ANCC CMSRN Practice Exam – 260 Questions with
Rationales | Medical-Surgical Nursing Certification |
Updated 2026
TABLE OF CONTENTS
1. Domain 1: Assessment and Diagnosis Questions 1-65
2. Domain 2: Planning and Implementation Questions 66-130
3. Domain 3: Evaluation Questions 131-195
4. Domain 4: Professional Role and Leadership Questions 196-260
DOMAIN 1: ASSESSMENT AND DIAGNOSIS QUESTIONS 1-65
Question 1
A 68-year-old male patient is admitted with acute confusion, fever, and
flank pain. His urine dipstick is positive for leukocyte esterase and nitrites.
Which of the following is the most likely diagnosis?
A. Pyelonephritis
B. Cystitis
C. Urethritis
D. Prostatitis
,Correct Answer: A
Rationale: Pyelonephritis is an infection of the renal pelvis and kidney
tissue. The classic presentation includes fever, flank pain, and costovertebral
angle tenderness along with positive urine dipstick findings. Cystitis
presents with suprapubic pain and dysuria without systemic symptoms.
Urethritis presents with urethral discharge and dysuria without fever or
flank pain. Prostatitis presents with perineal pain, fever, and urinary
symptoms but lacks the classic flank pain pattern.
Question 2
A 55-year-old female patient reports progressive shortness of breath and a
non-productive cough for the past three months. She has never smoked and
has no known lung disease. On auscultation, you hear fine inspiratory
crackles at the lung bases. Which of the following is the most likely
diagnosis?
A. Idiopathic pulmonary fibrosis
B. COPD
C. Asthma
D. Pulmonary embolism
Correct Answer: A
Rationale: Idiopathic pulmonary fibrosis presents with progressive dyspnea,
non-productive cough, and fine basilar crackles on auscultation. It typically
occurs in patients over 50 without a smoking history. COPD is associated
with smoking and usually presents with wheezing and productive cough.
Asthma presents with episodic wheezing and reversible airflow obstruction.
,Pulmonary embolism presents with acute onset dyspnea and pleuritic chest
pain.
Question 3
A 72-year-old male patient is admitted with new-onset confusion. His
family reports that he was alert and oriented yesterday. His vital signs show
temperature 101.2 degrees Fahrenheit, heart rate 110, and blood pressure
100/60. His white blood cell count is elevated. Which of the following is the
most appropriate initial intervention?
A. Broad-spectrum antibiotics
B. Blood cultures
C. CT scan of the head
D. Lumbar puncture
Correct Answer: B
Rationale: Blood cultures should be obtained before antibiotics are
administered to identify the causative organism in a patient with suspected
sepsis. Broad-spectrum antibiotics are initiated after cultures are drawn. CT
scan of the head may be indicated if there are focal neurologic deficits or
history of trauma. Lumbar puncture is indicated if meningitis is suspected.
Question 4
A 45-year-old female patient presents with pain and swelling in her right
knee. She reports that the pain started suddenly this morning and she has no
history of trauma. Her serum uric acid level is 9.5 mg per dL. Which of the
following is the most likely diagnosis?
, A. Gout
B. Pseudogout
C. Septic arthritis
D. Rheumatoid arthritis
Correct Answer: A
Rationale: Gout is characterized by sudden onset of monoarticular arthritis,
often affecting the knee or first metatarsophalangeal joint. Elevated serum
uric acid supports the diagnosis. Pseudogout also presents with acute
monoarticular arthritis but is associated with calcium pyrophosphate crystals
and normal uric acid. Septic arthritis presents with fever, severe pain, and
joint effusion requiring aspiration. Rheumatoid arthritis typically presents
with symmetric polyarticular joint involvement.
Question 5
A 60-year-old male patient with a 40-pack-year smoking history presents
with hemoptysis and weight loss. Which of the following diagnostic tests is
most appropriate initially?
A. Chest x-ray
B. CT scan of the chest
C. Bronchoscopy
D. PET scan
Correct Answer: A
Rationales | Medical-Surgical Nursing Certification |
Updated 2026
TABLE OF CONTENTS
1. Domain 1: Assessment and Diagnosis Questions 1-65
2. Domain 2: Planning and Implementation Questions 66-130
3. Domain 3: Evaluation Questions 131-195
4. Domain 4: Professional Role and Leadership Questions 196-260
DOMAIN 1: ASSESSMENT AND DIAGNOSIS QUESTIONS 1-65
Question 1
A 68-year-old male patient is admitted with acute confusion, fever, and
flank pain. His urine dipstick is positive for leukocyte esterase and nitrites.
Which of the following is the most likely diagnosis?
A. Pyelonephritis
B. Cystitis
C. Urethritis
D. Prostatitis
,Correct Answer: A
Rationale: Pyelonephritis is an infection of the renal pelvis and kidney
tissue. The classic presentation includes fever, flank pain, and costovertebral
angle tenderness along with positive urine dipstick findings. Cystitis
presents with suprapubic pain and dysuria without systemic symptoms.
Urethritis presents with urethral discharge and dysuria without fever or
flank pain. Prostatitis presents with perineal pain, fever, and urinary
symptoms but lacks the classic flank pain pattern.
Question 2
A 55-year-old female patient reports progressive shortness of breath and a
non-productive cough for the past three months. She has never smoked and
has no known lung disease. On auscultation, you hear fine inspiratory
crackles at the lung bases. Which of the following is the most likely
diagnosis?
A. Idiopathic pulmonary fibrosis
B. COPD
C. Asthma
D. Pulmonary embolism
Correct Answer: A
Rationale: Idiopathic pulmonary fibrosis presents with progressive dyspnea,
non-productive cough, and fine basilar crackles on auscultation. It typically
occurs in patients over 50 without a smoking history. COPD is associated
with smoking and usually presents with wheezing and productive cough.
Asthma presents with episodic wheezing and reversible airflow obstruction.
,Pulmonary embolism presents with acute onset dyspnea and pleuritic chest
pain.
Question 3
A 72-year-old male patient is admitted with new-onset confusion. His
family reports that he was alert and oriented yesterday. His vital signs show
temperature 101.2 degrees Fahrenheit, heart rate 110, and blood pressure
100/60. His white blood cell count is elevated. Which of the following is the
most appropriate initial intervention?
A. Broad-spectrum antibiotics
B. Blood cultures
C. CT scan of the head
D. Lumbar puncture
Correct Answer: B
Rationale: Blood cultures should be obtained before antibiotics are
administered to identify the causative organism in a patient with suspected
sepsis. Broad-spectrum antibiotics are initiated after cultures are drawn. CT
scan of the head may be indicated if there are focal neurologic deficits or
history of trauma. Lumbar puncture is indicated if meningitis is suspected.
Question 4
A 45-year-old female patient presents with pain and swelling in her right
knee. She reports that the pain started suddenly this morning and she has no
history of trauma. Her serum uric acid level is 9.5 mg per dL. Which of the
following is the most likely diagnosis?
, A. Gout
B. Pseudogout
C. Septic arthritis
D. Rheumatoid arthritis
Correct Answer: A
Rationale: Gout is characterized by sudden onset of monoarticular arthritis,
often affecting the knee or first metatarsophalangeal joint. Elevated serum
uric acid supports the diagnosis. Pseudogout also presents with acute
monoarticular arthritis but is associated with calcium pyrophosphate crystals
and normal uric acid. Septic arthritis presents with fever, severe pain, and
joint effusion requiring aspiration. Rheumatoid arthritis typically presents
with symmetric polyarticular joint involvement.
Question 5
A 60-year-old male patient with a 40-pack-year smoking history presents
with hemoptysis and weight loss. Which of the following diagnostic tests is
most appropriate initially?
A. Chest x-ray
B. CT scan of the chest
C. Bronchoscopy
D. PET scan
Correct Answer: A
