NR 326 COMBINED MEDICAL SERVICES
(CMS) EXAM PREP QUESTIONS WITH
CORRECT ANSWERS 2026/2027
1. A patient with bipolar disorder is prescribed lithium carbonate. Which laboratory result
would the nurse identify as indicating lithium toxicity?
A. Serum lithium level of 1.6 mEq/L
B. Serum lithium level of 1.2 mEq/L
C. Serum lithium level of 0.8 mEq/L
D. Serum lithium level of 0.5 mEq/L
Answer: A
Conceptual Explanation: The therapeutic range for lithium is generally 0.6 to 1.2 mEq/L.
Levels above 1.5 mEq/L are considered toxic and require immediate intervention.
2. According to CMS standards, what is the maximum duration for a behavioral restraint
order for an adult patient aged 18 or older?
A. 4 hours
B. 2 hours
,C. 8 hours
D. 24 hours
Answer: A
Conceptual Explanation: CMS guidelines state that for adults 18 and older, a restraint
order for behavioral management is limited to 4 hours, after which a new order and
evaluation are required.
3. A patient is exhibiting signs of Serotonin Syndrome. Which medication combination most
likely contributed to this condition?
A. Phenelzine and Pseudoephedrine
B. Fluoxetine and St. John’s Wort
C. Lithium and Valproic Acid
D. Haloperidol and Lorazepam
Answer: B
Conceptual Explanation: Serotonin syndrome occurs when multiple serotonergic agents,
such as SSRIs (Fluoxetine) and herbal supplements like St. John’s Wort, are combined.
4. Which assessment finding is a hallmark symptom of Neuroleptic Malignant Syndrome
(NMS)?
A. Hypothermia and bradycardia
B. Muscle rigidity and hyperpyrexia
, C. Respiratory depression and miosis
D. Fine hand tremors and polyuria
Answer: B
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by severe muscle rigidity, high fever (hyperpyrexia), tachycardia, and
autonomic instability.
5. A nurse is caring for a patient experiencing a hypertensive crisis after consuming aged
cheese while on an MAOI. Which medication should the nurse anticipate administering?
A. Phentolamine
B. Naloxone
C. Protamine sulfate
D. Vitamin K
Answer: A
Conceptual Explanation: Phentolamine is an alpha-adrenergic blocker used to treat
hypertensive crises associated with MAOI interactions with tyramine-rich foods.
6. A patient with schizophrenia is prescribed Clozapine. Which monitoring parameter is most
critical due to the risk of agranulocytosis?
A. Platelet count
B. Serum creatinine
(CMS) EXAM PREP QUESTIONS WITH
CORRECT ANSWERS 2026/2027
1. A patient with bipolar disorder is prescribed lithium carbonate. Which laboratory result
would the nurse identify as indicating lithium toxicity?
A. Serum lithium level of 1.6 mEq/L
B. Serum lithium level of 1.2 mEq/L
C. Serum lithium level of 0.8 mEq/L
D. Serum lithium level of 0.5 mEq/L
Answer: A
Conceptual Explanation: The therapeutic range for lithium is generally 0.6 to 1.2 mEq/L.
Levels above 1.5 mEq/L are considered toxic and require immediate intervention.
2. According to CMS standards, what is the maximum duration for a behavioral restraint
order for an adult patient aged 18 or older?
A. 4 hours
B. 2 hours
,C. 8 hours
D. 24 hours
Answer: A
Conceptual Explanation: CMS guidelines state that for adults 18 and older, a restraint
order for behavioral management is limited to 4 hours, after which a new order and
evaluation are required.
3. A patient is exhibiting signs of Serotonin Syndrome. Which medication combination most
likely contributed to this condition?
A. Phenelzine and Pseudoephedrine
B. Fluoxetine and St. John’s Wort
C. Lithium and Valproic Acid
D. Haloperidol and Lorazepam
Answer: B
Conceptual Explanation: Serotonin syndrome occurs when multiple serotonergic agents,
such as SSRIs (Fluoxetine) and herbal supplements like St. John’s Wort, are combined.
4. Which assessment finding is a hallmark symptom of Neuroleptic Malignant Syndrome
(NMS)?
A. Hypothermia and bradycardia
B. Muscle rigidity and hyperpyrexia
, C. Respiratory depression and miosis
D. Fine hand tremors and polyuria
Answer: B
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by severe muscle rigidity, high fever (hyperpyrexia), tachycardia, and
autonomic instability.
5. A nurse is caring for a patient experiencing a hypertensive crisis after consuming aged
cheese while on an MAOI. Which medication should the nurse anticipate administering?
A. Phentolamine
B. Naloxone
C. Protamine sulfate
D. Vitamin K
Answer: A
Conceptual Explanation: Phentolamine is an alpha-adrenergic blocker used to treat
hypertensive crises associated with MAOI interactions with tyramine-rich foods.
6. A patient with schizophrenia is prescribed Clozapine. Which monitoring parameter is most
critical due to the risk of agranulocytosis?
A. Platelet count
B. Serum creatinine
