200+ Free CMSRN Practice Questions

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A patient is being started on warfarin therapy. Which laboratory value should the nurse monitor most closely?

Partial thromboplastin time (PTT)

International normalized ratio (INR)

Platelet count

Bleeding time

to track

2026 Statistics

Key Facts: CMSRN Exam

150

Total Items

MSNCB CMSRN Candidate Handbook

125 + 25

Scored + Unscored

MSNCB CMSRN Exam Blueprint

Exam Time

MSNCB CMSRN Candidate Handbook

95/125

Passing Score

MSNCB scaled scoring

71%

First-Time Pass Rate

MSNCB statistics

$267/$394

Member / Nonmember Fee

MSNCB 2026 fees

The CMSRN exam contains 150 items (125 scored + 25 unscored pilot questions) administered over 3 hours. MSNCB reports approximately 71% first-time pass rate. The 2023 exam blueprint emphasizes patient/care management (32%) and nursing teamwork/collaboration (21%). Certification is valid for 5 years with renewal through continuing education or re-examination.

Sample CMSRN Practice Questions

Try these sample questions to test your CMSRN exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A patient is being started on warfarin therapy. Which laboratory value should the nurse monitor most closely?

A.Partial thromboplastin time (PTT)

B.International normalized ratio (INR)

C.Platelet count

D.Bleeding time

Explanation: Warfarin is an oral anticoagulant that works by inhibiting vitamin K-dependent clotting factors. The INR is the standard laboratory test used to monitor warfarin therapy, with a typical therapeutic range of 2.0-3.0 for most indications. PTT is used to monitor heparin therapy. Platelet count monitors for heparin-induced thrombocytopenia, and bleeding time is not routinely used for anticoagulation monitoring.

2Which action should the nurse take first when a patient experiences a severe allergic reaction with respiratory distress?

A.Administer oxygen via non-rebreather mask

B.Call the rapid response team

C.Remove the suspected allergen if present

D.Establish intravenous access

Explanation: In any emergency situation, the first priority is to remove the cause if possible. Removing the suspected allergen (such as a medication being infused or a latex glove) stops continued exposure while other interventions are initiated. While oxygen and calling for help are critical, removing the source addresses the root cause.

3The nurse is caring for a patient with a potassium level of 6.2 mEq/L. Which ECG finding would be most concerning?

A.Tall, peaked T waves

B.ST segment depression

C.U waves present

D.Prolonged QT interval

Explanation: Hyperkalemia (K+ >5.5 mEq/L) causes characteristic ECG changes including tall, peaked T waves (tented T waves), followed by PR prolongation, QRS widening, and eventually ventricular fibrillation or asystole. Tall T waves are often the first and most distinctive finding. U waves are associated with hypokalemia, not hyperkalemia.

4Which isolation precaution is required for a patient with confirmed Clostridioides difficile infection?

A.Standard precautions only

B.Contact precautions

C.Droplet precautions

D.Airborne precautions

Explanation: C. difficile requires Contact Precautions because it is transmitted via the fecal-oral route through contact with contaminated surfaces or equipment. Alcohol-based hand sanitizers are not effective against C. difficile spores; soap and water must be used for hand hygiene. Contact precautions include gown and gloves for room entry.

5A patient has been diagnosed with active tuberculosis. Which statement by the nurse indicates correct understanding of isolation requirements?

A.The patient should be in a negative pressure room with airborne precautions

B.The patient needs contact precautions with a private room

C.Standard precautions are sufficient if the patient wears a mask

D.Droplet precautions should be maintained for 48 hours after starting treatment

Explanation: Active pulmonary tuberculosis requires Airborne Precautions in a negative pressure room (AIIR - Airborne Infection Isolation Room) to prevent the spread of airborne droplet nuclei. Staff must wear N95 respirators. The patient remains on airborne precautions until they are no longer infectious, which is typically determined by three negative sputum smears, not just starting treatment.

6A patient is receiving intravenous heparin. The nurse notes the PTT is 95 seconds (therapeutic range 60-80 seconds). What is the most appropriate nursing action?

A.Continue the current infusion rate and reassess in 4 hours

B.Stop the heparin infusion immediately

C.Hold the infusion for 1 hour, then restart at a decreased rate per protocol

D.Increase the infusion rate and recheck PTT in 2 hours

Explanation: A PTT of 95 seconds is supratherapeutic but not critically high. Per most heparin protocols, when PTT is 1.5-2.5 times the control (or above the therapeutic range but less than 3 times control), the nurse should hold the infusion for a specified time, then restart at a decreased rate. Immediate stopping is reserved for critical bleeding or PTT >3 times control.

7Which medication requires the nurse to check the apical pulse for 1 full minute before administration?

A.Metoprolol

B.Digoxin

C.Lisinopril

D.Amlodipine

Explanation: Digoxin, a cardiac glycoside, requires checking the apical pulse for 60 seconds before administration. Withhold the medication and notify the provider if the pulse is <60 bpm in an adult. This safety measure is necessary because digoxin slows AV conduction, and bradycardia is a sign of potential toxicity.

8A patient with heart failure is prescribed furosemide 40 mg IV. The nurse should monitor for which potential adverse effect?

A.Hyperkalemia

B.Hypernatremia

C.Hypokalemia

D.Hypercalcemia

Explanation: Furosemide is a loop diuretic that causes potassium wasting in the kidneys, leading to hypokalemia. The nurse should monitor potassium levels and assess for signs of hypokalemia (muscle weakness, cardiac dysrhythmias). Potassium supplementation or a potassium-sparing diuretic may be prescribed concurrently.

9A patient with diabetes is being discharged home on insulin. Which statement indicates the patient needs further education?

A.I should rotate my injection sites to prevent lipodystrophy

B.I will store my unopened insulin vials in the refrigerator

C.I should skip my insulin if I am not eating a full meal

D.I will check my blood sugar before meals and at bedtime

Explanation: Patients should never skip insulin without consulting their healthcare provider. Long-acting (basal) insulin is typically given regardless of food intake. Rapid-acting insulin dosing may be adjusted based on carbohydrate intake and blood glucose levels, but skipping insulin entirely can lead to hyperglycemia and diabetic ketoacidosis.

10Which intervention is most appropriate for preventing falls in a hospitalized patient with orthostatic hypotension?

A.Keep all bed rails up at all times

B.Encourage the patient to change positions slowly

C.Restrict fluids to maintain blood pressure

D.Apply a vest restraint when the patient is alone

Explanation: Teaching the patient to change positions slowly (especially from lying to sitting to standing) allows time for the baroreceptor reflex to compensate and helps prevent orthostatic hypotension and falls. Keeping all bed rails up is a restraint and requires a physician order. Fluid restriction would worsen hypotension. Vest restraints are inappropriate for fall prevention.

About the CMSRN Exam

CMSRN certification validates expertise in medical-surgical nursing across five domains: Patient/Care Management (32%), Holistic Patient Care (15%), Elements of Interprofessional Care (17%), Professional Concepts (15%), and Nursing Teamwork and Collaboration (21%). It demonstrates competency in caring for adult medical-surgical patients across the care continuum.

Questions

150 scored questions

Time Limit

3 hours

Passing Score

95/125 scored (scaled score)

Exam Fee

$267 AMSN members / $394 non-members (MSNCB (Medical-Surgical Nursing Certification Board))

CMSRN Exam Content Outline

32%

Patient/Care Management

Assessment, diagnosis, planning, implementation, evaluation, pharmacology, patient safety, infection prevention, emergency response, and care coordination for medical-surgical patients

15%

Holistic Patient Care

Cultural competence, spiritual care, patient advocacy, family dynamics, grief and loss, comfort care, and supporting patients through health challenges

17%

Elements of Interprofessional Care

Interprofessional collaboration, delegation, continuity of care, ethics, evidence-based practice, and working effectively with the healthcare team

15%

Professional Concepts

Professional growth, quality improvement, research utilization, leadership, regulatory compliance, and advancing the nursing profession

21%

Nursing Teamwork and Collaboration

Team building, conflict resolution, communication, mentoring, and effective collaboration to optimize patient outcomes

How to Pass the CMSRN Exam

What You Need to Know

Passing score: 95/125 scored (scaled score)
Exam length: 150 questions
Time limit: 3 hours
Exam fee: $267 AMSN members / $394 non-members

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CMSRN Study Tips from Top Performers

1Focus on the 32% Patient/Care Management domain - this is the largest portion of the exam

2Review all major body systems: cardiovascular, respiratory, GI, renal, endocrine, neuro, musculoskeletal, and integumentary

3Practice questions covering delegation, prioritization, and scope of practice

4Study pharmacology concepts including drug classes, side effects, and nursing interventions

5Understand interprofessional collaboration and when to consult other healthcare team members

6Review patient education principles and health promotion strategies

Frequently Asked Questions

What is the CMSRN pass rate?

MSNCB reports approximately 71% first-time pass rate for the CMSRN exam. Pass rates may vary by candidate preparation and experience level.

How many questions are on the CMSRN exam?

The CMSRN exam contains 150 total questions: 125 scored items and 25 unscored pilot items. The pilot questions are used for future exam development.

What is the CMSRN exam format?

The CMSRN is a computer-based exam administered at PSI testing centers. All questions are multiple-choice with four options. You have 3 hours to complete the exam.

What are the CMSRN eligibility requirements?

To sit for the CMSRN exam, you must have: 1) An active, unrestricted RN license, 2) 2 years (24 months) of full-time medical-surgical nursing experience, AND 3) 2,000 hours of practice in medical-surgical nursing within the past 3 years.

How much does CMSRN certification cost?

The CMSRN exam fee is $267 for AMSN members and $394 for non-members. This includes a $75 non-refundable application fee. Retest fees are reduced.

How long is CMSRN certification valid?

CMSRN certification is valid for 5 years. Renewal can be achieved through continuing education (90 contact hours) or by re-taking and passing the examination.

What is the difference between CMSRN and ANCC Med-Surg certification?

Both certifications validate medical-surgical nursing expertise. CMSRN is offered by MSNCB (affiliated with AMSN) while ANCC offers RN-BC in Medical-Surgical Nursing. Both are nationally recognized; some facilities may prefer one over the other.