CMSRN ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Questions
Domain 1: Patient/Care Management (32% of exam)
Cardiovascular & Hematological
1. A patient with heart failure is receiving IV furosemide. Which assessment finding requires
priority action?
A. Mild dizziness during ambulation
B. Potassium level of 2.9 mEq/L
C. Trace peripheral edema
D. Urine output of 200 mL in 4 hours
Answer: B
Rationale: Furosemide is a loop diuretic that can cause significant potassium wasting. A
potassium level of 2.9 mEq/L indicates severe hypokalemia, which places the patient at high risk
for life-threatening dysrhythmias . While dizziness and decreased urine output are concerns,
hypokalemia is the most immediate threat. Trace edema is expected in a patient with heart
failure.
2. A patient is 1 day post-operative following a total hip replacement. The patient reports
sudden onset of sharp chest pain and shortness of breath. The nurse notes the patient is
tachycardic and hypoxic. Which action should the nurse take first?
A. Administer prescribed PRN pain medication
B. Encourage the patient to take deep breaths
C. Apply oxygen and notify the provider immediately
D. Elevate the head of the bed to 90 degrees
,Answer: C
Rationale: This patient's symptoms (sudden chest pain, dyspnea, tachycardia, hypoxia) are
classic signs of a pulmonary embolism (PE), a life-threatening post-operative complication. The
priority is to stabilize the patient with oxygen and immediately notify the provider for rapid
intervention . Elevating the head of the bed may help breathing, but it should not delay oxygen
administration and notification.
3. A patient is receiving a blood transfusion. Fifteen minutes after the infusion starts, the
patient complains of chills, low back pain, and nausea. What is the priority nursing action?
A. Slow the infusion rate and call the provider.
B. Stop the transfusion and keep the IV line open with normal saline.
C. Administer an antihistamine as a PRN order.
D. Obtain a urine sample to test for hemoglobin.
Answer: B
Rationale: These symptoms are consistent with a hemolytic transfusion reaction, a life-
threatening emergency. The priority is to stop the transfusion immediately to prevent further
hemolysis. The IV line should be kept open with normal saline to maintain venous access for
emergency medications . The tubing and blood bag should be sent to the lab for investigation.
Respiratory
4. A patient with COPD is receiving oxygen at 2 L/min via nasal cannula. The patient's
respiratory rate is 10 breaths/min, and they are difficult to arouse. The nurse notes the
patient's oxygen saturation is 95%. What is the most likely cause of this change?
A. The patient is experiencing an exacerbation of COPD.
B. The patient has developed a pneumothorax.
C. The patient has lost their hypoxic drive to breathe.
D. The patient is having an allergic reaction.
Answer: C
Rationale: In some patients with severe COPD, the primary stimulus to breathe is hypoxia
(hypoxic drive), not hypercapnia. Administering high-flow oxygen can remove this stimulus,
leading to respiratory depression and CO₂ retention, which can cause altered mental status and
respiratory failure . This is a classic complication of oxygen therapy in COPD.
,5. A patient with a new tracheostomy is coughing and has thick, copious secretions. What is
the most appropriate intervention?
A. Deflate the tracheostomy cuff.
B. Instill normal saline into the tracheostomy tube.
C. Suction the tracheostomy tube using sterile technique.
D. Instruct the patient to cough more effectively.
Answer: C
Rationale: An artificial airway (tracheostomy) bypasses the upper airway's normal
humidification and filtration, leading to thick secretions. When a patient is unable to clear these
secretions effectively, suctioning is necessary to maintain airway patency . Sterile technique is
required to prevent infection. Instilling normal saline is no longer recommended as a standard
practice.
6. A patient is admitted with pneumonia. Which finding is the clearest indicator that the
patient is experiencing respiratory failure?
A. Productive cough with green sputum
B. Oxygen saturation of 85% on room air
C. Fever of 101.5°F (38.6°C)
D. Crackles heard in the lung bases
Answer: B
Rationale: An SpO₂ of 85% indicates significant hypoxemia, which is a hallmark of respiratory
failure . While a productive cough, fever, and crackles are signs of pneumonia, they do not
indicate that the respiratory system is failing to exchange oxygen.
Endocrine & Renal
7. A patient with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL. The primary
goal of initial fluid resuscitation is to:
A. Decrease the blood glucose level.
B. Improve renal perfusion.
C. Increase blood pressure.
D. Restore intravascular volume.
Answer: D
, Rationale: The primary cause of DKA is a lack of insulin leading to hyperglycemia and osmotic
diuresis, which causes severe dehydration and a loss of electrolytes . The first priority is to
restore intravascular volume with IV fluids to improve tissue perfusion and correct the shock
state. Insulin therapy is started after fluid resuscitation is underway.
8. A patient with a history of chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L.
Which intervention is most appropriate to rapidly lower this level?
A. Administer oral sodium polystyrene sulfonate (Kayexalate).
B. Administer IV calcium gluconate.
C. Prepare the patient for emergency hemodialysis.
D. Administer IV insulin and dextrose.
Answer: D
Rationale: Insulin forces potassium into the cells, which rapidly lowers serum potassium levels.
Dextrose is given with the insulin to prevent hypoglycemia . Calcium gluconate stabilizes the
cardiac membrane but does not lower potassium. Dialysis is the definitive treatment but takes
time to initiate, whereas insulin/dextrose works in minutes. Sodium polystyrene sulfonate
(Kayexalate) works too slowly for a critically high potassium.
Neurological
9. A patient has a seizure that lasts for 4 minutes. The seizure was characterized by bilateral
jerking movements and the patient is now post-ictal. What is the priority nursing action?
A. Restrain the patient to prevent injury.
B. Insert a padded tongue blade to protect the airway.
C. Turn the patient to their side and reassess the airway.
D. Place the patient in a supine position and apply oxygen.
Answer: C
Rationale: During and immediately after a seizure, the priority is maintaining a patent airway
and preventing aspiration . Turning the patient to a side-lying position helps facilitate drainage
of oral secretions. Restraining a patient during or after a seizure can cause injury. Padded
tongue blades should never be inserted into a seizing patient's mouth.
10. A patient who is 2 days post-operative following a craniotomy reports a severe headache
and nausea. The nurse notes the patient’s pupils are unequal. What is the priority action?
ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Questions
Domain 1: Patient/Care Management (32% of exam)
Cardiovascular & Hematological
1. A patient with heart failure is receiving IV furosemide. Which assessment finding requires
priority action?
A. Mild dizziness during ambulation
B. Potassium level of 2.9 mEq/L
C. Trace peripheral edema
D. Urine output of 200 mL in 4 hours
Answer: B
Rationale: Furosemide is a loop diuretic that can cause significant potassium wasting. A
potassium level of 2.9 mEq/L indicates severe hypokalemia, which places the patient at high risk
for life-threatening dysrhythmias . While dizziness and decreased urine output are concerns,
hypokalemia is the most immediate threat. Trace edema is expected in a patient with heart
failure.
2. A patient is 1 day post-operative following a total hip replacement. The patient reports
sudden onset of sharp chest pain and shortness of breath. The nurse notes the patient is
tachycardic and hypoxic. Which action should the nurse take first?
A. Administer prescribed PRN pain medication
B. Encourage the patient to take deep breaths
C. Apply oxygen and notify the provider immediately
D. Elevate the head of the bed to 90 degrees
,Answer: C
Rationale: This patient's symptoms (sudden chest pain, dyspnea, tachycardia, hypoxia) are
classic signs of a pulmonary embolism (PE), a life-threatening post-operative complication. The
priority is to stabilize the patient with oxygen and immediately notify the provider for rapid
intervention . Elevating the head of the bed may help breathing, but it should not delay oxygen
administration and notification.
3. A patient is receiving a blood transfusion. Fifteen minutes after the infusion starts, the
patient complains of chills, low back pain, and nausea. What is the priority nursing action?
A. Slow the infusion rate and call the provider.
B. Stop the transfusion and keep the IV line open with normal saline.
C. Administer an antihistamine as a PRN order.
D. Obtain a urine sample to test for hemoglobin.
Answer: B
Rationale: These symptoms are consistent with a hemolytic transfusion reaction, a life-
threatening emergency. The priority is to stop the transfusion immediately to prevent further
hemolysis. The IV line should be kept open with normal saline to maintain venous access for
emergency medications . The tubing and blood bag should be sent to the lab for investigation.
Respiratory
4. A patient with COPD is receiving oxygen at 2 L/min via nasal cannula. The patient's
respiratory rate is 10 breaths/min, and they are difficult to arouse. The nurse notes the
patient's oxygen saturation is 95%. What is the most likely cause of this change?
A. The patient is experiencing an exacerbation of COPD.
B. The patient has developed a pneumothorax.
C. The patient has lost their hypoxic drive to breathe.
D. The patient is having an allergic reaction.
Answer: C
Rationale: In some patients with severe COPD, the primary stimulus to breathe is hypoxia
(hypoxic drive), not hypercapnia. Administering high-flow oxygen can remove this stimulus,
leading to respiratory depression and CO₂ retention, which can cause altered mental status and
respiratory failure . This is a classic complication of oxygen therapy in COPD.
,5. A patient with a new tracheostomy is coughing and has thick, copious secretions. What is
the most appropriate intervention?
A. Deflate the tracheostomy cuff.
B. Instill normal saline into the tracheostomy tube.
C. Suction the tracheostomy tube using sterile technique.
D. Instruct the patient to cough more effectively.
Answer: C
Rationale: An artificial airway (tracheostomy) bypasses the upper airway's normal
humidification and filtration, leading to thick secretions. When a patient is unable to clear these
secretions effectively, suctioning is necessary to maintain airway patency . Sterile technique is
required to prevent infection. Instilling normal saline is no longer recommended as a standard
practice.
6. A patient is admitted with pneumonia. Which finding is the clearest indicator that the
patient is experiencing respiratory failure?
A. Productive cough with green sputum
B. Oxygen saturation of 85% on room air
C. Fever of 101.5°F (38.6°C)
D. Crackles heard in the lung bases
Answer: B
Rationale: An SpO₂ of 85% indicates significant hypoxemia, which is a hallmark of respiratory
failure . While a productive cough, fever, and crackles are signs of pneumonia, they do not
indicate that the respiratory system is failing to exchange oxygen.
Endocrine & Renal
7. A patient with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL. The primary
goal of initial fluid resuscitation is to:
A. Decrease the blood glucose level.
B. Improve renal perfusion.
C. Increase blood pressure.
D. Restore intravascular volume.
Answer: D
, Rationale: The primary cause of DKA is a lack of insulin leading to hyperglycemia and osmotic
diuresis, which causes severe dehydration and a loss of electrolytes . The first priority is to
restore intravascular volume with IV fluids to improve tissue perfusion and correct the shock
state. Insulin therapy is started after fluid resuscitation is underway.
8. A patient with a history of chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L.
Which intervention is most appropriate to rapidly lower this level?
A. Administer oral sodium polystyrene sulfonate (Kayexalate).
B. Administer IV calcium gluconate.
C. Prepare the patient for emergency hemodialysis.
D. Administer IV insulin and dextrose.
Answer: D
Rationale: Insulin forces potassium into the cells, which rapidly lowers serum potassium levels.
Dextrose is given with the insulin to prevent hypoglycemia . Calcium gluconate stabilizes the
cardiac membrane but does not lower potassium. Dialysis is the definitive treatment but takes
time to initiate, whereas insulin/dextrose works in minutes. Sodium polystyrene sulfonate
(Kayexalate) works too slowly for a critically high potassium.
Neurological
9. A patient has a seizure that lasts for 4 minutes. The seizure was characterized by bilateral
jerking movements and the patient is now post-ictal. What is the priority nursing action?
A. Restrain the patient to prevent injury.
B. Insert a padded tongue blade to protect the airway.
C. Turn the patient to their side and reassess the airway.
D. Place the patient in a supine position and apply oxygen.
Answer: C
Rationale: During and immediately after a seizure, the priority is maintaining a patent airway
and preventing aspiration . Turning the patient to a side-lying position helps facilitate drainage
of oral secretions. Restraining a patient during or after a seizure can cause injury. Padded
tongue blades should never be inserted into a seizing patient's mouth.
10. A patient who is 2 days post-operative following a craniotomy reports a severe headache
and nausea. The nurse notes the patient’s pupils are unequal. What is the priority action?
