Free CMSRN practice

20 free CMSRN practice questions

Twenty original medical-surgical nursing scenarios for MSNCB's CMSRN exam, from just culture and urinary catheter removal to hospice choices, discharge transitions, rapid response calls, and delegation. The items are split across the five domains of the current CMSRN Exam Blueprint in proportion to their scored item counts, with Patient/Care Management the largest, but 20 items cannot match the real exam's length, topic mix, or difficulty, and your score here does not predict a pass.

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Patient/Care ManagementStep 1 · Choose one answer

A med-surg nurse followed every required step of her unit's IV medication process but picked up the wrong one of two look-alike antibiotic bags that pharmacy stores side by side. The bedside barcode scan stopped her before she hung it, and she reported the near miss right away. The patient was not harmed. Under a just culture, how should the nurse manager respond?

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All 20 CMSRN questions with explanations

Try the set above first, then use this list to review. Each answer and explanation stays closed until you open it.

Question 1 · Patient/Care Management
A med-surg nurse followed every required step of her unit's IV medication process but picked up the wrong one of two look-alike antibiotic bags that pharmacy stores side by side. The bedside barcode scan stopped her before she hung it, and she reported the near miss right away. The patient was not harmed. Under a just culture, how should the nurse manager respond?
1. Discipline her, since the error could have caused serious harm
2. Support her and change how the look-alike bags are stored
3. Take no action, since the barcode scan caught it in time
4. Coach her to stop taking shortcuts when she picks up bags
Show answer and explanation for question 1
Correct answer: B · Support her and change how the look-alike bags are stored
AHRQ's PSNet describes a just culture as one that addresses the system issues behind unsafe acts while keeping individual accountability, with zero tolerance for reckless behavior. It separates human error, such as a slip, from at-risk behavior, such as a shortcut, and from reckless behavior, such as ignoring required safety steps, and it bases the response on the type of behavior, not on how severe the event was. This nurse followed every step and made a slip that the look-alike storage invited, so the fitting response is to support her and fix the storage. Discipline based on the harm the error could have caused judges by severity. Coaching about shortcuts fits at-risk behavior, which the stem rules out. Taking no action leaves the look-alike setup in place for the next nurse.
Look for this next time: In a just culture, the response depends on the behavior: a slip within a sound process calls for support and a system fix, not punishment.
Question 2 · Patient/Care Management
Before a med-surg unit switches to a new model of infusion pump, its safety committee wants to map every step of programming the pump, list the ways each step could fail, and rank those failures by how likely, how detectable, and how harmful they would be. Which method fits this goal?
1. A root cause analysis of the unit's last pump error
2. A safety huddle held at the start of every shift
3. Near-miss reports collected after the go-live date
4. A failure mode and effects analysis of the process
Show answer and explanation for question 2
Correct answer: D · A failure mode and effects analysis of the process
AHRQ's PSNet glossary defines failure mode and effects analysis (FMEA) as a common process used to prospectively identify error risk within a process. It starts by mapping every step, with programming an infusion pump as one of its examples, then estimates how each step can fail, how likely the failure is to be detected, and its impact if it is not, and combines these into a criticality index that ranks what to fix first. A root cause analysis is one of the most widely used retrospective methods: it reconstructs an event that has already happened, so it cannot rank the failure modes of a process not yet in use. Near-miss reports after go-live also look back at events. A safety huddle shares current risks but does not map and score each step.
Look for this next time: Use FMEA to find and rank failure risks before a process starts, and root cause analysis to study an event after it happens.
Question 3 · Patient/Care Management
A patient had an indwelling urinary catheter placed for a long abdominal operation. On the morning of postoperative day 1, she is alert and walks to the chair with help. She has no urinary retention, no open sacral or perineal wound, and no need for hourly urine output. The order gives no reason to keep the catheter, and the unit has a nurse-directed removal protocol. What should the nurse do?
1. Remove the catheter now, using the unit's nurse-directed protocol
2. Keep it until she can walk to the bathroom on her own
3. Keep it in case she becomes incontinent overnight
4. Keep it until the surgeon's next rounds in 2 days
Show answer and explanation for question 3
Correct answer: A · Remove the catheter now, using the unit's nurse-directed protocol
CDC's Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009, last updated 2019) says to remove a catheter as soon as possible after surgery, preferably within 24 hours, unless there is an appropriate indication for continued use. Its examples of appropriate indications include acute urinary retention or bladder outlet obstruction, accurate output measurement in critically ill patients, and healing of open sacral or perineal wounds in incontinent patients; none applies here. The guideline lists using a catheter as a substitute for nursing care of a patient with incontinence as an inappropriate use, so keeping it for possible incontinence is ruled out. Needing help to walk to the bathroom is a nursing care need, not an indication. The guideline also lists nurse-directed removal protocols among effective quality improvement programs, so waiting 2 days for rounds adds avoidable catheter days.
Look for this next time: Remove a postoperative urinary catheter as soon as no indication remains, preferably within 24 hours, using a nurse-directed protocol when one exists.
Question 4 · Patient/Care Management
A confused older patient keeps pulling at his IV line, and less restrictive measures have not stopped him. His behavior is not violent. The provider has examined him and is about to enter an order for soft wrist restraints worded "as needed for pulling at lines." What should the nurse tell the provider?
1. As-needed wording is acceptable for nonviolent restraint
2. No order is needed, since the nurse can judge when to apply
3. Restraint orders may not be written on an as-needed basis
4. As-needed wording is allowed once the family gives consent
Show answer and explanation for question 4
Correct answer: C · Restraint orders may not be written on an as-needed basis
Under the CMS hospital Conditions of Participation, 42 CFR 482.13(e)(6), orders for restraint or seclusion must never be written as a standing order or on an as needed (PRN) basis. The rule makes no exception for nonviolent restraint, and family consent does not change it. Restraint must also follow the order of a physician or other licensed practitioner who is responsible for the patient's care and authorized by hospital policy under state law, so a nurse cannot apply restraints at her own discretion without an order. The same regulation allows restraint only when less restrictive interventions have been found ineffective and requires the least restrictive effective technique, which the stem says has already been considered.
Look for this next time: Under CMS rules, a restraint order can never be written as a PRN or standing order, whether or not the behavior is violent.
Question 5 · Patient/Care Management
Before discharge after surgery, a patient asks how to get rid of the opioid tablets he will have left once his pain resolves. A pharmacy near his home has a drug take-back drop box. According to the FDA, what is the best advice?
1. Bring the leftover tablets to the pharmacy's take-back box
2. Flush the tablets down the toilet as soon as he stops them
3. Crush them, mix them with coffee grounds, and bin them
4. Keep them in a medicine cabinet in case the pain returns
Show answer and explanation for question 5
Correct answer: A · Bring the leftover tablets to the pharmacy's take-back box
The FDA's guidance on disposing of unused medicines says the best way to dispose of most unused or expired medicines is to use a take-back option right away, such as a drug take-back location or a prepaid mail-back envelope; pharmacies and police stations may host drop-off boxes. Only when no take-back option is available does the FDA point to its flush list: medicines on that list, which covers certain opioids, may then be flushed, and others go in the household trash. For the trash, the FDA says not to crush tablets, to mix them with something unappealing such as used coffee grounds, and to seal the mixture in a plastic bag. Keeping leftover opioids at home is the risk the guidance aims to remove, since someone else can take them.
Look for this next time: When a drug take-back option is available, it is the FDA's first choice for disposing of unused medicines, including opioids.
Question 6 · Patient/Care Management
A med-surg nurse is the designated person monitoring a patient under moderate sedation during a bedside procedure that a physician is performing. The sedation level is still being adjusted when the physician asks the nurse to step out to the supply room for a missing item. What should the nurse do?
1. Go quickly, since the physician can watch the monitor
2. Go, after raising the pulse oximeter's alarm volume
3. Hand monitoring to the physician doing the procedure
4. Stay, and ask another staff member to bring the item
Show answer and explanation for question 6
Correct answer: D · Stay, and ask another staff member to bring the item
The American Society of Anesthesiologists' 2018 practice guidelines for moderate procedural sedation and analgesia call for a designated individual other than the practitioner performing the procedure to monitor the patient throughout the procedure. That person should be trained to recognize apnea and airway obstruction and be authorized to seek help. The guidelines allow the monitor to assist only with minor, interruptible tasks, and only once the sedation level and vital signs have stabilized, with monitoring maintained. Leaving the room while the sedation is still being adjusted meets none of those conditions, and neither the proceduralist glancing at the screen nor a louder alarm replaces the designated monitor. The safe choice is to stay and have someone else fetch the item.
Look for this next time: During moderate sedation, the designated monitor stays with the patient, and the practitioner doing the procedure cannot also be the monitor.
Question 7 · Patient/Care Management
A patient has a short-term, nontunneled central venous catheter in the internal jugular vein. Its transparent dressing was changed 2 days ago. This morning the nurse finds one edge of the dressing lifted and the area under it damp. What should the nurse do?
1. Tape the lifted edge down until the next scheduled change
2. Replace the dressing now, ahead of the usual schedule
3. Leave it, since transparent dressings can stay 7 days
4. Switch to a gauze dressing changed every 7 days instead
Show answer and explanation for question 7
Correct answer: B · Replace the dressing now, ahead of the usual schedule
CDC's Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011, last updated 2017) say to replace a catheter site dressing if it becomes damp, loosened, or visibly soiled. On short-term central venous catheter sites, transparent dressings are replaced at least every 7 days and gauze dressings every 2 days. The 7-day interval is a maximum for an intact dressing, so it is no reason to leave a damp, lifted one in place, and taping the edge keeps the damp dressing over the insertion site. Switching to gauze would call for a change every 2 days, not every 7. The dressing should be replaced now.
Look for this next time: Replace a central line dressing as soon as it is damp, loosened, or soiled; the 7-day interval for transparent dressings applies only to intact ones.
Question 8 · Holistic Patient Care
A patient tells the nurse she is upset that her call light went unanswered for a long time last night. The nurse apologizes and the charge nurse talks with her, but the patient says she still wants to file a formal complaint with the hospital. What should the nurse do?
1. Tell her complaints can be filed only in writing, after discharge
2. Tell her the issue is closed, since the charge nurse spoke to her
3. Explain the grievance process and whom she can contact to file
4. Suggest she describe it on the survey mailed after discharge
Show answer and explanation for question 8
Correct answer: C · Explain the grievance process and whom she can contact to file
The CMS Conditions of Participation, 42 CFR 482.13(a)(2), require a hospital to have a process for prompt resolution of patient grievances and to inform each patient whom to contact to file one. The procedure must accept written or verbal grievances, set time frames for review and response, and end with a written notice that names a hospital contact, the steps taken to investigate, the results, and the completion date. Limiting her to a written complaint after discharge contradicts the written-or-verbal rule. A satisfaction survey is not the grievance process. Declaring the matter closed ignores her request, so the nurse explains the process and the contact. Grievances and service recovery appear in the CMSRN blueprint under patient satisfaction management.
Look for this next time: When a patient wants to file a grievance, explain the hospital's process and whom to contact; CMS requires hospitals to tell patients both.
Question 9 · Holistic Patient Care
A nurse is planning discharge teaching about a new blood thinner for a retired engineer with a graduate degree, who says he reads everything about his health. Following AHRQ's health literacy universal precautions, how should the nurse plan the teaching?
1. Use plain language and confirm he understands, as with anyone
2. Use technical terms, since his degree shows high health literacy
3. Give him the written leaflet and skip checking his understanding
4. Screen his reading level, then simplify only if the score is low
Show answer and explanation for question 9
Correct answer: A · Use plain language and confirm he understands, as with anyone
AHRQ's Health Literacy Universal Precautions Toolkit describes universal precautions as structuring health information and services so that everyone can understand and use them, which calls for simplifying communication and confirming understanding with everyone. The approach does not sort patients first, so his degree, his reading habits, or a screening score do not decide who gets plain language and a check of understanding. Technical terms and a leaflet without a check both drop the confirmation step, and screening before simplifying applies the precautions to only some patients. AHRQ's teach-back tool adds that asking a patient to explain the plan in his own words is not a test of his memory but a check of how well the plan was explained.
Look for this next time: Health literacy universal precautions mean plain language and a check of understanding for every patient, whatever their education.
Question 10 · Holistic Patient Care
A patient with advanced heart failure, covered by Medicare, is considering hospice care. He tells the nurse, "If I sign up, I can never go back to my regular treatment." Under Medicare's hospice rules, what is accurate?
1. That is right: electing hospice is permanent once he signs
2. He can leave hospice only if his illness goes into remission
3. He must wait for the current election period to end first
4. He can revoke it at any time and resume his waived coverage
Show answer and explanation for question 10
Correct answer: D · He can revoke it at any time and resume his waived coverage
Under 42 CFR 418.28, a Medicare beneficiary or his representative may revoke the hospice election at any time during an election period by filing a signed statement with the hospice that gives an effective date, which cannot be earlier than the date of the revocation. After revoking, he is no longer covered for hospice care, he resumes Medicare coverage of the benefits he waived when he elected hospice, and he may elect hospice again later for any election period he is still eligible for. So the election is not permanent, there is no remission requirement, and he does not have to wait for the election period to end. Correcting this belief supports an informed end-of-life choice, a palliative care topic in the CMSRN blueprint.
Look for this next time: A Medicare hospice election can be revoked at any time, and the coverage the patient waived for hospice then resumes.
Question 11 · Elements of Interprofessional Care
At discharge, a nurse compares the medicines a patient took at home before admission with his discharge orders. His home thyroid medicine is missing from the discharge orders, and nothing in the record says it was stopped on purpose. What should the nurse do next?
1. Tell him to restart his own supply once he gets home
2. Add the thyroid medicine to his discharge list herself
3. Ask the prescriber to resolve it before he goes home
4. Discharge him and flag it for his next clinic visit
Show answer and explanation for question 11
Correct answer: C · Ask the prescriber to resolve it before he goes home
AHRQ's PSNet defines medication reconciliation as avoiding inadvertent inconsistencies across a transition in care by comparing the patient's current regimen with the regimen planned for the new setting. Discrepancies at discharge put patients at risk of adverse drug events, which PSNet notes are among the most common adverse events after hospital discharge. A home medicine missing from the orders with no documented reason is an unexplained discrepancy, and only the prescriber can say whether stopping it was intended, so it is resolved before the patient leaves. Adding a medicine to the list herself would be prescribing, telling him to restart it bypasses that decision, and a flag for a later clinic visit leaves the possible error in place after discharge.
Look for this next time: An unexplained difference between home medicines and discharge orders goes back to the prescriber before the patient leaves.
Question 12 · Elements of Interprofessional Care
A patient will go home with home health services after a hip replacement. Several Medicare-participating home health agencies serve his area, and he asks the nurse which one to use. The nurse has heard good things about one of them. What should the nurse do?
1. Recommend the agency she has heard good things about
2. Give him the list of agencies and support his choice
3. Pick the agency closest to his home and refer him
4. Tell him the hospital assigns an agency at discharge
Show answer and explanation for question 12
Correct answer: B · Give him the list of agencies and support his choice
CMS's discharge planning rule, 42 CFR 482.43(d), requires the hospital to include in the discharge plan a list of Medicare-participating home health agencies that serve the patient's area, to tell the patient of his freedom to choose among them, and to respect his goals and preferences when possible. The hospital must not specify or otherwise limit the qualified providers available to him. Steering him to the agency the nurse likes, picking the nearest one for him, and saying the hospital assigns one each limit his choice. The same rule requires the hospital to help patients choose by sharing quality and resource-use data on post-acute providers, so the nurse can support his decision with that information.
Look for this next time: For home health or other post-acute care, the hospital gives the patient a list of available providers and respects his choice.
Question 13 · Elements of Interprofessional Care
A 79-year-old patient admitted with pneumonia coughs and has a wet, gurgly voice each time she drinks thin liquids. Which member of the interprofessional team is the right one to evaluate her swallowing?
1. A registered dietitian, for a calorie count and diet plan
2. A respiratory therapist, for airway clearance treatment
3. A physical therapist, for her seating and posture at meals
4. A speech-language pathologist, to assess how she swallows
Show answer and explanation for question 13
Correct answer: D · A speech-language pathologist, to assess how she swallows
ASHA's Practice Portal on adult dysphagia lists coughing or throat clearing during or after eating or drinking, and a wet or gurgly voice, among the signs of a swallowing problem, and it says speech-language pathologists play a central role in assessing and managing swallowing disorders, through comprehensive assessment that includes non-instrumental and instrumental procedures. A swallowing screen identifies who needs that comprehensive assessment. A registered dietitian plans nutrition but does not evaluate the swallow itself. A respiratory therapist treats the airway and lungs, not the swallowing mechanism. A physical therapist works on mobility and positioning. Speech consultation is one of the resources for nutrition that the CMSRN blueprint names.
Look for this next time: Coughing and a wet voice with drinks call for a swallowing assessment by a speech-language pathologist.
Question 14 · Professional Concepts
During a phone call, a provider gives a med-surg nurse a new medication order. Hospital policy allows telephone orders in this situation. What should the nurse do to close the communication loop?
1. Repeat the drug name and ask for the rest by text message
2. Write it down, read it back in full, and get confirmation
3. Remember the order and enter it after the call has ended
4. Enter the order and ask the provider to confirm it at rounds
Show answer and explanation for question 14
Correct answer: B · Write it down, read it back in full, and get confirmation
AHRQ's TeamSTEPPS pocket guide describes closed-loop communication, including the check-back, in which the receiver repeats the message and the sender confirms it was understood correctly. AHRQ's PSNet adds that read-back protocols, in which the listener repeats the key information so the speaker can confirm it, address the misheard names and numbers that are common on the phone. Writing the order down, reading all of it back, and hearing the provider confirm it closes the loop during the call. Repeating only the drug name leaves the rest unverified, and a text message changes channels instead of confirming. Relying on memory skips the check, and waiting for confirmation at rounds leaves the order unverified while it is carried out.
Look for this next time: Close the loop on a telephone order during the call: write it down, read it back in full, and get the provider's confirmation.
Question 15 · Professional Concepts
On postoperative day 2, a patient seems wrong to his nurse: he is newly restless and his breathing looks more labored, though his vital signs are still inside the hospital's rapid response trigger values. The hospital's rapid response criteria include a staff member's significant concern about a patient. What should the nurse do?
1. Recheck vital signs in an hour and call if one crosses a trigger
2. Raise the concern with the provider at morning rounds
3. Call the rapid response team now, based on her concern
4. Ask the charge nurse to look in on him after her break
Show answer and explanation for question 15
Correct answer: C · Call the rapid response team now, based on her concern
AHRQ's PSNet primer on rapid response systems lists typical calling criteria: heart rate, respiratory rate, systolic blood pressure, and oxygen saturation thresholds, an acute change in mental status, low urine output, and a staff member's significant concern about the patient's condition. Any staff member may call when a criterion is met, so vital signs inside the trigger range do not cancel a concern that the hospital's own criteria name, and new restlessness may itself be an acute change in mental status. Waiting an hour, waiting for rounds, or waiting for the charge nurse's break delays the early response that rapid response systems exist to provide. Deteriorating patients and rapid response teams appear in the CMSRN blueprint under critical thinking.
Look for this next time: When the rapid response criteria include staff concern, a nurse's worry about a deteriorating patient is reason enough to call.
Question 16 · Professional Concepts
A med-surg unit wants to try a new hourly rounding script intended to reduce patient falls. Using the Plan-Do-Study-Act (PDSA) method, how should the team begin?
1. Test it with a few nurses on one shift, study it, then refine
2. Roll out the script on every unit, then review falls in a year
3. Wait for a published trial proving the script works elsewhere
4. Write the script into unit policy before anyone tries it
Show answer and explanation for question 16
Correct answer: A · Test it with a few nurses on one shift, study it, then refine
AHRQ's Plan-Do-Study-Act directions describe PDSA as a way to test a change: the team breaks the work into small steps, tries one, evaluates the outcome, improves it, and tests again. AHRQ notes that a PDSA will likely involve only a portion of the practice at first, and that implementation is broadened once feedback has refined the process. A trial with a few nurses on one shift fits that design. Rolling it out everywhere and checking a year later skips the small test and the quick study step. Writing it into policy before any test fixes an untested process in place. Waiting for a published trial elsewhere is not a PDSA cycle and delays what the unit could learn locally.
Look for this next time: PDSA tests a change on a small scale, studies the result, and refines it before spreading it.
Question 17 · Nursing Teamwork and Collaboration
A med-surg RN is deciding what to delegate to a trained, competent unlicensed assistive personnel (UAP), within facility policy and the state's nurse practice act. Which activity is appropriate to delegate?
1. The full admission assessment of a patient who just arrived
2. Routine vital signs on a stable patient with no recent change
3. Judging whether a patient understood his discharge teaching
4. Deciding whether a patient's new pain needs a provider call
Show answer and explanation for question 17
Correct answer: B · Routine vital signs on a stable patient with no recent change
The NCSBN and ANA National Guidelines for Nursing Delegation (2019) say the licensed nurse cannot delegate nursing judgment, clinical reasoning, or critical decision making, and that the right circumstance for delegation includes a patient whose condition is stable. Routine vital signs on a stable patient, with clear instructions about what to report and when, can be delegated where facility policy and state law allow it. An admission assessment, judging whether teaching was understood, and deciding whether new pain needs a provider call all require nursing judgment, so they stay with the RN. Whatever is delegated, the RN keeps overall accountability for the patient.
Look for this next time: Delegate routine tasks for stable patients, and keep assessment, evaluation, and judgment calls with the RN.
Question 18 · Nursing Teamwork and Collaboration
An RN delegated vital signs every 4 hours for a stable patient to a UAP, with instructions to report any systolic blood pressure below 100 mm Hg. The UAP reports a reading of 92/58 and says the patient feels dizzy. What should the RN do?
1. Ask the UAP to recheck it in an hour and report back
2. Have the UAP walk the patient to ease the dizziness
3. Document the reading and wait for the next scheduled check
4. Assess the patient herself now and reconsider the delegation
Show answer and explanation for question 18
Correct answer: D · Assess the patient herself now and reconsider the delegation
The NCSBN and ANA National Guidelines for Nursing Delegation (2019) say the delegatee must report a change in the patient's condition, and the licensed nurse must then reassess the situation and whether the delegation is still appropriate. The RN keeps accountability for the patient, and clinical reasoning cannot be delegated. A reading below the reporting threshold together with new dizziness is a change, so the RN assesses the patient now. Having the UAP recheck in an hour hands the follow-up judgment back to the delegatee. Documenting and waiting ignores the very report the RN asked for. Walking a dizzy patient with a low blood pressure adds fall risk and is not part of the delegated task.
Look for this next time: When a delegatee reports a change, the RN reassesses the patient and decides whether the delegation still fits.
Question 19 · Nursing Teamwork and Collaboration
A unit is moving shift report to the bedside. In a staff meeting, nurses say they understand the safety reasons for the change, but several say they will not take part and plan to keep giving report at the nurses' station. In the ADKAR change model, which element is the barrier?
1. Awareness of the reasons the change is needed
2. Knowledge of how to give report at the bedside
3. Desire to take part in and support the change
4. Reinforcement that keeps the change in place
Show answer and explanation for question 19
Correct answer: C · Desire to take part in and support the change
Prosci's ADKAR model breaks change into five elements: Awareness of why the change is needed, Desire to take part in and support it, Knowledge of how to change, Ability to put new skills into practice, and Reinforcement to sustain the change. Prosci advises finding the earliest element where progress is stuck. These nurses already understand the reasons, so Awareness is in place, but they say they will not take part, which is a Desire gap. Teaching the bedside report method addresses Knowledge, and Reinforcement sustains a change that has already been adopted, so both come later in the sequence. The CMSRN blueprint names ADKAR under change management in its leadership topics.
Look for this next time: In ADKAR, staff who understand why a change is needed but refuse to take part have a Desire barrier.
Question 20 · Nursing Teamwork and Collaboration
During a mass casualty event, the hospital activates its incident command structure. A med-surg nurse is assigned to a team that reports to a team leader. A physician she knows from her unit asks her to leave the team and help him elsewhere. Under the incident command principle of unity of command, what should the nurse do?
1. Ask her team leader before she takes on another task
2. Go with the physician, since he has more authority
3. Split her time between the two tasks to help more people
4. Return to her home unit, where the physician works
Show answer and explanation for question 20
Correct answer: A · Ask her team leader before she takes on another task
FEMA's Incident Command System review document defines chain of command as the orderly line of authority within the incident organization, and unity of command as each individual reporting to only one person. Once the hospital is working under its incident command structure, the nurse takes assignments through her team leader, so a request from anyone else goes through that leader before she changes tasks. A physician's everyday clinical seniority does not replace the incident chain of command. Splitting her time between two assignments, or returning to her home unit, leaves her team leader without an accurate picture of who is doing what. The CMSRN blueprint lists the hospital incident command structure under disaster planning and management.
Look for this next time: Under unity of command, each person in an incident reports to one supervisor, so new tasks come through that supervisor.

Use the sample well

The rationale matters more than the score.

A short set can show you what deserves another look. Twenty questions are a small sample, so this set cannot measure readiness for the 150-question CMSRN exam (125 scored) or predict a pass.

Answer before reviewing

Decide which part of med-surg practice the question tests, such as safety, a care transition, communication, or delegation, then pick the action a competent med-surg nurse would take. Read why each of the other three options falls short.

Read every rationale

Confirm why the best option fits, even when you were right.

Follow the pattern

Use recurring misses—not one score—to choose your next focus.

Want the wider map? Read what the five CMSRN domains cover.

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Keep practicing, build a study plan, or browse the CMSRN guides.

20 original questions

20 free CMSRN practice questions

All 20 CMSRN questions with explanations

Before a med-surg unit switches to a new model of infusion pump, its safety committee wants to map every step of programming the pump, list the ways each step could fail, and rank those failures by how likely, how detectable, and how harmful they would be. Which method fits this goal?

Before discharge after surgery, a patient asks how to get rid of the opioid tablets he will have left once his pain resolves. A pharmacy near his home has a drug take-back drop box. According to the FDA, what is the best advice?

A med-surg nurse is the designated person monitoring a patient under moderate sedation during a bedside procedure that a physician is performing. The sedation level is still being adjusted when the physician asks the nurse to step out to the supply room for a missing item. What should the nurse do?

A patient has a short-term, nontunneled central venous catheter in the internal jugular vein. Its transparent dressing was changed 2 days ago. This morning the nurse finds one edge of the dressing lifted and the area under it damp. What should the nurse do?

A patient tells the nurse she is upset that her call light went unanswered for a long time last night. The nurse apologizes and the charge nurse talks with her, but the patient says she still wants to file a formal complaint with the hospital. What should the nurse do?

A nurse is planning discharge teaching about a new blood thinner for a retired engineer with a graduate degree, who says he reads everything about his health. Following AHRQ's health literacy universal precautions, how should the nurse plan the teaching?

A patient with advanced heart failure, covered by Medicare, is considering hospice care. He tells the nurse, "If I sign up, I can never go back to my regular treatment." Under Medicare's hospice rules, what is accurate?

At discharge, a nurse compares the medicines a patient took at home before admission with his discharge orders. His home thyroid medicine is missing from the discharge orders, and nothing in the record says it was stopped on purpose. What should the nurse do next?

A patient will go home with home health services after a hip replacement. Several Medicare-participating home health agencies serve his area, and he asks the nurse which one to use. The nurse has heard good things about one of them. What should the nurse do?

A 79-year-old patient admitted with pneumonia coughs and has a wet, gurgly voice each time she drinks thin liquids. Which member of the interprofessional team is the right one to evaluate her swallowing?

During a phone call, a provider gives a med-surg nurse a new medication order. Hospital policy allows telephone orders in this situation. What should the nurse do to close the communication loop?

A med-surg unit wants to try a new hourly rounding script intended to reduce patient falls. Using the Plan-Do-Study-Act (PDSA) method, how should the team begin?

A med-surg RN is deciding what to delegate to a trained, competent unlicensed assistive personnel (UAP), within facility policy and the state's nurse practice act. Which activity is appropriate to delegate?

An RN delegated vital signs every 4 hours for a stable patient to a UAP, with instructions to report any systolic blood pressure below 100 mm Hg. The UAP reports a reading of 92/58 and says the patient feels dizzy. What should the RN do?

A unit is moving shift report to the bedside. In a staff meeting, nurses say they understand the safety reasons for the change, but several say they will not take part and plan to keep giving report at the nurses' station. In the ADKAR change model, which element is the barrier?