CMSRN EXAM BANK 2026/2027 | ACCURATE REAL
EXAM 150 QUESTIONS AND ANSWERS WITH DETAILED
RATIONALES EACH | CURRENTLY TESTING AND
FREQUENTLY TESTED VERSIONS | EXPERT VERIFIED FOR
GUARANTEED PASS | LATEST UPDATE ALREADY
GRADED A+
Question 1: A patient with a history of heart failure is admitted with shortness of breath and
edema. The nurse notes jugular venous distention (JVD) and crackles in the lung bases. Which
intervention should be prioritized?
A. Administer a bolus of 0.9% normal saline.
B. Place the patient in a high-Fowler's position.
C. Encourage the patient to increase oral fluid intake.
D. Apply a sequential compression device to the lower extremities.
Answer: B. Place the patient in a high-Fowler's position.
Rationale: The patient is exhibiting signs of fluid volume overload and pulmonary congestion.
Placing the patient in a high-Fowler's position (sitting upright at 90 degrees) promotes lung
expansion and decreases venous return to the heart, which helps to reduce shortness of breath
and pulmonary edema. It is a rapid, non-invasive intervention that should be prioritized to
improve oxygenation .
Question 2: A post-operative patient is on a patient-controlled analgesia (PCA) pump with
morphine. The nurse notes a respiratory rate of 8 breaths/min and a sedation score of 3 on a 0-
4 scale. What is the most appropriate initial action?
A. Administer naloxone per protocol.
B. Increase the basal rate of the PCA pump.
1
, C. Encourage the patient to take deep breaths.
D. Stop the PCA infusion and assess the patient.
Answer: D. Stop the PCA infusion and assess the patient.
Rationale: A respiratory rate of 8 and a high sedation score indicate significant respiratory
depression, a potential side effect of opioid analgesics. The first and most critical action is to
immediately stop the infusion of the offending medication to prevent further respiratory
compromise. After stopping the pump, the nurse should assess the patient and may need to
administer naloxone as a reversal agent per facility protocol .
Question 3: A patient with diabetes mellitus is receiving an insulin infusion. Which laboratory
value is most critical to monitor to prevent a life-threatening complication?
A. Serum sodium.
B. Serum potassium.
C. Serum calcium.
D. Serum creatinine.
Answer: B. Serum potassium.
Rationale: When insulin is administered, it drives potassium back into the cells along with
glucose. This can cause a rapid and potentially fatal drop in serum potassium levels
(hypokalemia), leading to cardiac arrhythmias. Close monitoring of serum potassium is
essential, especially during the initial phase of insulin therapy for hyperglycemic crises .
Question 4: The nurse is caring for a patient who has a new colostomy. Which of the following
observations indicates the patient is ready to begin self-care teaching?
A. The patient states, "I'm ready to learn about my colostomy."
B. The patient has an adequate support system at home.
C. The patient has mastered changing the ostomy appliance independently.
D. The patient is able to sleep through the night.
Answer: A. The patient states, "I'm ready to learn about my colostomy."
Rationale: The most important indicator of readiness to learn is the patient's expressed verbal
readiness. The patient's psychological state, especially acceptance and motivation, is
paramount. If the patient expresses a desire to learn, it signals that they are beginning to accept
the change and are psychologically prepared for the education. Mastering the skill (C) would be
the outcome of the teaching, not the readiness for it .
Question 5: A patient with a new diagnosis of heart failure is being discharged. Which
statement by the patient indicates a need for further teaching?
A. "I will weigh myself daily at the same time."
B. "I will limit my sodium intake to 2 grams per day."
2
, C. "I can take an extra dose of my diuretic if I feel more short of breath today."
D. "I can take an over-the-counter NSAID for my occasional joint pain."
Answer: D. "I can take an over-the-counter NSAID for my occasional joint pain."
Rationale: This statement indicates a need for further teaching because NSAIDs can cause
sodium and fluid retention, which can worsen the patient's heart failure. Patients with heart
failure should be advised to avoid NSAIDs unless specifically prescribed and monitored by their
healthcare provider . Taking an extra diuretic dose is usually not advised without specific
instructions; this also indicates a need for further teaching.
Question 6: During a shift report, the nurse learns a patient has a prescription for enoxaparin
(Lovenox). To ensure medication safety, what information should be verified?
A. The patient's most recent serum potassium level.
B. The patient's exact weight in kilograms.
C. The patient's baseline international normalized ratio (INR).
D. The patient's allergy to sulfa medications.
Answer: B. The patient's exact weight in kilograms.
Rationale: Enoxaparin (Lovenox) is an anticoagulant that is dosed based on the patient's weight.
Administering the correct dose is critical for its effectiveness and to minimize the risk of
bleeding complications (such as hemorrhage). An accurate weight is essential for calculating the
safe and therapeutic dose .
Question 7: A patient is admitted with a pulmonary embolism (PE). The nurse notes that the
patient's oxygen saturation has dropped from 94% to 88% on 2 L/min via nasal cannula. What is
the priority action?
A. Apply a non-rebreather mask at 15 L/min.
B. Increase the nasal cannula to 6 L/min.
C. Prepare to assist with intubation.
D. Re-position the patient to the left side.
Answer: A. Apply a non-rebreather mask at 15 L/min.
Rationale: A patient with a pulmonary embolism is at high risk for hypoxemia. When the SpO2
drops to 88% on a low-flow device, the nurse must provide more oxygen. A non-rebreather
mask can deliver a much higher FiO2 (up to 80-90%) and is the appropriate escalation of
respiratory support. While intubation might be required, it is not the first step if less invasive
support is effective .
Question 8: Which of the following is a key sign of an acute kidney injury (AKI) that the nurse
should be vigilant about in the post-operative period?
A. Oliguria (urine output <0.5 mL/kg/hr).
3
, B. Hypertension.
C. Hyperkalemia.
D. Fever.
Answer: A. Oliguria (urine output <0.5 mL/kg/hr).
Rationale: In the post-operative period, the most sensitive and early sign of acute kidney injury
is a decrease in urine output (oliguria), defined as less than 0.5 mL/kg/hr. This occurs when
renal perfusion decreases, leading to pre-renal azotemia. Monitoring urine output is a crucial
indicator of kidney function and fluid status. While hyperkalemia is a consequence of AKI,
oliguria is often the earliest sign .
Question 9: A patient with a history of a stroke is having difficulty swallowing. Which action is
most important to prevent aspiration?
A. Keep the patient in a semi-Fowler's position during meals.
B. Offer the patient thin liquids to make swallowing easier.
C. Place the food on the weaker side of the mouth.
D. Perform a chin-tuck swallow during meals.
Answer: D. Perform a chin-tuck swallow during meals.
Rationale: A chin-tuck maneuver (tucking the chin down toward the chest) is an effective
compensatory strategy to help protect the airway during swallowing. This position narrows the
airway opening and helps move the tongue base back, which facilitates bolus passage and
reduces the risk of aspiration. This is more than just maintaining an upright position and is an
active strategy for safe swallowing .
Question 10: A nurse is caring for a patient with a suspected intestinal obstruction. The patient
is complaining of severe, colicky abdominal pain and has a nasogastric (NG) tube to low
intermittent suction. What is the primary purpose of this intervention?
A. To prevent nausea and vomiting.
B. To assess the pH of gastric contents.
C. To decompress the bowel and relieve pressure.
D. To provide a route for medication administration.
Answer: C. To decompress the bowel and relieve pressure.
Rationale: The primary purpose of an NG tube to low intermittent suction in a patient with an
intestinal obstruction is to decompress the stomach and intestines. By removing air and fluid, it
reduces intraluminal pressure, which alleviates the colicky pain and prevents further distention
and potential perforation .
Question 11: Which of the following patients is at the highest risk for developing a pressure
injury?
4
EXAM 150 QUESTIONS AND ANSWERS WITH DETAILED
RATIONALES EACH | CURRENTLY TESTING AND
FREQUENTLY TESTED VERSIONS | EXPERT VERIFIED FOR
GUARANTEED PASS | LATEST UPDATE ALREADY
GRADED A+
Question 1: A patient with a history of heart failure is admitted with shortness of breath and
edema. The nurse notes jugular venous distention (JVD) and crackles in the lung bases. Which
intervention should be prioritized?
A. Administer a bolus of 0.9% normal saline.
B. Place the patient in a high-Fowler's position.
C. Encourage the patient to increase oral fluid intake.
D. Apply a sequential compression device to the lower extremities.
Answer: B. Place the patient in a high-Fowler's position.
Rationale: The patient is exhibiting signs of fluid volume overload and pulmonary congestion.
Placing the patient in a high-Fowler's position (sitting upright at 90 degrees) promotes lung
expansion and decreases venous return to the heart, which helps to reduce shortness of breath
and pulmonary edema. It is a rapid, non-invasive intervention that should be prioritized to
improve oxygenation .
Question 2: A post-operative patient is on a patient-controlled analgesia (PCA) pump with
morphine. The nurse notes a respiratory rate of 8 breaths/min and a sedation score of 3 on a 0-
4 scale. What is the most appropriate initial action?
A. Administer naloxone per protocol.
B. Increase the basal rate of the PCA pump.
1
, C. Encourage the patient to take deep breaths.
D. Stop the PCA infusion and assess the patient.
Answer: D. Stop the PCA infusion and assess the patient.
Rationale: A respiratory rate of 8 and a high sedation score indicate significant respiratory
depression, a potential side effect of opioid analgesics. The first and most critical action is to
immediately stop the infusion of the offending medication to prevent further respiratory
compromise. After stopping the pump, the nurse should assess the patient and may need to
administer naloxone as a reversal agent per facility protocol .
Question 3: A patient with diabetes mellitus is receiving an insulin infusion. Which laboratory
value is most critical to monitor to prevent a life-threatening complication?
A. Serum sodium.
B. Serum potassium.
C. Serum calcium.
D. Serum creatinine.
Answer: B. Serum potassium.
Rationale: When insulin is administered, it drives potassium back into the cells along with
glucose. This can cause a rapid and potentially fatal drop in serum potassium levels
(hypokalemia), leading to cardiac arrhythmias. Close monitoring of serum potassium is
essential, especially during the initial phase of insulin therapy for hyperglycemic crises .
Question 4: The nurse is caring for a patient who has a new colostomy. Which of the following
observations indicates the patient is ready to begin self-care teaching?
A. The patient states, "I'm ready to learn about my colostomy."
B. The patient has an adequate support system at home.
C. The patient has mastered changing the ostomy appliance independently.
D. The patient is able to sleep through the night.
Answer: A. The patient states, "I'm ready to learn about my colostomy."
Rationale: The most important indicator of readiness to learn is the patient's expressed verbal
readiness. The patient's psychological state, especially acceptance and motivation, is
paramount. If the patient expresses a desire to learn, it signals that they are beginning to accept
the change and are psychologically prepared for the education. Mastering the skill (C) would be
the outcome of the teaching, not the readiness for it .
Question 5: A patient with a new diagnosis of heart failure is being discharged. Which
statement by the patient indicates a need for further teaching?
A. "I will weigh myself daily at the same time."
B. "I will limit my sodium intake to 2 grams per day."
2
, C. "I can take an extra dose of my diuretic if I feel more short of breath today."
D. "I can take an over-the-counter NSAID for my occasional joint pain."
Answer: D. "I can take an over-the-counter NSAID for my occasional joint pain."
Rationale: This statement indicates a need for further teaching because NSAIDs can cause
sodium and fluid retention, which can worsen the patient's heart failure. Patients with heart
failure should be advised to avoid NSAIDs unless specifically prescribed and monitored by their
healthcare provider . Taking an extra diuretic dose is usually not advised without specific
instructions; this also indicates a need for further teaching.
Question 6: During a shift report, the nurse learns a patient has a prescription for enoxaparin
(Lovenox). To ensure medication safety, what information should be verified?
A. The patient's most recent serum potassium level.
B. The patient's exact weight in kilograms.
C. The patient's baseline international normalized ratio (INR).
D. The patient's allergy to sulfa medications.
Answer: B. The patient's exact weight in kilograms.
Rationale: Enoxaparin (Lovenox) is an anticoagulant that is dosed based on the patient's weight.
Administering the correct dose is critical for its effectiveness and to minimize the risk of
bleeding complications (such as hemorrhage). An accurate weight is essential for calculating the
safe and therapeutic dose .
Question 7: A patient is admitted with a pulmonary embolism (PE). The nurse notes that the
patient's oxygen saturation has dropped from 94% to 88% on 2 L/min via nasal cannula. What is
the priority action?
A. Apply a non-rebreather mask at 15 L/min.
B. Increase the nasal cannula to 6 L/min.
C. Prepare to assist with intubation.
D. Re-position the patient to the left side.
Answer: A. Apply a non-rebreather mask at 15 L/min.
Rationale: A patient with a pulmonary embolism is at high risk for hypoxemia. When the SpO2
drops to 88% on a low-flow device, the nurse must provide more oxygen. A non-rebreather
mask can deliver a much higher FiO2 (up to 80-90%) and is the appropriate escalation of
respiratory support. While intubation might be required, it is not the first step if less invasive
support is effective .
Question 8: Which of the following is a key sign of an acute kidney injury (AKI) that the nurse
should be vigilant about in the post-operative period?
A. Oliguria (urine output <0.5 mL/kg/hr).
3
, B. Hypertension.
C. Hyperkalemia.
D. Fever.
Answer: A. Oliguria (urine output <0.5 mL/kg/hr).
Rationale: In the post-operative period, the most sensitive and early sign of acute kidney injury
is a decrease in urine output (oliguria), defined as less than 0.5 mL/kg/hr. This occurs when
renal perfusion decreases, leading to pre-renal azotemia. Monitoring urine output is a crucial
indicator of kidney function and fluid status. While hyperkalemia is a consequence of AKI,
oliguria is often the earliest sign .
Question 9: A patient with a history of a stroke is having difficulty swallowing. Which action is
most important to prevent aspiration?
A. Keep the patient in a semi-Fowler's position during meals.
B. Offer the patient thin liquids to make swallowing easier.
C. Place the food on the weaker side of the mouth.
D. Perform a chin-tuck swallow during meals.
Answer: D. Perform a chin-tuck swallow during meals.
Rationale: A chin-tuck maneuver (tucking the chin down toward the chest) is an effective
compensatory strategy to help protect the airway during swallowing. This position narrows the
airway opening and helps move the tongue base back, which facilitates bolus passage and
reduces the risk of aspiration. This is more than just maintaining an upright position and is an
active strategy for safe swallowing .
Question 10: A nurse is caring for a patient with a suspected intestinal obstruction. The patient
is complaining of severe, colicky abdominal pain and has a nasogastric (NG) tube to low
intermittent suction. What is the primary purpose of this intervention?
A. To prevent nausea and vomiting.
B. To assess the pH of gastric contents.
C. To decompress the bowel and relieve pressure.
D. To provide a route for medication administration.
Answer: C. To decompress the bowel and relieve pressure.
Rationale: The primary purpose of an NG tube to low intermittent suction in a patient with an
intestinal obstruction is to decompress the stomach and intestines. By removing air and fluid, it
reduces intraluminal pressure, which alleviates the colicky pain and prevents further distention
and potential perforation .
Question 11: Which of the following patients is at the highest risk for developing a pressure
injury?
4
