2025 Adult Medical Surgical Nursing Content Mastery Series (CMS) Exams STUDY
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GUIDE ACTUAL EXAM QUESTIONS AND WELL ELABORATED ANSWERS (MOST TES
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TED QUESTIONS WITH VERIFIED ANSWERS) LATEST
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The nurse notes that the handgrip of the client with hypokalemia has di
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minished since the previous assessment one hour ago. Which interventi
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on by the nurse is the priority?
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a. assess the client's respiratory rate, rhythm, and depth
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b. document findings and monitor the client A A A A A
c. measure the client's pulse and blood pressure
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d. call the health care provider - CORRECT ANSWER A
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In a client with hypokkalemia, progressive skeletal muscle weakness is
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Aassociated with increasing severity of hypokalemia. The most life-
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Athreatening complication of hypokalemia is respiratory insufficiency. It
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is imperative for the nurse to perform a respiratory assessment first to
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make sure that the client is not in immediate jeopardy. Next, the nurse
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would call the health care provider to obtain orders for potassium repla
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cement.
The physician orders Lasix (furosemide) 60 mg po every day for your pat
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ient. On hand you have Lasix 40 mg. How many tablets will you give the p
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atient?
a. 3
b. 1
c. 1 1/2
A
d. 2 1/5 - CORRECT ANSWER
A A A A C
60/40 (desired/have) A
A client has been taught to restrict dietary sodium. Which food selection
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by the client indicates to the nurse that teaching has been effective?
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a. a grilled cheese sandwich with tomato soup
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,b. Chinese take-out, including steamed rice A A A A
c. a chicken leg, one slice of bread with butter, and steamed carrots
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d. slices of ham and cheese on whole grain crackers -
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CORRECT ANSWER C
A A
Clients on restricted sodium diets generally should avoid processed, sm
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oked, and pickled foods and those with sauces and other condiments. F
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oods lowest in sodium include fish, poultry, and fresh produce. The chin
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ese food likely would have soy sauce, the tomato soup is processed, and
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the crackers are a snack food - a category of foods often high in sodium.
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When a client is assessed, which behavior best indicates that he or she
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is experiencing changes associated with acute pain?
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a. inability to concentrate A A
b. expressed hopelessness A
c. psychosocial withdrawal A
d. anger and hostility - CORRECT ANSWER
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The characteristics most common to chronic pain are psychosocial with
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drawal, anger and hostility, depression, and hopelessness. The inability
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to concentrate is associated much more with acute pain, before any phy
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siologic or behavioral adaptation has occurred.
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A nurse is caring for several clients at risk for overhydration. The nurse
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assesses the older client with which finding first?
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A) Has had diabetes mellitus for 12 years
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B) Had abdominal surgery and has a nasogastric tube
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C) Just received 3 units of packed red blood cells
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D) Uses sodium-containing antacids frequently - CORRECT ANSWER
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C
Blood replacement therapy involves intravenous fluid administration, w
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hich inherently increases the risk for overhydration. The fact that the flu
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id consists of packed red blood cells greatly increases the risk, because
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Athis fluid increases the colloidal oncotic pressure of the
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,blood, causing fluid to move from interstitial and intracellular spaces int
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o the plasma volume. An older adult may not have sufficient cardiac or r
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enal reserve to manage this extra fluid.
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The client with a stroke was admitted to a medical-
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surgical unit. Which tasks does the nurse delegate to the unlicens
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ed assistive personnel?
A A
A) Assess level of consciousness. A A A
B) Evaluate the pulse oximetry reading. A A A A
C) Assist the client with meals. A A A A
D) Complete the nursing care plan. - CORRECT ANSWERA A A A A A A C
The nurse needs to know the five rights of delegation: right task, right ci
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rcumstances, right person, right communication, and right supervision. A A A A A A A A
Unlicensed assistive personnel can help with feeding, but only the nurse
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Acan care plan, assess the level of consciousness, and evaluate the oxy
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genation of the client. A A A
Interrelated concepts to the professional nursing role a nurse manager
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would consider when addressing concerns about the quality of patient e
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ducation include: A
A) adherence.
B) developmental level. A
C) motivation.
D) technology. - CORRECT ANSWER A A A D
The interrelated concepts to the professional role of a nurse include hea
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lth promotion, leadership, technology/informatics, quality, collaboration
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, and communication. Adherence, culture, developmental level, family d
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ynamics, and motivation are considered interrelated concepts to patien
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t attributes and preference.
A A A
During orientation to an emergency department, the nurse educator wo
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uld be concerned if the new nurse listed which of the following as a risk f
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actor for impaired thermoregulation?
A A A
A) Temperature extremes A
, B) Occupational exposure A
C) Impaired cognition A
D) Physical agility - CORRECT ANSWER A A A A D
Physical agility is not a risk factor for impaired thermoregulation. The nu
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rse educator would use this information to plan additional teaching to in
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clude medical conditions and gait disturbance as risk factors for hypoth
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ermia, because their bodies have a reduced ability to generate heat. Imp
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aired cognition is a risk factor. Recreational or occupational exposure is
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Aa risk factor. Temperature extremes are risk factors for impaired therm
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oregulation.
An older adult client is in physical restraints. Which intervention by the n
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urse is the priority?
A A A
A) Assess the client hourly while keeping the restraints in place.
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B) Assess the client once each shift, releasing the restraints for f
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eeding.
C) Assess the client twice each shift while keeping the restraints in p
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lace.
D) Assess the client every 30 to 60 minutes, releasing restraints every 2
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Ahours. - CORRECT ANSWER D A A A
The application of restraints can have serious consequences. Thus, the
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Anurse should check the client every 30 to 60 minutes, releasing the res
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traints every 2 hours for positioning and toileting. The other answers w
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ould not be appropriate because the client would not be assessed frequ
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ently enough, and circulation to the limbs could be compromised. Asse
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ssing every hour and releasing the restraints every 2 hours is in complia
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nce with federal policy for monitoring clients in restraints.
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The nurse is assessing a client with a long-
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term history of arthritic pain. Assessment reveals a heart rate of 115 be
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ats/min and blood pressure of 170/80 mm Hg. Which intervention will the
A A A A A A A A A A A A
nurse carry out first? A A A
A) Administer blood pressure medication. A A A
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GUIDE ACTUAL EXAM QUESTIONS AND WELL ELABORATED ANSWERS (MOST TES
A A A A A A A A A
TED QUESTIONS WITH VERIFIED ANSWERS) LATEST
A A A A A
The nurse notes that the handgrip of the client with hypokalemia has di
A A A A A A A A A A A A
minished since the previous assessment one hour ago. Which interventi
A A A A A A A A A
on by the nurse is the priority?
A A A A A A
a. assess the client's respiratory rate, rhythm, and depth
A A A A A A A
b. document findings and monitor the client A A A A A
c. measure the client's pulse and blood pressure
A A A A A A
d. call the health care provider - CORRECT ANSWER A
A A A A A A A
In a client with hypokkalemia, progressive skeletal muscle weakness is
A A A A A A A A A
Aassociated with increasing severity of hypokalemia. The most life-
A A A A A A A A
Athreatening complication of hypokalemia is respiratory insufficiency. It
A A A A A A A A
is imperative for the nurse to perform a respiratory assessment first to
A A A A A A A A A A A A
make sure that the client is not in immediate jeopardy. Next, the nurse
A A A A A A A A A A A A A
would call the health care provider to obtain orders for potassium repla
A A A A A A A A A A A
cement.
The physician orders Lasix (furosemide) 60 mg po every day for your pat
A A A A A A A A A A A A
ient. On hand you have Lasix 40 mg. How many tablets will you give the p
A A A A A A A A A A A A A A A
atient?
a. 3
b. 1
c. 1 1/2
A
d. 2 1/5 - CORRECT ANSWER
A A A A C
60/40 (desired/have) A
A client has been taught to restrict dietary sodium. Which food selection
A A A A A A A A A A A
by the client indicates to the nurse that teaching has been effective?
A A A A A A A A A A A A
a. a grilled cheese sandwich with tomato soup
A A A A A A
,b. Chinese take-out, including steamed rice A A A A
c. a chicken leg, one slice of bread with butter, and steamed carrots
A A A A A A A A A A A
d. slices of ham and cheese on whole grain crackers -
A A A A A A A A A
CORRECT ANSWER C
A A
Clients on restricted sodium diets generally should avoid processed, sm
A A A A A A A A A
oked, and pickled foods and those with sauces and other condiments. F
A A A A A A A A A A A
oods lowest in sodium include fish, poultry, and fresh produce. The chin
A A A A A A A A A A A
ese food likely would have soy sauce, the tomato soup is processed, and
A A A A A A A A A A A A
the crackers are a snack food - a category of foods often high in sodium.
A A A A A A A A A A A A A A A
When a client is assessed, which behavior best indicates that he or she
A A A A A A A A A A A A
is experiencing changes associated with acute pain?
A A A A A A A
a. inability to concentrate A A
b. expressed hopelessness A
c. psychosocial withdrawal A
d. anger and hostility - CORRECT ANSWER
A A A A A A
The characteristics most common to chronic pain are psychosocial with
A A A A A A A A A
drawal, anger and hostility, depression, and hopelessness. The inability
A A A A A A A A A
to concentrate is associated much more with acute pain, before any phy
A A A A A A A A A A A
siologic or behavioral adaptation has occurred.
A A A A A
A nurse is caring for several clients at risk for overhydration. The nurse
A A A A A A A A A A A A
assesses the older client with which finding first?
A A A A A A A A
A) Has had diabetes mellitus for 12 years
A A A A A A
B) Had abdominal surgery and has a nasogastric tube
A A A A A A A
C) Just received 3 units of packed red blood cells
A A A A A A A A
D) Uses sodium-containing antacids frequently - CORRECT ANSWER
A A A A A A
C
Blood replacement therapy involves intravenous fluid administration, w
A A A A A A A
hich inherently increases the risk for overhydration. The fact that the flu
A A A A A A A A A A A
id consists of packed red blood cells greatly increases the risk, because
A A A A A A A A A A A
Athis fluid increases the colloidal oncotic pressure of the
A A A A A A A A
,blood, causing fluid to move from interstitial and intracellular spaces int
A A A A A A A A A A
o the plasma volume. An older adult may not have sufficient cardiac or r
A A A A A A A A A A A A A
enal reserve to manage this extra fluid.
A A A A A A
The client with a stroke was admitted to a medical-
A A A A A A A A A
surgical unit. Which tasks does the nurse delegate to the unlicens
A A A A A A A A A A
ed assistive personnel?
A A
A) Assess level of consciousness. A A A
B) Evaluate the pulse oximetry reading. A A A A
C) Assist the client with meals. A A A A
D) Complete the nursing care plan. - CORRECT ANSWERA A A A A A A C
The nurse needs to know the five rights of delegation: right task, right ci
A A A A A A A A A A A A A
rcumstances, right person, right communication, and right supervision. A A A A A A A A
Unlicensed assistive personnel can help with feeding, but only the nurse
A A A A A A A A A A
Acan care plan, assess the level of consciousness, and evaluate the oxy
A A A A A A A A A A A
genation of the client. A A A
Interrelated concepts to the professional nursing role a nurse manager
A A A A A A A A A A
would consider when addressing concerns about the quality of patient e
A A A A A A A A A A
ducation include: A
A) adherence.
B) developmental level. A
C) motivation.
D) technology. - CORRECT ANSWER A A A D
The interrelated concepts to the professional role of a nurse include hea
A A A A A A A A A A A
lth promotion, leadership, technology/informatics, quality, collaboration
A A A A A
, and communication. Adherence, culture, developmental level, family d
A A A A A A A A
ynamics, and motivation are considered interrelated concepts to patien
A A A A A A A A
t attributes and preference.
A A A
During orientation to an emergency department, the nurse educator wo
A A A A A A A A A
uld be concerned if the new nurse listed which of the following as a risk f
A A A A A A A A A A A A A A A
actor for impaired thermoregulation?
A A A
A) Temperature extremes A
, B) Occupational exposure A
C) Impaired cognition A
D) Physical agility - CORRECT ANSWER A A A A D
Physical agility is not a risk factor for impaired thermoregulation. The nu
A A A A A A A A A A A
rse educator would use this information to plan additional teaching to in
A A A A A A A A A A A
clude medical conditions and gait disturbance as risk factors for hypoth
A A A A A A A A A A
ermia, because their bodies have a reduced ability to generate heat. Imp
A A A A A A A A A A A
aired cognition is a risk factor. Recreational or occupational exposure is
A A A A A A A A A A
Aa risk factor. Temperature extremes are risk factors for impaired therm
A A A A A A A A A A
oregulation.
An older adult client is in physical restraints. Which intervention by the n
A A A A A A A A A A A A
urse is the priority?
A A A
A) Assess the client hourly while keeping the restraints in place.
A A A A A A A A A
B) Assess the client once each shift, releasing the restraints for f
A A A A A A A A A A
eeding.
C) Assess the client twice each shift while keeping the restraints in p
A A A A A A A A A A A
lace.
D) Assess the client every 30 to 60 minutes, releasing restraints every 2
A A A A A A A A A A A
Ahours. - CORRECT ANSWER D A A A
The application of restraints can have serious consequences. Thus, the
A A A A A A A A A
Anurse should check the client every 30 to 60 minutes, releasing the res
A A A A A A A A A A A A
traints every 2 hours for positioning and toileting. The other answers w
A A A A A A A A A A A
ould not be appropriate because the client would not be assessed frequ
A A A A A A A A A A A
ently enough, and circulation to the limbs could be compromised. Asse
A A A A A A A A A A
ssing every hour and releasing the restraints every 2 hours is in complia
A A A A A A A A A A A A
nce with federal policy for monitoring clients in restraints.
A A A A A A A A
The nurse is assessing a client with a long-
A A A A A A A A
term history of arthritic pain. Assessment reveals a heart rate of 115 be
A A A A A A A A A A A A
ats/min and blood pressure of 170/80 mm Hg. Which intervention will the
A A A A A A A A A A A A
nurse carry out first? A A A
A) Administer blood pressure medication. A A A
