates advanced clinical judgment across complex adult health conditions,
prioritization, pharmacology, deterioration recognition, interpretation of clinical
findings, and evidence-based nursing interventions. It is designed for nursing students
and registered nurses preparing for high-level medical-surgical assessments who need
to apply knowledge rather than simply recall facts. Expect challenging scenario-based
questions involving unstable patients, competing priorities, laboratory trends,
medication safety, and multidisciplinary decision-making. The complete study resource
contains 100+ questions and answers with rationales to reinforce clinical reasoning and
preparation. Purchase and instantly get a downloadable and editable PDF.
QUESTIONS 1–30
Question 1
A 68-year-old patient with acute decompensated heart failure is receiving IV
furosemide. Two hours after administration, the patient develops increasing ventricular
ectopy, generalized weakness, and muscle cramps. Laboratory results show potassium
2.8 mEq/L and magnesium 1.4 mg/dL. Which action should the nurse prioritize?
2
, A. Administer the next scheduled dose of furosemide
B. Notify the provider and anticipate electrolyte replacement
C. Restrict the patient's oral fluid intake further Page number 3
D. Administer IV calcium gluconate immediately
Correct Answer: B. Notify the provider and anticipate electrolyte replacement
Rationale: Hypokalemia and hypomagnesemia substantially increase the risk of
ventricular dysrhythmias, particularly in a patient receiving aggressive diuresis. Prompt
correction of the electrolyte abnormalities is the priority.
Question 2
A patient with an inferior ST-elevation myocardial infarction suddenly develops
hypotension, jugular venous distention, and clear bilateral lung sounds. Which
intervention should the nurse anticipate?
A. Aggressive IV fluid administration
B. Immediate administration of IV furosemide
C. Nitroglycerin infusion titration
D. Positive-pressure ventilation
Correct Answer: A. Aggressive IV fluid administration
Rationale: The findings are characteristic of right ventricular infarction with impaired
preload-dependent cardiac output. Carefully administered IV fluids may improve right
ventricular filling and systemic perfusion.
Question 3
A patient with severe COPD exacerbation is receiving oxygen at 6 L/min by nasal
cannula. The patient becomes increasingly somnolent. ABG results are pH 7.25, PaCO₂
72 mm Hg, HCO₃⁻ 31 mEq/L, and PaO₂ 58 mm Hg. Which intervention is most
appropriate?
A. Continue the oxygen and reassess in 4 hours
B. Prepare for ventilatory support
C. Administer sodium bicarbonate
3
CMS PROCTORED EXAM
═══════════════════════════════════════════════════════════════
════════════════
210 EXAM QUESTIONS
with Answer Keys & Detailed Rationales
═══════════════════════════════════════════════════════════════
════════════════
COMPREHENSIVE COVERAGE:
✅ Cardiovascular Disorders & Hemodynamic Management
✅ Respiratory Disorders & Critical Care
✅ Neurologic & Musculoskeletal Conditions
✅ Renal, Endocrine & Metabolic Disorders
✅ Gastrointestinal & Hepatic Disorders
✅ Infection, Sepsis & Immune Dysfunction
✅ Oncology, Hematology & Complex Chronic Illness
✅ Pharmacology, Safety, Prioritization & Clinical Judgment
✅ NGN-Style Clinical Decision Making & Patient-Centered Care
,═══════════════════════════════════════════════════════════════
════════════════
PERFECT FOR CMS & NCLEX-RN PREP Page number 1
═══════════════════════════════════════════════════════════════
════════════════
INSTITUTION: Chamberlain College of Nursing
COURSE: Adult Medical-Surgical Nursing
YEAR:
═══════════════════════════════════════════════════════════════
════════════════
RN Adult Medical-Surgical CMS Proctored Exam – 210
Questions with Answer Keys & Rationales | NGN-Style |
2026/2027
TABLE OF CONTENTS
i. Cardiovascular Disorders and Hemodynamic Management
ii. Respiratory Disorders and Critical Care
iii. Neurologic and Musculoskeletal Conditions
iv. Renal, Endocrine, and Metabolic Disorders
v. Gastrointestinal and Hepatic Disorders
vi. Infection, Sepsis, and Immune Dysfunction
1
,vii. Oncology, Hematology, and Complex Chronic Illness
viii. Pharmacology, Safety, Prioritization, and Clinical Judgment
ix. NGN-Style Clinical Decision Making and Patient-Centered Care Page number 2
INTRODUCTION
This comprehensive RN Adult Medical-Surgical CMS Proctored Exam practice set
evaluates advanced clinical judgment across complex adult health conditions,
prioritization, pharmacology, deterioration recognition, interpretation of clinical
findings, and evidence-based nursing interventions. It is designed for nursing students
and registered nurses preparing for high-level medical-surgical assessments who need
to apply knowledge rather than simply recall facts. Expect challenging scenario-based
questions involving unstable patients, competing priorities, laboratory trends,
medication safety, and multidisciplinary decision-making. The complete study resource
contains 100+ questions and answers with rationales to reinforce clinical reasoning and
preparation. Purchase and instantly get a downloadable and editable PDF.
QUESTIONS 1–30
Question 1
A 68-year-old patient with acute decompensated heart failure is receiving IV
furosemide. Two hours after administration, the patient develops increasing ventricular
ectopy, generalized weakness, and muscle cramps. Laboratory results show potassium
2.8 mEq/L and magnesium 1.4 mg/dL. Which action should the nurse prioritize?
2
, A. Administer the next scheduled dose of furosemide
B. Notify the provider and anticipate electrolyte replacement
C. Restrict the patient's oral fluid intake further Page number 3
D. Administer IV calcium gluconate immediately
Correct Answer: B. Notify the provider and anticipate electrolyte replacement
Rationale: Hypokalemia and hypomagnesemia substantially increase the risk of
ventricular dysrhythmias, particularly in a patient receiving aggressive diuresis. Prompt
correction of the electrolyte abnormalities is the priority.
Question 2
A patient with an inferior ST-elevation myocardial infarction suddenly develops
hypotension, jugular venous distention, and clear bilateral lung sounds. Which
intervention should the nurse anticipate?
A. Aggressive IV fluid administration
B. Immediate administration of IV furosemide
C. Nitroglycerin infusion titration
D. Positive-pressure ventilation
Correct Answer: A. Aggressive IV fluid administration
Rationale: The findings are characteristic of right ventricular infarction with impaired
preload-dependent cardiac output. Carefully administered IV fluids may improve right
ventricular filling and systemic perfusion.
Question 3
A patient with severe COPD exacerbation is receiving oxygen at 6 L/min by nasal
cannula. The patient becomes increasingly somnolent. ABG results are pH 7.25, PaCO₂
72 mm Hg, HCO₃⁻ 31 mEq/L, and PaO₂ 58 mm Hg. Which intervention is most
appropriate?
A. Continue the oxygen and reassess in 4 hours
B. Prepare for ventilatory support
C. Administer sodium bicarbonate
3
