CMSRN — Certified Medical-Surgical
Registered Nurse Exam Complete Practice
Questions with Verified Answers &
Rationales
Based on the official MSNCB (Medical-Surgical Nursing Certification Board) exam
blueprint, which tests competencies in Patient Care Management, Nursing Teamwork
& Collaboration, Interprofessional Care, Professional Concepts, and Holistic
Patient Care
Section 1: Patient Care Management (Questions 1-35)
Question 1
A 45-year-old female with ulcerative colitis underwent total
proctocolectomy with permanent ileostomy 12 hours ago. Which finding
requires immediate physician notification?
• A) The stoma appears pale and dry
• B) The stoma appears red and shiny
• C) There is 200 mL of dark green output from the stoma
• D) There is 50 mL of serosanguinous drainage from the stoma
Correct ,,,,Answer,,,,: A
Rationale: A healthy stoma is pink/red and moist due to mucous
production. A pale, dry stoma indicates ischemia of the stoma or bowel,
which is a surgical emergency requiring immediate intervention .
,Question 2
A patient with a new ileostomy has peristomal skin irritation. What action
should the nurse take before reapplying the appliance?
• A) Wash the area with antiseptic soap and water
• B) Clean the site with Dakin's solution
• C) Use a solid skin barrier (pectin-based or karaya wafer)
• D) Obtain an order for a topical antibiotic
Correct ,,,,Answer,,,,: C
Rationale: Ileostomy drainage quickly irritates surrounding tissue. A solid
skin barrier with pectin base or karaya wafer provides measurable
thickness and hydrocolloid adhesive properties to protect peristomal
skin .
Question 3
Before ileostomy surgery, which patient comment indicates a concern
about body image?
• A) "I will have to stop my aerobics classes"
• B) "I'm so afraid I may not survive the surgery"
• C) "I need to go shopping for some loose, baggy clothes"
• D) "I'm concerned this may be only the first of many surgeries"
Correct ,,,,Answer,,,,: C
Rationale: Body image concerns reflect how patients perceive
themselves post-surgery. The belief that special clothing is needed after
,ileostomy indicates body image anxiety. Minor adjustments (stretch
underwear, pantyhose) may be needed, but special clothing is not
required .
Question 4
A patient with type 2 diabetes is prescribed metformin (Glucophage) and
also takes medication for hypertension. What is most important to
monitor?
• A) Glomerular filtration rate (GFR)
• B) Serum potassium
• C) Hemoglobin A1C
• D) Liver enzymes
Correct ,,,,Answer,,,,: A
Rationale: Metformin is contraindicated in patients with renal impairment
due to risk of lactic acidosis. GFR monitoring is essential, especially in
patients with hypertension who are at risk for chronic kidney disease .
Question 5
A patient asks the nurse how to find reliable healthcare information
online. Which website should the nurse recommend?
• A) www.caringbridge.org
• B) www.cancer.gov
• C) www.webmd.com
, • D) www.google.com
Correct ,,,,Answer,,,,: B
Rationale: Government-sponsored websites (.gov) are the most reliable
sources for health information as they adhere to strict accuracy and
evidence-based standards. Commercial sites may contain biased or
unverified information .
Question 6
A postoperative patient reports increasing abdominal pain with a rigid
abdomen. What should the nurse do first?
• A) Administer prescribed analgesics
• B) Notify the provider immediately
• C) Encourage deep breathing exercises
• D) Increase IV fluids
Correct ,,,,Answer,,,,: B
Rationale: A rigid abdomen with increasing pain suggests peritonitis, a
surgical emergency requiring rapid provider notification. Analgesics
should not be given before provider assessment as they may mask
symptoms .
Question 7
A patient with heart failure receives IV furosemide. Which finding requires
priority action?
Registered Nurse Exam Complete Practice
Questions with Verified Answers &
Rationales
Based on the official MSNCB (Medical-Surgical Nursing Certification Board) exam
blueprint, which tests competencies in Patient Care Management, Nursing Teamwork
& Collaboration, Interprofessional Care, Professional Concepts, and Holistic
Patient Care
Section 1: Patient Care Management (Questions 1-35)
Question 1
A 45-year-old female with ulcerative colitis underwent total
proctocolectomy with permanent ileostomy 12 hours ago. Which finding
requires immediate physician notification?
• A) The stoma appears pale and dry
• B) The stoma appears red and shiny
• C) There is 200 mL of dark green output from the stoma
• D) There is 50 mL of serosanguinous drainage from the stoma
Correct ,,,,Answer,,,,: A
Rationale: A healthy stoma is pink/red and moist due to mucous
production. A pale, dry stoma indicates ischemia of the stoma or bowel,
which is a surgical emergency requiring immediate intervention .
,Question 2
A patient with a new ileostomy has peristomal skin irritation. What action
should the nurse take before reapplying the appliance?
• A) Wash the area with antiseptic soap and water
• B) Clean the site with Dakin's solution
• C) Use a solid skin barrier (pectin-based or karaya wafer)
• D) Obtain an order for a topical antibiotic
Correct ,,,,Answer,,,,: C
Rationale: Ileostomy drainage quickly irritates surrounding tissue. A solid
skin barrier with pectin base or karaya wafer provides measurable
thickness and hydrocolloid adhesive properties to protect peristomal
skin .
Question 3
Before ileostomy surgery, which patient comment indicates a concern
about body image?
• A) "I will have to stop my aerobics classes"
• B) "I'm so afraid I may not survive the surgery"
• C) "I need to go shopping for some loose, baggy clothes"
• D) "I'm concerned this may be only the first of many surgeries"
Correct ,,,,Answer,,,,: C
Rationale: Body image concerns reflect how patients perceive
themselves post-surgery. The belief that special clothing is needed after
,ileostomy indicates body image anxiety. Minor adjustments (stretch
underwear, pantyhose) may be needed, but special clothing is not
required .
Question 4
A patient with type 2 diabetes is prescribed metformin (Glucophage) and
also takes medication for hypertension. What is most important to
monitor?
• A) Glomerular filtration rate (GFR)
• B) Serum potassium
• C) Hemoglobin A1C
• D) Liver enzymes
Correct ,,,,Answer,,,,: A
Rationale: Metformin is contraindicated in patients with renal impairment
due to risk of lactic acidosis. GFR monitoring is essential, especially in
patients with hypertension who are at risk for chronic kidney disease .
Question 5
A patient asks the nurse how to find reliable healthcare information
online. Which website should the nurse recommend?
• A) www.caringbridge.org
• B) www.cancer.gov
• C) www.webmd.com
, • D) www.google.com
Correct ,,,,Answer,,,,: B
Rationale: Government-sponsored websites (.gov) are the most reliable
sources for health information as they adhere to strict accuracy and
evidence-based standards. Commercial sites may contain biased or
unverified information .
Question 6
A postoperative patient reports increasing abdominal pain with a rigid
abdomen. What should the nurse do first?
• A) Administer prescribed analgesics
• B) Notify the provider immediately
• C) Encourage deep breathing exercises
• D) Increase IV fluids
Correct ,,,,Answer,,,,: B
Rationale: A rigid abdomen with increasing pain suggests peritonitis, a
surgical emergency requiring rapid provider notification. Analgesics
should not be given before provider assessment as they may mask
symptoms .
Question 7
A patient with heart failure receives IV furosemide. Which finding requires
priority action?
