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Quizzes > Health & Medicine > Human Anatomy & Medicine

Free CMSRN Practice Questions Quiz: Ace Your Med-Surg Cert!

Boost Your Score with Med-Surg Certification Practice Questions & Q&A

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
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Ready to boost your med-surg expertise? Whether you're a busy RN aiming for your CMSRN or a seasoned nurse refreshing skills, this medical-surgical nursing certification practice Q&A is your roadmap to confidence. Our Free CMSRN Practice Questions Quiz - Med-Surg Nursing Q&A helps you prepare for certification with realistic cmsrn practice questions. You'll test critical thinking, review common post-op scenarios, and tackle key pharmacology concepts in this med-surg certification practice questions challenge. Warm up with our med surg practice questions , then simulate exam conditions with the Med-Surg Nursing Quiz . Track your progress, identify knowledge gaps, and build a study plan that leads to success. Dive in now and take your first step toward acing the CMSRN!

A patient with hypokalemia is most likely to exhibit which ECG finding?
Tall, peaked T waves
Flattened T waves with U waves
Prolonged QRS complex
Shortened PR interval
Hypokalemia often manifests on ECG as flattened T waves and the appearance of U waves due to delayed ventricular repolarization. This finding is a hallmark of low serum potassium and helps differentiate from hyperkalemia, which produces peaked T waves. Proper potassium replacement and monitoring are essential to correct these changes. NCBI: ECG Changes in Electrolyte Abnormalities
Which lab value is most important to monitor in a patient receiving unfractionated heparin therapy?
Prothrombin time (PT)
Activated partial thromboplastin time (aPTT)
International normalized ratio (INR)
Bleeding time
Heparin prolongs the intrinsic coagulation pathway and is monitored by measuring aPTT. The therapeutic range is generally 1.5–2.5 times the control value. PT and INR are used for warfarin monitoring, while bleeding time assesses platelet function rather than coagulation factors. American Society of Hematology: Heparin Monitoring
A patient in diabetic ketoacidosis (DKA) requires initial fluid resuscitation with which solution?
0.45% NaCl (half-normal saline)
5% dextrose in water (D5W)
0.9% NaCl (normal saline)
Lactated Ringer’s solution
Initial fluid resuscitation in DKA is with isotonic 0.9% saline to restore intravascular volume and correct dehydration. After initial stabilization, fluids may be adjusted based on corrected sodium and glycemic status, possibly switching to half-normal saline or adding dextrose when glucose drops below 200–250 mg/dL. Diabetes Care: Hyperglycemic Crises
Which pulmonary artery catheter measurement best reflects left ventricular preload?
Central venous pressure (CVP)
Pulmonary artery pressure (PAP)
Pulmonary capillary wedge pressure (PCWP)
Cardiac output (CO)
Pulmonary capillary wedge pressure approximates left atrial pressure and thus left ventricular preload. It is measured by inflating the catheter balloon in a distal pulmonary artery branch. CVP estimates right-sided preload, and PAP reflects pulmonary arterial pressures. Circulation: PAC Monitoring
Which antibiotic is most associated with nephrotoxicity?
Vancomycin
Gentamicin
Ceftriaxone
Azithromycin
Aminoglycosides such as gentamicin are known for nephrotoxicity due to accumulation in proximal tubular cells. Monitoring of serum drug levels and renal function is essential during therapy. Vancomycin also can be nephrotoxic but to a lesser extent when dosed and monitored appropriately. NCBI: Aminoglycoside Nephrotoxicity
An irregularly irregular pulse with no distinct P waves on ECG is diagnostic of:
Atrial flutter
Atrial fibrillation
Ventricular tachycardia
Sinus arrhythmia
Atrial fibrillation produces an irregularly irregular rhythm and absent P waves, replaced by fibrillatory waves. Atrial flutter shows sawtooth waves and a regular atrial rate. Ventricular tachycardia has wide QRS complexes, and sinus arrhythmia varies with respiration but retains P waves. ACC: Atrial Fibrillation Basics
Rhonchi heard on lung auscultation typically indicate:
Alveolar consolidation
Pleural friction rub
Airway obstruction with secretions
Collapsed alveoli
Rhonchi are low-pitched, continuous sounds arising from airflow through large airways filled with secretions. They often clear with coughing. Crackles/rales suggest alveolar fluid, and pleural rubs indicate inflamed pleura. NCBI: Lung Sounds
A high BUN-to-creatinine ratio (>20:1) often suggests which condition?
Intrinsic renal failure
Prerenal azotemia
Postrenal obstruction
Hepatorenal syndrome
A BUN-to-creatinine ratio greater than 20:1 is characteristic of prerenal azotemia due to reduced renal perfusion, which increases urea reabsorption. Intrinsic renal causes usually produce lower ratios, and postrenal obstruction can vary. Kidney.org: Prerenal Azotemia
Which PaO2/FiO2 ratio defines mild ARDS in a patient on mechanical ventilation?
?100 mm Hg
?200 mm Hg
?300 mm Hg
?400 mm Hg
The Berlin definition classifies ARDS severity by the PaO2/FiO2 ratio: mild ARDS is 200–300 mm Hg with PEEP ?5 cm H2O. Moderate is 100–200 mm Hg, and severe is <100 mm Hg. Accurate measurement and ventilator settings are crucial for classification. JAMA: Berlin Definition of ARDS
A drop in serum albumin contributes to third-spacing because it:
Increases capillary permeability
Decreases colloidal osmotic pressure
Raises hydrostatic pressure
Activates the renin-angiotensin system
Serum albumin maintains colloidal osmotic pressure within the vascular compartment. Low albumin reduces oncotic pull, allowing fluid to shift into interstitial spaces (third-spacing). Conditions such as liver disease and nephrotic syndrome can precipitate this fluid shift. NCBI: Oncotic Pressure and Fluid Shifts
Which of the following is a key feature of Addison’s disease?
Hypokalemia
Hyperglycemia
Hyperpigmented skin
Elevated cortisol levels
Addison’s disease (primary adrenal insufficiency) causes decreased cortisol and aldosterone, leading to hyperkalemia and skin hyperpigmentation from elevated ACTH. Hypoglycemia also occurs. Diagnosis is confirmed with an ACTH stimulation test. EndocrineWeb: Addison’s Disease
Cushing’s triad—hypertension, bradycardia, and irregular respirations—indicates:
Early increased intracranial pressure
Impending herniation
Hypovolemia
Septic shock
Cushing’s triad is a late sign of elevated intracranial pressure and impending brain herniation. It reflects central nervous system ischemia and loss of autoregulation. Prompt intervention is critical to prevent permanent neurologic damage. NCBI: Cushing’s Triad
Which enzyme elevation is most specific for acute pancreatitis?
Serum amylase
Serum lipase
AST
LDH
Serum lipase is more specific and remains elevated longer than amylase in acute pancreatitis. Amylase can also rise with salivary gland disease or other abdominal conditions. Lipase levels correlate better with severity. NCBI: Acute Pancreatitis Diagnosis
The first-line intervention for stable SVT is:
IV adenosine bolus
Carotid sinus massage
Vagal maneuvers
Synchronized cardioversion
Vagal maneuvers such as the Valsalva technique are first-line for stable supraventricular tachycardia because they can terminate the arrhythmia noninvasively. If unsuccessful, IV adenosine may be administered. Cardioversion is reserved for unstable patients. ACC: SVT Management
A patient develops heparin-induced thrombocytopenia. The best next step is to:
Switch to low-molecular-weight heparin
Administer platelet transfusion
Stop heparin and start argatroban
Continue heparin at a lower dose
In HIT, heparin must be stopped immediately, and a direct thrombin inhibitor such as argatroban should be started to prevent thrombosis. Switching to low-molecular-weight heparin is contraindicated due to cross-reactivity. Platelet transfusion can worsen thrombosis risk. ASH: HIT Management
Which ECG change is an early sign of hyperkalemia?
Flattened T waves
Prolonged QT interval
Peaked T waves
U waves
Hyperkalemia initially causes peaked, narrow-based T waves due to accelerated repolarization. As levels rise, P waves flatten, PR prolongs, and QRS widens. Flattened T waves and U waves are features of hypokalemia. NCBI: ECG Changes in Electrolyte Abnormalities
According to Winter’s formula, the expected PaCO2 in metabolic acidosis is calculated as:
1.5 × HCO3– + 8 ± 2
0.8 × HCO3– + 2
HCO3– + PaO2/2
2 × HCO3– – 4
Winter’s formula estimates the respiratory compensation for metabolic acidosis: expected PaCO2 = (1.5 × HCO3–) + 8 ± 2 mm Hg. It helps determine if there is a respiratory component beyond expected compensation. Life in the Fast Lane: Winter’s Formula
The drug of choice for acute malignant hyperthermia is:
Dantrolene
Sodium bicarbonate
Amiodarone
Diazepam
Dantrolene is a ryanodine receptor antagonist that halts the uncontrolled calcium release in skeletal muscle causing malignant hyperthermia. Early administration reduces mortality significantly. Supportive measures include cooling and acid-base correction. NCBI: Malignant Hyperthermia Management
Refeeding syndrome primarily involves a dangerous drop in which electrolyte?
Calcium
Magnesium
Phosphate
Sodium
Refeeding syndrome causes rapid intracellular uptake of phosphate when carbohydrate metabolism resumes, leading to severe hypophosphatemia. This can result in muscle weakness, respiratory failure, and arrhythmias. Gradual nutrition and electrolyte monitoring prevent complications. NCBI: Refeeding Syndrome
Using the Parkland formula for burn resuscitation, the fluid volume in the first 24 hours is calculated as:
2 mL × body weight (kg) × % TBSA burned
3 mL × body weight (kg) × % TBSA burned
4 mL × body weight (kg) × % TBSA burned
5 mL × body weight (kg) × % TBSA burned
The Parkland formula for adults prescribes 4 mL/kg/%TBSA of crystalloid over 24 hours. Half is given in the first 8 hours from the time of burn, and the remainder over the next 16 hours. It guides initial resuscitation in major burns. American Burn Association: Parkland Formula
Norepinephrine primarily exerts its hemodynamic effects through which receptor?
Beta-2 adrenergic
Alpha-1 adrenergic
Dopaminergic
Beta-1 adrenergic
Norepinephrine has strong alpha-1 agonist activity producing vasoconstriction and increased systemic vascular resistance. It also has modest beta-1 effects to support cardiac output. It is first-line for septic shock to maintain perfusion pressure. NCBI: Vasopressor Use in Shock
Which of the following is included in Ranson’s criteria on admission for acute pancreatitis?
WBC count <10,000/mm³
Serum LDH >350 IU/L
Age <45 years
Glucose <150 mg/dL
Ranson’s admission criteria for non–gallstone pancreatitis include age >55, WBC >16,000, glucose >200 mg/dL, AST >250 IU/L, and LDH >350 IU/L. These help predict severity and mortality risk. Other criteria apply at 48 hours. NCBI: Ranson’s Criteria
In acute decompensated heart failure with volume overload, the first-line medication is:
ACE inhibitor
Loop diuretic
Beta-blocker
Calcium channel blocker
Loop diuretics such as furosemide are first-line for symptomatic relief of volume overload in acute decompensated heart failure. They reduce preload and pulmonary congestion rapidly. ACE inhibitors are used once the patient is euvolemic. Circulation: Acute HF Management
For dental work prophylaxis in a patient with prosthetic heart valves, the recommended antibiotic is:
Amoxicillin
Clindamycin
Azithromycin
Ciprofloxacin
Amoxicillin 2 g orally one hour before dental procedures is recommended for prophylaxis against infective endocarditis in high-risk patients, including those with prosthetic valves. Clindamycin is an alternative for penicillin-allergic patients. Circulation: Endocarditis Prophylaxis
In hemodynamically unstable acute kidney injury patients, which CRRT modality is preferred for fluid removal and solute clearance?
Intermittent hemodialysis (IHD)
Continuous venovenous hemofiltration (CVVH)
Peritoneal dialysis
Slow low-efficiency daily dialysis (SLEDD)
Continuous venovenous hemofiltration provides gentle, continuous fluid removal by convection and better hemodynamic stability for critically ill patients compared to intermittent hemodialysis. It allows precise volume control and solute clearance over 24 hours. NCBI: CRRT Modalities in ICU
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Study Outcomes

  1. Apply Effective Test-Taking Strategies -

    Use timed CMSRN practice questions to hone pacing techniques and optimize time management for the actual certification exam.

  2. Analyze Performance Gaps -

    Review your results in medical-surgical nursing certification practice Q&A to identify knowledge strengths and areas needing further study.

  3. Interpret Detailed Rationales -

    Examine answer explanations in med surg nursing certification practice questions to deepen your understanding of pathophysiology and clinical decision-making.

  4. Reinforce Critical Concepts -

    Engage with a diverse set of medical surgical nursing certification practice questions to consolidate key principles and interventions.

  5. Simulate Exam Conditions -

    Experience realistic, timed drills to build confidence, reduce test anxiety, and prepare for the pace of the CMSRN exam.

  6. Recall Essential Clinical Guidelines -

    Memorize high-yield facts and best practices to ensure mastery of med-surg certification practice questions and readiness for exam day.

Cheat Sheet

  1. Acid-Base Balance Interpretation -

    Master the "ROME" mnemonic (Respiratory Opposite, Metabolic Equal) to quickly determine if a pH imbalance is respiratory or metabolic. For example, pH 7.30 and pCOâ‚‚ 50 mm Hg indicates respiratory acidosis. Practice with cmsrn practice questions on arterial blood gas scenarios from the American Thoracic Society.

  2. Fluid & Electrolyte Management -

    Review correction formulas like (desired Na❺ - current Na❺) × total body water (0.6 × kg) to safely raise serum sodium no more than 0.5 mEq/L per hour. Recognize hypokalemia signs (muscle cramps, U waves) versus hyperkalemia (peaked T waves), and integrate med surg nursing certification practice questions simulating lab interpretations. Evidence-based guidelines from the National Kidney Foundation guide safe electrolyte adjustments.

  3. Cardiac Rhythm Recognition -

    Use the "300-150-75-60-50" rule on ECG strips to estimate heart rate rapidly and identify dysrhythmias like atrial fibrillation or second-degree AV block. Evaluate P wave presence and measure PR intervals (normal 0.12 - 0.20 sec) in line with American Heart Association standards. Regular drills with med-surg nursing certification practice questions strengthen pattern recognition and response planning.

  4. Sepsis Identification & Management -

    Apply qSOFA (RR ≥22, altered mentation, SBP ≤100 mm Hg) alongside SIRS criteria to flag sepsis early and activate rapid response. Remember the "SEPSIS" bundle steps: Serial lactates, Early antibiotics, Prompt fluid resuscitation, Source control, Intensivist consult, and Supportive care from the Surviving Sepsis Campaign. Sharp understanding from medical-surgical nursing certification practice Q&A boosts your confidence in real-world scenarios.

  5. IV Dosage Calculations & Medication Safety -

    Master the formula (desired dose ÷ stock dose) × volume to calculate accurate IV infusions, and always double-check high-risk meds like heparin or insulin per Institute for Safe Medication Practices. Utilize mnemonic "D.O.S.E." (Desired ÷ Stock = Evaluate) for quick recall under pressure. Timed drills on med-surg certification practice questions enhance speed and accuracy for exam success.

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