CMSRN UPDATED 2026 EXAM SCRIPT QUESTIONS AND
ANSWERS GRADED A+
✔✔normal level of phosphate - ✔✔3-4.5
✔✔symptoms of this electrolyte imbalance are opposite of calcium since it has an
inverse relationship - ✔✔phosphate
✔✔Normal level of magnesium - ✔✔1.3-2.1
✔✔Normal level of sodium - ✔✔135-145
✔✔normal level of potassium - ✔✔3.5-5.0 mEq/L
✔✔symptoms of hypermagnesemia - ✔✔poor renal excretion, muscular depression
✔✔symptoms of hypomagnesemia - ✔✔Hyperactive deep tissue reflexes, tremors,
seizures, cardiac arrhythmia, confusion (resembles hypocalcemia)
✔✔treatment for hypermagnesemia - ✔✔calcium gluconate
✔✔what is serum osmolality? - ✔✔how thick solution is
✔✔what does it mean if serum osmolality is high? - ✔✔the patient is dry
✔✔what type of solution is NS, LR? - ✔✔isotonic
✔✔what does an isotonic solution do? - ✔✔expands blood volume
increases blood pressure if dehydrated
has same osmolarity as our cells
can cause electrolyte increase
✔✔what type of solution is D5LR, D5NS? - ✔✔hypertonic
✔✔what does a hypertonic solution do? - ✔✔Pulls fluid into the intravascular space
from tissue, do NOT give if dehydrated
✔✔what type of solution is 1/2 NS, 1/4 NS? - ✔✔hypotonic
✔✔what does a hypotonic solution do? - ✔✔contain less solute than our cells
used for cellular hydration
has more water than electrolytes
given after surgery due to dehydration
,✔✔What organ metabolizes most nutrients? - ✔✔liver
✔✔gallbladder location - ✔✔RUQ
✔✔appendix location - ✔✔RLQ
✔✔stomach location - ✔✔LUQ
✔✔what quadrant is indicative of IBD? - ✔✔LLQ
✔✔when a diabetic has epigastric pain, what can this indicate? - ✔✔gastroparesis, MI
✔✔what does it mean if abdominal auscultation is dull? - ✔✔fluid or mass
✔✔order for GI assessment? - ✔✔inspect, auscultate, peruss, palpate
✔✔GERD causes/risk factors - ✔✔obesity, hiatal hernia, esophageal sphincter
problems, gastric empty delay
✔✔symptoms of GERD - ✔✔-Dyspepsia
-Chest pain
-Esophagitis
-Hoarseness in the morning
-Persistent heartburn
-Dysphagia
-Can mimic heart attack symptoms.
✔✔treatment for GERD - ✔✔sleep with head elevated, used H2- receptor blockers
(pepcid, zantac) or proton pump inhibitors (prilosec)., meal timing
✔✔complications of GERD - ✔✔Esophagitis, ulceration, Barrett's esophagus,
respiratory issues (asthma, pneumonia), dental erosion
✔✔Location of peptic ulcers - ✔✔stomach or duodenum
✔✔causes of peptic ulcers - ✔✔NSAIDS, ASA, stress, smoking, caffeine, ETOH,
steroids, H.Pylori
✔✔Which type of peptic ulcer is most common? - ✔✔duodenal ulcers
✔✔Which type of peptic ulcer is characterized by pain RIGHT AFTER EATING, in high
epigastric area, and has pain with an empty stomach is erosion is through the mucosa?
- ✔✔gastric
, ✔✔which type of peptic ulcer is characterized by pain AT NIGHT or 2-4 hours AFTER
eating, if is chronic won't have symptoms, and pain comes and goes? - ✔✔duodenal
✔✔which type of peptic ulcer has a high mortality rate? - ✔✔gastric
✔✔what will someones breath with peptic ulcer typically smell like? - ✔✔ammonia
✔✔treatment for peptic ulcers - ✔✔Triple therapy:
1. Acid suppression (proton pump inhibitor-PPI)
2. Metronidazole
3. Amoxicillin/Biaxin
lifestyle and diet changes
✔✔peptic ulcer complications - ✔✔bleeding, perforation (with perf, need abx, fluids,
NGT, and pain meds, surgical repair)
✔✔which inflammatory bowel disease is affected by the ENTIRE bowel system,
characterized by cobblestone bowel, all layers of the bowel, with NO rectal bleeding -
✔✔crohns disease
✔✔which inflammatory bowel disease affects the LEFT colon, starts at the rectums and
ascends, has shallow ulcerations, and has either bloody diarrhea or formed stool with
streaks? - ✔✔ulcerative colitis
✔✔Diet for Inflammatory Bowel Disease - ✔✔High protein, high calorie (3,000+ a day),
low fiber, low roughage/residue
✔✔causes for large bowel obstruction - ✔✔MOST COMMON is neoplasm, diverticulitis,
strictures, abscesses
✔✔causes for small bowel obstruction - ✔✔adhesions, hernias, polyps, ileus, lymphoma
✔✔which type of bowel obstruction is characterized by gradual onset, pain is low grade,
absence of stool, distention, high bitches bowel sounds - ✔✔large bowel obstruction
✔✔which type of bowel obstruction is characterized by rapid onset, crampy colicky pain,
emesis, distention, high pitched bowel sounds - ✔✔small bowel obstruction
✔✔which type of bowel obstruction is more likely to need surgical intervention? -
✔✔large bowel obstruction
ANSWERS GRADED A+
✔✔normal level of phosphate - ✔✔3-4.5
✔✔symptoms of this electrolyte imbalance are opposite of calcium since it has an
inverse relationship - ✔✔phosphate
✔✔Normal level of magnesium - ✔✔1.3-2.1
✔✔Normal level of sodium - ✔✔135-145
✔✔normal level of potassium - ✔✔3.5-5.0 mEq/L
✔✔symptoms of hypermagnesemia - ✔✔poor renal excretion, muscular depression
✔✔symptoms of hypomagnesemia - ✔✔Hyperactive deep tissue reflexes, tremors,
seizures, cardiac arrhythmia, confusion (resembles hypocalcemia)
✔✔treatment for hypermagnesemia - ✔✔calcium gluconate
✔✔what is serum osmolality? - ✔✔how thick solution is
✔✔what does it mean if serum osmolality is high? - ✔✔the patient is dry
✔✔what type of solution is NS, LR? - ✔✔isotonic
✔✔what does an isotonic solution do? - ✔✔expands blood volume
increases blood pressure if dehydrated
has same osmolarity as our cells
can cause electrolyte increase
✔✔what type of solution is D5LR, D5NS? - ✔✔hypertonic
✔✔what does a hypertonic solution do? - ✔✔Pulls fluid into the intravascular space
from tissue, do NOT give if dehydrated
✔✔what type of solution is 1/2 NS, 1/4 NS? - ✔✔hypotonic
✔✔what does a hypotonic solution do? - ✔✔contain less solute than our cells
used for cellular hydration
has more water than electrolytes
given after surgery due to dehydration
,✔✔What organ metabolizes most nutrients? - ✔✔liver
✔✔gallbladder location - ✔✔RUQ
✔✔appendix location - ✔✔RLQ
✔✔stomach location - ✔✔LUQ
✔✔what quadrant is indicative of IBD? - ✔✔LLQ
✔✔when a diabetic has epigastric pain, what can this indicate? - ✔✔gastroparesis, MI
✔✔what does it mean if abdominal auscultation is dull? - ✔✔fluid or mass
✔✔order for GI assessment? - ✔✔inspect, auscultate, peruss, palpate
✔✔GERD causes/risk factors - ✔✔obesity, hiatal hernia, esophageal sphincter
problems, gastric empty delay
✔✔symptoms of GERD - ✔✔-Dyspepsia
-Chest pain
-Esophagitis
-Hoarseness in the morning
-Persistent heartburn
-Dysphagia
-Can mimic heart attack symptoms.
✔✔treatment for GERD - ✔✔sleep with head elevated, used H2- receptor blockers
(pepcid, zantac) or proton pump inhibitors (prilosec)., meal timing
✔✔complications of GERD - ✔✔Esophagitis, ulceration, Barrett's esophagus,
respiratory issues (asthma, pneumonia), dental erosion
✔✔Location of peptic ulcers - ✔✔stomach or duodenum
✔✔causes of peptic ulcers - ✔✔NSAIDS, ASA, stress, smoking, caffeine, ETOH,
steroids, H.Pylori
✔✔Which type of peptic ulcer is most common? - ✔✔duodenal ulcers
✔✔Which type of peptic ulcer is characterized by pain RIGHT AFTER EATING, in high
epigastric area, and has pain with an empty stomach is erosion is through the mucosa?
- ✔✔gastric
, ✔✔which type of peptic ulcer is characterized by pain AT NIGHT or 2-4 hours AFTER
eating, if is chronic won't have symptoms, and pain comes and goes? - ✔✔duodenal
✔✔which type of peptic ulcer has a high mortality rate? - ✔✔gastric
✔✔what will someones breath with peptic ulcer typically smell like? - ✔✔ammonia
✔✔treatment for peptic ulcers - ✔✔Triple therapy:
1. Acid suppression (proton pump inhibitor-PPI)
2. Metronidazole
3. Amoxicillin/Biaxin
lifestyle and diet changes
✔✔peptic ulcer complications - ✔✔bleeding, perforation (with perf, need abx, fluids,
NGT, and pain meds, surgical repair)
✔✔which inflammatory bowel disease is affected by the ENTIRE bowel system,
characterized by cobblestone bowel, all layers of the bowel, with NO rectal bleeding -
✔✔crohns disease
✔✔which inflammatory bowel disease affects the LEFT colon, starts at the rectums and
ascends, has shallow ulcerations, and has either bloody diarrhea or formed stool with
streaks? - ✔✔ulcerative colitis
✔✔Diet for Inflammatory Bowel Disease - ✔✔High protein, high calorie (3,000+ a day),
low fiber, low roughage/residue
✔✔causes for large bowel obstruction - ✔✔MOST COMMON is neoplasm, diverticulitis,
strictures, abscesses
✔✔causes for small bowel obstruction - ✔✔adhesions, hernias, polyps, ileus, lymphoma
✔✔which type of bowel obstruction is characterized by gradual onset, pain is low grade,
absence of stool, distention, high bitches bowel sounds - ✔✔large bowel obstruction
✔✔which type of bowel obstruction is characterized by rapid onset, crampy colicky pain,
emesis, distention, high pitched bowel sounds - ✔✔small bowel obstruction
✔✔which type of bowel obstruction is more likely to need surgical intervention? -
✔✔large bowel obstruction
