CMSRN / MEDSURG-BC (MEDICAL-SURGICAL) EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE
Core Domains *
• Cardiovascular System Disorders
• Respiratory System Disorders
• Neurological and Sensory Disorders
• Gastrointestinal and Metabolic Disorders
• Renal, Urinary, and Reproductive Systems
• Musculoskeletal and Integumentary Systems
• Endocrine and Immune Disorders
• Professional Practice, Ethics, and Regulatory Standards
Introduction * This comprehensive assessment is designed to evaluate the advanced clinical
competency, critical thinking, and applied knowledge of registered nurses preparing for
medical-surgical certification. The primary purpose of the exam is to validate professional
mastery across diverse patient populations, acute care settings, and complex clinical
presentations. The assessment rigorously measures core skills in clinical decision-making,
pathophysiology analysis, pharmacological management, and evidence-based patient
advocacy. Utilizing a balanced format of multiple-choice items and complex clinical
scenarios, the examination emphasizes real-world application, patient safety, and
interprofessional coordination. Candidates are tested on their ability to synthesize clinical
data, anticipate complications, and execute timely, legally compliant interventions aligned
with current professional standards.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with a history of heart failure is admitted with acute dyspnea,
orthopnea, and bilateral crackles extending to the mid-lung fields. Which diagnostic
laboratory finding is most specific for differentiating acute heart failure exacerbation
from chronic pulmonary disease?
A. Elevated serum creatinine B. Decreased hemoglobin C. Elevated B-type natriuretic
peptide (BNP) D. Decreased serum potassium
Explanation: B-type natriuretic peptide is released by ventricular myocardial cells in
response to increased wall tension and stretch, making it a highly specific biomarker for
acute heart failure and volume overload compared to pulmonary etiologies.
, 2. A nurse is caring for a client post-coronary artery bypass graft (CABG) who suddenly
develops muffled heart sounds, jugular venous distension, and hypotension despite
adequate fluid administration. What is the immediate priority nursing action?
A. Administer a rapid fluid bolus of normal saline B. Prepare the client for emergency
endotracheal intubation C. Notify the provider immediately and prepare for
pericardiocentesis D. Obtain a 12-lead electrocardiogram
Explanation: Muffled heart sounds, jugular venous distension, and hypotension form
Beck's triad, which is classic for cardiac tamponade—a life-threatening post-operative
complication requiring immediate fluid drainage.
3. A client is receiving intravenous heparin infusion for a deep vein thrombosis. The
baseline activated partial thromboplastin time (aPTT) is 30 seconds. The current aPTT
result is 95 seconds. What is the appropriate nursing intervention based on standard
protocol?
A. Increase the infusion rate by 2 mL/hour B. Continue the infusion at the current rate and
recheck in 6 hours C. Stop the infusion temporarily and notify the provider for a
protocol-guided adjustment D. Administer oral warfarin immediately
Explanation: An aPTT of 95 seconds is significantly above the standard therapeutic range
(typically 1.5 to 2.5 times the control), placing the client at high risk for hemorrhage; the
infusion must be stopped or decreased per protocol.
4. A nurse is evaluating a client with suspected infective endocarditis. Which physical
examination finding is most commonly associated with this condition?
A. Perorbital edema B. Osler nodes on the fingertips C. Barrel chest with prolonged
expiration D. Symmetrical peripheral edema
Explanation: Osler nodes are painful, tender, red-purple lesions found on the fingers and
toes caused by immune-complex deposition, highly characteristic of infective endocarditis.
5. A client with chronic stable angina is prescribed sublingual nitroglycerin tablets.
Which patient statement indicates a correct understanding of how to take the
medication?
A. "I should swallow the tablet whole with a large glass of water." B. "I can take one
tablet every five minutes for a maximum of three doses, and call emergency services if pain
persists after the first." C. "I should store the tablets in a clear plastic container in my
bathroom medicine cabinet." D. "A slight tingling sensation under my tongue means the
medication has lost its potency."
, Explanation: Sublingual nitroglycerin should be taken at the onset of chest pain,
repeating every five minutes for up to three doses, but emergency services must be called if
pain does not improve after the first dose. A tingling sensation indicates potency.
6. A client admitted with an acute anterior wall myocardial infarction develops sudden
severe dyspnea, frothy pink-tinged sputum, and anxiety. Auscultation reveals diffuse
crackles and wheezes. What is the nurse's immediate action?
A. Place the client in the supine position B. Position the client in high-Fowler's position
with legs dangling C. Encourage deep breathing and incentive spirometry D. Administer
sublingual nitroglycerin immediately
Explanation: Positioning the client upright in high-Fowler's position with legs dependent
decreases venous return (preload) to the right side of the heart, reducing pulmonary
congestion during acute pulmonary edema.
7. A nurse is reviewing the telemetry strip of a client and notes a regular rhythm at a
rate of 140 beats per minute, normal PR intervals, and narrow QRS complexes that
start and end abruptly. How is this rhythm classified?
A. Ventricular tachycardia B. Atrial fibrillation C. Supraventricular tachycardia (SVT) D.
Sinus tachycardia
Explanation: Paroxysmal supraventricular tachycardia is characterized by a rapid, regular
heart rate exceeding 150 beats per minute (or generally 140 to 250) with narrow QRS
complexes and a sudden onset and termination.
8. A client with peripheral arterial disease (PAD) reports severe rest pain in both lower
extremities. Which instruction should the nurse include in the discharge teaching?
A. Elevate your legs above the level of your heart whenever resting. B. Apply heating pads
directly to your lower legs to improve comfort. C. Keep your lower extremities in a
dependent position or slightly dependent. D. Wear tight-fitting elastic compression stockings
daily.
Explanation: Clients with arterial insufficiency should keep their legs dependent to
encourage arterial blood flow via gravity; elevation and compression further compromise
arterial perfusion.
9. A client is admitted with a diagnosis of essential hypertension and is prescribed
hydrochlorothiazide. Which electrolyte imbalance must the nurse monitor for
closely?
A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hypercalcemia
, Explanation: Thiazide diuretics inhibit sodium and chloride reabsorption in the distal
convoluted tubules, leading to increased excretion of sodium, water, and potassium, which
frequently results in hypokalemia.
10. A nurse is assessing a client who has undergone a permanent pacemaker insertion.
Which finding indicates a potential complication requiring immediate intervention?
A. Mild tenderness at the insertion site B. Client reporting fatigue with light ambulation
C. Hiccups that persist synchronously with the pulse rate D. A heart rate maintained above
the programmed lower limit
Explanation: Persistent hiccups indicate diaphragmatic pacing, which occurs when the
pacemaker lead has perforated or is placed too close to the right ventricle wall, stimulating
the phrenic nerve.
11. A client with a severe exacerbation of asthma arrives at the emergency department.
Auscultation of the chest reveals diminished breath sounds with absent wheezing.
What is the clinical significance of this finding?
A. The asthma attack is resolving successfully. B. Bronchospasm has completely ceased.
C. The client is experiencing a worsening condition with severe airflow obstruction (silent
chest). D. The client is adequately oxygenated on room air.
Explanation: A "silent chest" where wheezing suddenly disappears amidst severe
respiratory distress indicates extreme airflow limitation and impending respiratory arrest,
requiring emergency intervention.
12. A nurse is caring for a client receiving mechanical ventilation via endotracheal tube.
Which assessment technique is most reliable for confirming correct endotracheal
tube placement?
A. Auscultating bilateral breath sounds B. Observing symmetrical chest wall expansion C.
Obtaining a chest radiograph and end-tidal CO2 monitoring D. Checking for condensation
inside the endotracheal tube
Explanation: While auscultation and chest expansion provide rapid preliminary checks,
chest radiography and continuous end-tidal carbon dioxide monitoring are the definitive,
most reliable methods to confirm correct endotracheal tube placement.
13. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen via
nasal cannula at 4 L/min. The nurse notes the client is becoming increasingly
lethargic with a respiratory rate of 8 breaths per minute. What is the primary
physiological mechanism responsible for this status change?
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE
Core Domains *
• Cardiovascular System Disorders
• Respiratory System Disorders
• Neurological and Sensory Disorders
• Gastrointestinal and Metabolic Disorders
• Renal, Urinary, and Reproductive Systems
• Musculoskeletal and Integumentary Systems
• Endocrine and Immune Disorders
• Professional Practice, Ethics, and Regulatory Standards
Introduction * This comprehensive assessment is designed to evaluate the advanced clinical
competency, critical thinking, and applied knowledge of registered nurses preparing for
medical-surgical certification. The primary purpose of the exam is to validate professional
mastery across diverse patient populations, acute care settings, and complex clinical
presentations. The assessment rigorously measures core skills in clinical decision-making,
pathophysiology analysis, pharmacological management, and evidence-based patient
advocacy. Utilizing a balanced format of multiple-choice items and complex clinical
scenarios, the examination emphasizes real-world application, patient safety, and
interprofessional coordination. Candidates are tested on their ability to synthesize clinical
data, anticipate complications, and execute timely, legally compliant interventions aligned
with current professional standards.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with a history of heart failure is admitted with acute dyspnea,
orthopnea, and bilateral crackles extending to the mid-lung fields. Which diagnostic
laboratory finding is most specific for differentiating acute heart failure exacerbation
from chronic pulmonary disease?
A. Elevated serum creatinine B. Decreased hemoglobin C. Elevated B-type natriuretic
peptide (BNP) D. Decreased serum potassium
Explanation: B-type natriuretic peptide is released by ventricular myocardial cells in
response to increased wall tension and stretch, making it a highly specific biomarker for
acute heart failure and volume overload compared to pulmonary etiologies.
, 2. A nurse is caring for a client post-coronary artery bypass graft (CABG) who suddenly
develops muffled heart sounds, jugular venous distension, and hypotension despite
adequate fluid administration. What is the immediate priority nursing action?
A. Administer a rapid fluid bolus of normal saline B. Prepare the client for emergency
endotracheal intubation C. Notify the provider immediately and prepare for
pericardiocentesis D. Obtain a 12-lead electrocardiogram
Explanation: Muffled heart sounds, jugular venous distension, and hypotension form
Beck's triad, which is classic for cardiac tamponade—a life-threatening post-operative
complication requiring immediate fluid drainage.
3. A client is receiving intravenous heparin infusion for a deep vein thrombosis. The
baseline activated partial thromboplastin time (aPTT) is 30 seconds. The current aPTT
result is 95 seconds. What is the appropriate nursing intervention based on standard
protocol?
A. Increase the infusion rate by 2 mL/hour B. Continue the infusion at the current rate and
recheck in 6 hours C. Stop the infusion temporarily and notify the provider for a
protocol-guided adjustment D. Administer oral warfarin immediately
Explanation: An aPTT of 95 seconds is significantly above the standard therapeutic range
(typically 1.5 to 2.5 times the control), placing the client at high risk for hemorrhage; the
infusion must be stopped or decreased per protocol.
4. A nurse is evaluating a client with suspected infective endocarditis. Which physical
examination finding is most commonly associated with this condition?
A. Perorbital edema B. Osler nodes on the fingertips C. Barrel chest with prolonged
expiration D. Symmetrical peripheral edema
Explanation: Osler nodes are painful, tender, red-purple lesions found on the fingers and
toes caused by immune-complex deposition, highly characteristic of infective endocarditis.
5. A client with chronic stable angina is prescribed sublingual nitroglycerin tablets.
Which patient statement indicates a correct understanding of how to take the
medication?
A. "I should swallow the tablet whole with a large glass of water." B. "I can take one
tablet every five minutes for a maximum of three doses, and call emergency services if pain
persists after the first." C. "I should store the tablets in a clear plastic container in my
bathroom medicine cabinet." D. "A slight tingling sensation under my tongue means the
medication has lost its potency."
, Explanation: Sublingual nitroglycerin should be taken at the onset of chest pain,
repeating every five minutes for up to three doses, but emergency services must be called if
pain does not improve after the first dose. A tingling sensation indicates potency.
6. A client admitted with an acute anterior wall myocardial infarction develops sudden
severe dyspnea, frothy pink-tinged sputum, and anxiety. Auscultation reveals diffuse
crackles and wheezes. What is the nurse's immediate action?
A. Place the client in the supine position B. Position the client in high-Fowler's position
with legs dangling C. Encourage deep breathing and incentive spirometry D. Administer
sublingual nitroglycerin immediately
Explanation: Positioning the client upright in high-Fowler's position with legs dependent
decreases venous return (preload) to the right side of the heart, reducing pulmonary
congestion during acute pulmonary edema.
7. A nurse is reviewing the telemetry strip of a client and notes a regular rhythm at a
rate of 140 beats per minute, normal PR intervals, and narrow QRS complexes that
start and end abruptly. How is this rhythm classified?
A. Ventricular tachycardia B. Atrial fibrillation C. Supraventricular tachycardia (SVT) D.
Sinus tachycardia
Explanation: Paroxysmal supraventricular tachycardia is characterized by a rapid, regular
heart rate exceeding 150 beats per minute (or generally 140 to 250) with narrow QRS
complexes and a sudden onset and termination.
8. A client with peripheral arterial disease (PAD) reports severe rest pain in both lower
extremities. Which instruction should the nurse include in the discharge teaching?
A. Elevate your legs above the level of your heart whenever resting. B. Apply heating pads
directly to your lower legs to improve comfort. C. Keep your lower extremities in a
dependent position or slightly dependent. D. Wear tight-fitting elastic compression stockings
daily.
Explanation: Clients with arterial insufficiency should keep their legs dependent to
encourage arterial blood flow via gravity; elevation and compression further compromise
arterial perfusion.
9. A client is admitted with a diagnosis of essential hypertension and is prescribed
hydrochlorothiazide. Which electrolyte imbalance must the nurse monitor for
closely?
A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hypercalcemia
, Explanation: Thiazide diuretics inhibit sodium and chloride reabsorption in the distal
convoluted tubules, leading to increased excretion of sodium, water, and potassium, which
frequently results in hypokalemia.
10. A nurse is assessing a client who has undergone a permanent pacemaker insertion.
Which finding indicates a potential complication requiring immediate intervention?
A. Mild tenderness at the insertion site B. Client reporting fatigue with light ambulation
C. Hiccups that persist synchronously with the pulse rate D. A heart rate maintained above
the programmed lower limit
Explanation: Persistent hiccups indicate diaphragmatic pacing, which occurs when the
pacemaker lead has perforated or is placed too close to the right ventricle wall, stimulating
the phrenic nerve.
11. A client with a severe exacerbation of asthma arrives at the emergency department.
Auscultation of the chest reveals diminished breath sounds with absent wheezing.
What is the clinical significance of this finding?
A. The asthma attack is resolving successfully. B. Bronchospasm has completely ceased.
C. The client is experiencing a worsening condition with severe airflow obstruction (silent
chest). D. The client is adequately oxygenated on room air.
Explanation: A "silent chest" where wheezing suddenly disappears amidst severe
respiratory distress indicates extreme airflow limitation and impending respiratory arrest,
requiring emergency intervention.
12. A nurse is caring for a client receiving mechanical ventilation via endotracheal tube.
Which assessment technique is most reliable for confirming correct endotracheal
tube placement?
A. Auscultating bilateral breath sounds B. Observing symmetrical chest wall expansion C.
Obtaining a chest radiograph and end-tidal CO2 monitoring D. Checking for condensation
inside the endotracheal tube
Explanation: While auscultation and chest expansion provide rapid preliminary checks,
chest radiography and continuous end-tidal carbon dioxide monitoring are the definitive,
most reliable methods to confirm correct endotracheal tube placement.
13. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen via
nasal cannula at 4 L/min. The nurse notes the client is becoming increasingly
lethargic with a respiratory rate of 8 breaths per minute. What is the primary
physiological mechanism responsible for this status change?
