Free CMSRN Practice Test: 50 Questions With Rationales

This free CMSRN practice test has 50 original questions for U.S. adult medical-surgical nursing, sampling all five MSNCB exam domains, each with a rationale and a source. They're unofficial: this isn't a full-length exam or a predictor of passing.

Practice questions

Question 1 of 50

Nursing Teamwork and Collaboration · Delegation and Supervision · CMSRN-TC01

A medical-surgical registered nurse (RN) works with an assistive personnel (AP) team member trained and competent in routine vital signs. State rules and facility policy permit the task. Which assignment is most appropriate?

• A. Assessing a patient just admitted with community-acquired pneumonia
• B. Measuring and recording vital signs for a patient two days after surgery whose vital signs have been stable
• C. Evaluating a patient's response to IV morphine and deciding whether further treatment is needed
• D. Teaching a patient how to self-inject enoxaparin before discharge

Question 2 of 50

Patient/Care Management · Medication Management · CMSRN-PC01

An adult receiving insulin says she feels shaky before lunch. Bedside glucose is 58 mg/dL. She is alert, swallows safely, and the unit's hypoglycemia protocol lets the nurse give oral glucose. Which action is best now?

• A. Wait for the lunch tray, then recheck glucose after the meal
• B. Give a chocolate bar and recheck glucose in 1 hour
• C. Give 15 g of fast-acting carbohydrate per protocol and recheck glucose in 15 minutes
• D. Give the scheduled mealtime insulin now so it is working when the tray arrives

Question 3 of 50

Holistic Patient Care · Education of Patients and Families · CMSRN-HC01

After teaching a patient about a new anticoagulant, the nurse asks him to explain when he should call for help. His answer is incorrect. What should the nurse do next?

• A. Re-explain that point in a different, simpler way, then ask him to explain it again in his own words
• B. Repeat the original explanation word for word so the message stays consistent
• C. Ask, "Do you understand now?" and document that teaching is complete
• D. Give him the written handout and ask him to read it at home

Question 4 of 50

Elements of Interprofessional Care · Care Coordination and Transition Management · CMSRN-IP01

On admission, a patient's pharmacy fill history lists metoprolol 25 mg twice daily. The patient says his cardiologist stopped it last month. The admission orders include metoprolol. What is the nurse's best action?

• A. Give the ordered dose, because the pharmacy list is the official record
• B. Hold the medication and delete it from the home list without telling anyone
• C. Give half the ordered dose until morning rounds
• D. Verify the information with the patient and available sources, and bring the discrepancy to the prescriber to resolve

Question 5 of 50

Professional Concepts · Communication · CMSRN-PR01

A nurse calls about a patient one day after hip replacement. Heart rate has risen from 88 to 118, blood pressure has fallen from 128/76 to 96/58, and the dressing is saturated. Which statement is the Assessment part of SBAR?

• A. "Mr. Diaz had a hip replacement yesterday and is on enoxaparin."
• B. "I'm calling about Mr. Diaz in room 412. His heart rate is 118 and his blood pressure is 96/58."
• C. "I'm concerned he may be bleeding. His dressing is saturated and his pressure has dropped since this morning."
• D. "I'd like you to come see him now. Do you want a CBC drawn?"

Question 6 of 50

Patient/Care Management · Patient Safety · CMSRN-PC02

While helping a patient with breakfast, the nurse notices sudden right-sided facial droop, right arm drift, and slurred speech. The patient was talking normally 10 minutes ago. What should the nurse do first?

• A. Activate the facility's stroke or rapid response process and report both the time symptoms were first observed and when the patient was last known to be normal
• B. Finish breakfast, then recheck in 30 minutes to see whether the symptoms resolve
• C. Give the patient's scheduled morning aspirin now
• D. Document the findings and report them at the next scheduled rounds

Question 7 of 50

Nursing Teamwork and Collaboration · Delegation and Supervision · CMSRN-TC02

A patient care technician (PCT) taking routine 1400 vital signs on a stable postoperative patient reports that the patient now says she "can't catch her breath." Her oxygen saturation (SpO2) reads 89%. What should the RN do?

• A. Tell the PCT to start oxygen at 2 L/min and recheck in 15 minutes
• B. Ask the PCT to finish the remaining vital signs, then reassess
• C. Tell the PCT to reposition the patient and report back if she doesn't improve
• D. Go assess the patient now. Her condition has changed, so the RN reassesses and decides what happens next

Question 8 of 50

Patient/Care Management · Surgical/Procedural Nursing Management · CMSRN-PC03

Two days after abdominal surgery, a patient suddenly reports shortness of breath and sharp chest pain that gets worse when she takes a deep breath. Her heart rate is 124 beats/min. What is the nurse's priority?

• A. Coach incentive spirometry and reassess in an hour
• B. Start the facility's rapid response or escalation process for urgent evaluation
• C. Give the as-needed oral pain medication and reassess at the next check
• D. Walk the patient in the hallway to help open the lungs

Question 9 of 50

Elements of Interprofessional Care · Care Coordination and Transition Management · CMSRN-IP02

At shift change, using I-PASS and the documented patient-specific plan, the oncoming nurse says: "So she's a watcher, the potassium recheck is due at 2200, and if it's under 3.5 mmol/L I call the resident. Did I get that right?" Which I-PASS element is this?

• A. Illness severity
• B. Patient summary
• C. Synthesis by receiver
• D. Situation awareness and contingency planning

Question 10 of 50

Holistic Patient Care · Diversity and Inclusion · CMSRN-HC02

At a hospital covered by Section 1557, an adult with limited English proficiency needs discharge teaching on a new insulin regimen in Spanish. Her adult son is bilingual and offers to interpret. A qualified medical interpreter is available by video. It is not an emergency, and the patient hasn't asked for her son to interpret. What should the nurse do?

• A. Use the qualified interpreter and speak directly to the patient
• B. Let her son interpret, since he'll be helping her at home
• C. Ask a bilingual housekeeper who is not qualified as an interpreter or bilingual patient-service staff member to interpret
• D. Teach in slow, simple English and give a Spanish handout

Question 11 of 50

Patient/Care Management · Medication Management · CMSRN-PC04

A nurse finds a vial of potassium chloride concentrate and an order that reads "KCl 10 mEq IV push now." What is the nurse's best action?

• A. Give it slowly over 5 minutes through the peripheral IV
• B. Dilute it in a 10 mL saline flush syringe and give it IV push
• C. Give it IV push, then flush with saline to protect the vein
• D. Do not give it. Contact the prescriber and pharmacy to clarify the order for a properly diluted infusion

Question 12 of 50

Professional Concepts · Communication · CMSRN-PR02

The charge nurse says, "Maria, please do the 1600 glucose check on room 7 and tell me the result." Maria replies, "Room 7, 1600 glucose check, and I'll report the result to you." What completes the check-back?

• A. Maria does the task. No further reply is needed
• B. The charge nurse confirms, "That's correct"
• C. The charge nurse gives Maria a different task without confirming this message
• D. Maria writes the task on the unit whiteboard

Question 13 of 50

Nursing Teamwork and Collaboration · Leadership · CMSRN-TC03

A unit launches bedside shift report. In the first week, several nurses ask, "Why are we doing this? The old way worked fine." Using the ADKAR model, which element should the manager address first?

• A. Awareness: explain why the change is needed
• B. Knowledge: schedule more training on the report steps
• C. Ability: observe report at the bedside and coach technique
• D. Reinforcement: recognize nurses who use the new process

Question 14 of 50

Patient/Care Management · Pain Management · CMSRN-PC05

Forty minutes after IV morphine, a postoperative patient is hard to arouse and has a respiratory rate of 7/min with shallow breaths. What is the nurse's priority?

• A. Let the patient sleep, since rest means the pain is controlled
• B. Give the next scheduled dose early so pain doesn't break through when she wakes
• C. Stay with the patient, stimulate and support her breathing, and call for emergency help under the facility's protocol
• D. Recheck the respiratory rate in one hour

Question 15 of 50

Holistic Patient Care · Patient-Centered Care · CMSRN-HC03

During admission, a patient mentions that her faith shapes what she eats, but she doesn't say how. The current order is a standard diet. What should the nurse do?

• A. Order the meal plan most people of her stated faith follow
• B. Keep the standard diet, since religious preferences aren't part of the medical plan
• C. Ask the chaplain to decide which diet is appropriate
• D. Ask her what her beliefs mean for her meals, then plan with her and the dietary team

Question 16 of 50

Nursing Teamwork and Collaboration · Delegation and Supervision · CMSRN-TC04

The plan of care for a stable patient says blood pressure may be taken on the right arm only. The RN is handing routine vital signs to a competent PCT under applicable rules and facility policy. Which instruction best meets the "right directions and communication" part of delegation?

• A. "Get vitals on 12 when you can, and let me know if anything looks off."
• B. "Take vitals on 12 by 1000, using the right arm only for blood pressure. Tell me right away if the systolic is under 100 mmHg or the heart rate is over 110 beats/min."
• C. "Take vitals on 12 and chart them. I'll look later."
• D. "Take vitals on 12 and decide whether she needs her 1000 blood pressure pill."

Question 17 of 50

Patient/Care Management · Infection Prevention · CMSRN-PC06

On day 5 of IV antibiotics, a patient has had four loose stools since midnight. He has had no laxatives or stool softeners. A C. diff test has been sent and is pending. What should the nurse do now?

• A. Start contact precautions in a single room with a dedicated toilet, per facility protocol, while the test is pending
• B. Wait for the test result before starting precautions
• C. Use standard precautions only until diarrhea is confirmed to be infectious
• D. Room the patient with another patient who has diarrhea of unknown cause

Question 18 of 50

Professional Concepts · Communication · CMSRN-PR03

A nurse sees a physician about to perform a nonemergency central-line insertion without a full-body sterile drape. She says, "I'm concerned. We need a full-body drape." The physician keeps going. She repeats the concern clearly, and he says, "It's fine." What should she do next?

• A. Stay quiet and document the breach afterward
• B. Leave the room so she isn't part of the breach
• C. Take stronger action: stop the procedure if she can do so safely, and escalate through the chain of command
• D. Wait until the procedure is over and discuss it privately

Question 19 of 50

Elements of Interprofessional Care · Documentation · CMSRN-IP03

The electronic health record (EHR) goes down unexpectedly at 0200, and the facility activates its approved paper-documentation downtime plan. A nurse needs to document a 0300 medication and an assessment. What should she do?

• A. Keep notes on her phone and enter them when the system is back
• B. Hold all documentation and chart it from memory at the end of the shift
• C. Skip routine documentation until the EHR returns
• D. Document at the time of care on the facility's approved downtime paper forms, then follow the recovery process to get the information into the EHR

Question 20 of 50

Patient/Care Management · Infection Prevention · CMSRN-PC07

Three days after hip surgery, a patient can stand to void and has no urinary retention. His indwelling urinary catheter has no documented ongoing indication, and the unit's nurse-driven removal protocol applies. A colleague suggests keeping it "so we can get a urine culture easily later." What is the best response?

• A. Keep it until discharge to save trips to the bathroom
• B. Remove it under the protocol. Collecting a urine specimen isn't a reason to keep a catheter in a patient who can void
• C. Keep it and change the drainage bag daily to lower infection risk
• D. Keep it and ask for a preventive antibiotic

Case study: questions 21–23
Mr. Okafor, 81, was admitted to a CMS-participating hospital two days ago with pneumonia and is receiving IV antibiotics through a peripheral IV in his left forearm. Tonight he is newly confused. He keeps picking at the IV and has pulled at the tape twice. He is not aggressive toward staff, and his vital signs and oxygen saturation are unchanged from the evening check.

Question 21 of 50

Patient/Care Management · Patient Safety · CMSRN-PC08

Based on the case above, what should the nurse do first?

• A. Apply bilateral soft wrist restraints to protect the IV
• B. Give the as-needed sleep medication ordered for insomnia so he settles
• C. Assess the new confusion promptly, notify the provider, and use less restrictive measures such as reorientation and closer observation under facility policy
• D. Apply a vest restraint so both arms stay free

Question 22 of 50

Patient/Care Management · Patient Safety · CMSRN-PC09

(Uses the case study above question 21.)

Despite those measures, Mr. Okafor pulls out the IV, and it has to be restarted. The provider enters this order: "Soft wrist restraints PRN for pulling at lines." What should the nurse do?

• A. Contact the provider to clarify, because restraint orders can't be written as PRN
• B. Apply restraints whenever he reaches for the IV, as the order allows
• C. Apply restraints now and keep them on until morning rounds
• D. Ask the family to sign consent for PRN restraints

Question 23 of 50

Elements of Interprofessional Care · Documentation · CMSRN-IP04

(Uses the case study above question 21.)

During a chart review after restraint use, the nurse finds documentation of Mr. Okafor's behavior, the less restrictive measures attempted, the restraint applied, and his response. The note says only "needed to protect the IV" to explain why restraint was used and continued. Which documentation issue should the nurse identify?

• A. A valid restraint order makes further explanation of necessity unnecessary
• B. The word "confused" is enough to establish why restraint was necessary
• C. The note should list staffing convenience as the reason to continue restraint
• D. The record must identify the condition or symptoms that warranted restraint to protect immediate physical safety and explain why continued use was needed

Question 24 of 50

Holistic Patient Care · Patient-Centered Care · CMSRN-HC04

An alert, oriented adult who can make his own decisions refuses his scheduled bowel prep and colonoscopy, saying he's scared. What should the nurse do?

• A. Start the prep anyway, since he signed consent yesterday
• B. Explore his concerns, make sure he has the information he needs, notify the provider, and document his decision
• C. Tell him the hospital requires him to complete ordered tests
• D. Ask his daughter to override his decision

Question 25 of 50

Nursing Teamwork and Collaboration · Delegation and Supervision · CMSRN-TC05

Under applicable state rules and facility policy, an RN delegates a blood glucose check on a stable patient to a PCT who is competent to do it. The PCT gets busy and asks another PCT to do it instead. Which statement is correct?

• A. The PCT should not pass the task on. She should tell the RN, who decides how to reassign it
• B. Passing it on is fine as long as both PCTs are trained
• C. The second PCT now becomes accountable for the patient
• D. The RN is no longer responsible once the task is delegated

Question 26 of 50

Patient/Care Management · Medication Management · CMSRN-PC10

A peripheral IV running normal saline only is warm, red, and tender along the vein, with a firm cord above the insertion site. What should the nurse do?

• A. Slow the infusion and reassess in 4 hours
• B. Put on a new transparent dressing and keep using the site
• C. Stop the infusion, remove the peripheral catheter, and get new access at another site if therapy is still needed
• D. Flush the catheter firmly to clear it

Question 27 of 50

Professional Concepts · Quality Management · CMSRN-PR04

Before giving a medication, a nurse notices the pharmacy-labeled syringe is for a different patient. Nothing reached the patient, and the correct dose has been obtained. What should the nurse do next?

• A. Nothing more, since no harm occurred
• B. Mention it informally to the pharmacist and skip the report
• C. Report it only if it happens again
• D. Report the near miss through the facility's safety event reporting system

Question 28 of 50

Elements of Interprofessional Care · Nursing Process/Clinical Judgement Measurement Model · CMSRN-IP05

A patient who has been on contact precautions for several days tells the nurse, "Nobody comes in unless they have to. I feel forgotten." Which action best individualizes her care?

• A. Cluster care to limit room entries, since fewer entries reduce transmission
• B. Acknowledge her feelings, schedule regular check-ins within precautions, and add her concern to the care plan
• C. End precautions early to improve her mood
• D. Explain that isolation is required and nothing can be changed

Question 29 of 50

Patient/Care Management · Infection Prevention / Medication Management · CMSRN-PC11

A nurse draws 2 mL from a 10 mL single-dose vial for one patient. A coworker suggests using the rest for another patient's dose with a new needle and syringe. What is correct?

• A. Don't use it for a second patient. Single-dose vials are for one patient, and leftover contents aren't saved
• B. It's fine, because the needle and syringe are new
• C. It's fine if the second dose is drawn up within 1 hour
• D. Store the vial in the medication room for the same patient's next dose

Question 30 of 50

Holistic Patient Care · Palliative/End-of-Life Care · CMSRN-HC05

A patient receiving chemotherapy for lung cancer is offered a palliative care consult for pain and fatigue. She asks, "Does this mean I have to stop my treatment?" Which reply is accurate?

• A. "Yes. Palliative care starts when cancer treatment stops."
• B. "Palliative care and hospice are the same thing."
• C. "No. Palliative care can be given alongside your cancer treatment to help with symptoms and side effects."
• D. "Only people expected to live less than six months can get palliative care."

Question 31 of 50

Nursing Teamwork and Collaboration · Disaster Planning and Management · CMSRN-TC06

During a mass-casualty incident, the hospital activates an incident command system using standard ICS section roles. A unit needs more IV pumps, linens, and meals for staff. Which section coordinates these operational support resources, rather than tracking their costs?

• A. Operations
• B. Logistics
• C. Planning
• D. Finance/Administration

Question 32 of 50

Patient/Care Management · Infection Prevention · CMSRN-PC12

A patient admitted for weight loss has had a cough for two months, night sweats, and blood-streaked sputum. Sputum tests for tuberculosis are pending. Which precautions should the nurse start?

• A. Standard precautions until the sputum results return
• B. Droplet precautions, with staff wearing a surgical mask
• C. Contact precautions, with gown and gloves
• D. Airborne precautions in an airborne infection isolation room (AIIR), with staff using a fit-tested N95 or an appropriate higher-level respirator

Question 33 of 50

Professional Concepts · Healthy Practice Environment / Scope of Practice and Ethics · CMSRN-PR05

Near the end of a hectic shift, a coworker asks a nurse to chart a set of vital signs for a patient "since they're always normal," even though they weren't taken. What should the nurse do?

• A. Decline to chart data that wasn't collected, take the vital signs if they're still needed, and raise the concern through appropriate channels
• B. Chart the usual values this once, since the patient has been stable
• C. Chart the values and add a note that they were estimated
• D. Leave the vital signs blank and say nothing

Question 34 of 50

Elements of Interprofessional Care · Interprofessional Collaboration / Care Coordination · CMSRN-IP06

At 1900, a day-shift RN transfers responsibility for five patients to the night-shift RN. Under the ANA–NCSBN delegation guidelines, what is this transfer called?

• A. Delegation
• B. Assignment to assistive personnel
• C. A handoff
• D. Supervision

Question 35 of 50

Patient/Care Management · Patient Safety · CMSRN-PC13

Two nurses on different shifts make the same slip: each grabs the wrong concentration from look-alike bags stored side by side. One patient has no harm; the other needs extra monitoring. In a just culture, how should leaders respond?

• A. Discipline the nurse whose patient needed monitoring, and counsel the other
• B. Respond the same way to both, based on the behavior (a slip), and fix the look-alike storage
• C. Take no action, since slips can't be prevented
• D. Suspend both nurses to show errors aren't tolerated

Question 36 of 50

Holistic Patient Care · Patient-Centered Care · CMSRN-HC06

A patient tells the nurse, "I want to file a formal complaint about how the night staff treated me." What should the nurse do?

• A. Suggest he fill out the satisfaction survey after discharge
• B. Promise him the night staff will be disciplined
• C. Suggest he wait until he's calmer and see whether it still matters
• D. Tell him how to submit a grievance through the hospital's process, including whom to contact, and notify the charge nurse or manager per policy

Question 37 of 50

Nursing Teamwork and Collaboration · Leadership · CMSRN-TC07

After training and coaching, staff used a new fall-risk huddle consistently for two months. They can explain why it matters, still support the change, and can demonstrate the steps. No new workflow barrier has emerged. Leaders then stopped feedback and follow-up, and use has slid back to old habits. Which ADKAR element needs attention?

• A. Reinforcement
• B. Awareness
• C. Knowledge
• D. Desire

Question 38 of 50

Patient/Care Management · Patient Safety · CMSRN-PC14

A unit will switch to a new smart infusion pump next month. The manager wants to find where the new process could fail before any patient is harmed. Which method fits best?

• A. Root cause analysis (RCA)
• B. A review of last year's incident reports
• C. Failure modes and effects analysis (FMEA)
• D. Peer review of individual nurses

Question 39 of 50

Professional Concepts · Healthy Practice Environment · CMSRN-PR06

A nurse is asked to stay four extra hours after a 12-hour shift. She slept poorly, skipped meals, and took a sedating antihistamine this morning. She is struggling to stay alert and judges that she cannot safely work the extra hours. Her unit uses the TeamSTEPPS I'M SAFE checklist. What should she do?

• A. Stay, and drink coffee to stay alert
• B. Stay, but quietly take only the lowest-acuity patients
• C. Stay, since declining extra hours looks unsupportive
• D. Tell the charge nurse she can't safely work the extra hours today

Question 40 of 50

Elements of Interprofessional Care · Interprofessional Collaboration · CMSRN-IP07

Midway through a day shift, two admissions arrive at once and one patient transfers to the ICU. The team's start-of-shift plan no longer fits the workload. No one needs emergency rescue right now. What should the charge nurse do?

• A. Wait for the end-of-shift debrief to discuss what happened
• B. Call a brief huddle to update priorities, assignments, and the plan
• C. Keep the original assignments so no one gets confused
• D. Hold a full staff meeting after the next shift change

Question 41 of 50

Patient/Care Management · Infection Prevention / Medication Management · CMSRN-PC15

Before giving an IV medication through a central line's needleless connector, what should the nurse do?

• A. Scrub the access hub with friction using an appropriate antiseptic immediately before accessing it
• B. Wipe the hub once at the start of the shift to cover the whole shift
• C. Skip cleaning, since the connector cap stays closed between uses
• D. Flush first, then clean the hub after the medication is given

Question 42 of 50

Holistic Patient Care · Palliative/End-of-Life Care · CMSRN-HC07

A ventilated patient's death is imminent under the hospital's agreed OPO referral protocol. The family is at the bedside. The nurse is not a trained designated requestor. What should the nurse do?

• A. Ask the family now whether they would consider organ donation
• B. Wait until death is declared, then notify the organ procurement organization (OPO)
• C. Notify the OPO under the hospital's protocol, and leave the formal donation request to the OPO representative or a trained designated requestor
• D. Ask the physician to decide whether the patient is a suitable donor before calling the OPO

Question 43 of 50

Nursing Teamwork and Collaboration · Career Development Relationships / Professional Development · CMSRN-TC08

An RN asks a new PCT to remove a patient's peripheral IV. Applicable state rules and unit policy permit PCTs to do that task after competency validation. The PCT says she hasn't been trained or checked off yet. What is the best response?

• A. Coach her through it verbally from the doorway
• B. Have her watch a video, then do it
• C. Tell her it's simple and she should try
• D. Accept her decline, do it yourself or assign someone competent, and let the unit leader know she needs training

Question 44 of 50

Patient/Care Management · Nutrition · CMSRN-PC16

A patient receiving chemotherapy has painful mouth sores. He swallows safely and has no other diet restrictions. Which lunch is the best choice?

• A. Toasted sandwich with potato chips and orange juice
• B. Scrambled eggs, mashed potatoes, and a glass of cool milk
• C. Spicy chicken curry with rice
• D. Raw vegetable salad with vinaigrette

Question 45 of 50

Professional Concepts · Critical Thinking · CMSRN-PR07

At the start of shift, a charge nurse runs through STEP. She notes that the unit's only bariatric lift is out of service and that there are no open beds for tonight's expected admissions. Which part of STEP is she assessing?

• A. Status of the patient
• B. Team members
• C. Environment
• D. Progress toward the goal

Question 46 of 50

Elements of Interprofessional Care · Documentation · CMSRN-IP08

A patient asks for a copy of his current medical record, including this admission, in electronic form. The hospital keeps its records electronically. What should the nurse do?

• A. Route the request through the hospital's records-access process. He has the right to his records, in the form he asks for if it's readily producible
• B. Tell him records can only be released after discharge
• C. Tell him his physician must approve the request first
• D. Provide a paper copy instead without checking whether the requested electronic format is readily producible

Question 47 of 50

Nursing Teamwork and Collaboration · Career Development Relationships · CMSRN-TC09

A preceptor notices that her orientee's SBAR calls to providers leave out a clear request. The calls have been safe but slow. Which feedback approach is best?

• A. Wait until the orientee's 90-day evaluation to bring it up
• B. Tell the orientee, in front of the team, that her calls are disorganized
• C. Say "You're doing great!" to protect her confidence
• D. Soon after the next call, point out the specific missing piece privately, explain its effect, and agree on how she'll include it next time

Question 48 of 50

Holistic Patient Care · Education of Patients and Families / Health Promotion · CMSRN-HC08

A patient with diabetes reports several treated low-glucose episodes over the past week. His glucose is currently in his usual target range and he feels well. Which statement shows he understands the next step for preventing repeated lows?

• A. "I will stop all insulin on my own until I have a week without a low."
• B. "I will contact my diabetes care team, share my glucose readings and details about medicines, meals, and activity, and follow their advice before changing my medicines."
• C. "I do not need to tell anyone because each episode improved after treatment."
• D. "I will report only the glucose numbers; my medicine timing, meals, and activity do not matter."

Question 49 of 50

Professional Concepts · Quality Management · CMSRN-PR08

A quality report defines fall rate as falls ÷ patient-days × 1,000. Last quarter, Unit A had 5 falls in 2,500 patient-days, and Unit B had 4 falls in 1,000 patient-days. Which statement is accurate? (The data are fictional.)

• A. Unit A has the higher fall rate, because it had more falls
• B. The two units have the same fall rate
• C. Unit A's rate is 2.0 and Unit B's is 4.0 falls per 1,000 patient-days, so Unit B's observed rate is twice Unit A's
• D. Unit A's rate is 5.0 and Unit B's is 4.0 falls per 1,000 patient-days

Question 50 of 50

Nursing Teamwork and Collaboration · Leadership · CMSRN-TC10

Two nurses keep clashing because one routinely leaves IV pump alarms for the next shift. No patient is in danger right now. Using the DESC script, what should the nurse say first?

• A. "Last night, three pump alarms were still unresolved at the 0700 handoff."
• B. "You're always lazy about alarms."
• C. "If this keeps up, I'm going to report you."
• D. "Let's agree that pump-alarm problems are addressed and any outstanding concerns are handed over before report ends."

Score your set

Record your answer before opening its explanation. Count that first answer as correct or incorrect; do not change the score after reading the rationale. An explanation opened before you chose an answer is review without an attempt, not a wrong answer.

Each row lists the question numbers for one domain. Enter both your correct answers and your attempted answers. Your practice percentage is correct ÷ attempted × 100; use the attempted count for that row, not every question in the domain. With no attempted answers, no percentage is available. A result with fewer than 50 attempted answers is partial. Record skipped questions and answers reviewed without an attempt separately.

The full answer key reveals every answer. Choose and record your responses before opening it; otherwise treat the newly exposed answers as review rather than unassisted attempts.

How this set lines up with the CMSRN exam

The real CMSRN has 150 multiple-choice questions and a three-hour time limit. Only 125 of the 150 count toward your score. The other 25 are unscored pilot questions, and you can't tell which ones they are (MSNCB, CMSRN Certification — Exam Details; CMSRN Certification Handbook, pp. 10–11). The handbook also tells candidates to know how to read case studies, which is why questions 21–23 share one patient.

This set approximates the domain allocation of the 2023 CMSRN Exam Blueprint, active since May 15, 2023:

The exam weights and scored-question counts are MSNCB's. This set's actual shares are 32%, 16%, 16%, 16%, and 20%, so they do not exactly reproduce all five published weights. The last column is our scaling: 50 ÷ 125 = 0.4, so each domain's official count × 0.4, rounded to whole questions (16, 7.6, 8.4, 7.6, 10.4 become 16, 8, 8, 8, 10).

Notice that 18 of the 50 questions come from Professional Concepts and Nursing Teamwork and Collaboration. That's 36%, the same share those two domains hold on the exam (45 of 125 scored questions). It covers delegation, communication tools, ethics, change management, and disaster roles.

Fifty questions can't cover every topic in the blueprint. This set samples each domain. It doesn't cover every disease, procedure, or leadership concept you could see.

What your score on this set means

Your score tells you which of these 50 questions you missed and why. It can't tell you whether you'd pass.

MSNCB requires a standard score of 95 to pass, which it describes as about 71% correct. Your raw score out of 125 is converted to that standard score so that different exam forms are compared fairly (MSNCB, Exam Details). This set isn't one of those forms. It hasn't been equated to the exam, so a percentage here can't be converted into a CMSRN score.

Domain rows are small too. After all 8 questions in an eight-item domain are attempted, one question moves that result by 12.5 percentage points. Review the concepts behind your misses; a small sample is not a precise measure of what you know about the whole domain.

Reviewing what you missed

Speed isn't the goal. For each miss, write three short lines:

1. The cue I missed. Which fact in the question decided the answer? It might be the patient's stability, what was already tried, who is licensed to do what, or the exact wording of the order.
2. Why my choice failed. Use the "Why not the others" note. Some wrong options fit a different situation; others are unsafe or violate the rule being tested.
3. What to review. Name the rule or concept, then open the linked source.

For example: Cue I missed: the question said a less restrictive step hadn't been tried yet. Why my choice failed: I jumped to the stronger intervention. Review: the least-restrictive principle and when escalation is allowed.

Come back to your missed questions a day or two later and answer them again before you open the rationale.

Timing yourself (optional)

The real exam gives you 180 minutes for 150 questions, an average of 72 seconds per question. At that pace, these 50 questions take 60 minutes. That's our arithmetic, not an MSNCB rule. One option is a timed first pass followed by an untimed review of the rationales. This pacing suggestion does not replace approved exam accommodations.

Official exam resources

MSNCB's CMSRN Resources page links the handbook, the blueprint, and the exam reference list. The handbook says these resources don't include current exam questions, aren't required, and aren't the only or preferred way to prepare (Handbook, p. 21).

Stay away from anything sold as "real" or "recalled" CMSRN questions. MSNCB lists suspected pre-knowledge of test content and sharing exam knowledge among the reasons it may deny or revoke certification (Handbook, Appendix D).

For eligibility, use MSNCB's certification page. For fees, scheduling, and exam-day details, use MSNCB's exam processes page.

Sources and how we checked

Each question lists its source inside its rationale. The exam format, passing standard, and domain weights come from MSNCB's official pages and documents. The answers themselves rest on the clinical guidance, federal regulations, professional standards, and named communication or change models linked in each rationale, not on the blueprint. Federal hospital-rights questions use the CMS hospital Conditions of Participation; language-access questions state when Section 1557 applies. The blueprint tells us what to cover, not what's correct.

Exam facts:

• MSNCB — CMSRN Certification
• MSNCB — CMSRN Certification Handbook
• MSNCB — 2023 CMSRN Exam Blueprint

Teaching sources used in the questions:

• ANA–NCSBN — National Guidelines for Nursing Delegation (2019)
• CDC — Treatment of Low Blood Sugar (Hypoglycemia)
• AHRQ — TeamSTEPPS Pocket Guide (Pub. No. 23-0043, rev. May 2023)
• AHRQ — MATCH Toolkit for Medication Reconciliation, Introduction
• CDC — Signs and Symptoms of Stroke
• CDC — About Venous Thromboembolism (Blood Clots)
• 45 CFR 92.201 — Meaningful access for individuals with limited English proficiency (eCFR)
• Pfizer prescribing information — Potassium Chloride for Injection Concentrate, Warnings
• Prosci — The ADKAR Model
• Pfizer prescribing information — Morphine Sulfate Injection, Warnings and Precautions
• AHRQ — Consider Culture: Tool 10 (3rd edition, 2024)
• CDC — Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities
• CDC — Isolation Precautions Guideline (2007), Part III
• CDC — Checklist for Prevention of Central Line Associated Blood Stream Infections
• ONC/ASTP — SAFER Guide: Contingency Planning (2025)
• CDC — CAUTI Guideline: Summary of Recommendations
• 42 CFR 482.13 — Condition of participation: Patient's rights (eCFR)
• CDC/HICPAC — Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011; October 2017 update)
• AHRQ PSNet — Strategies and Approaches for Investigating Patient Safety Events
• AHRQ PSNet — Reporting Patient Safety Events
• CDC — Preventing Unsafe Injection Practices
• National Cancer Institute — Palliative Care in Cancer
• FEMA Emergency Management Institute — ICS General Staff (IS-362)
• ANA — 2025 Code of Ethics for Nurses, Provision 5.3
• AHRQ PSNet — Culture of Safety primer
• 42 CFR 482.45 — Organ, tissue, and eye procurement (eCFR)
• American Cancer Society — What to Do for Mouth Sores (revised January 2026)
• NHLBI — Stroke: Diagnosis

• MedlinePlus (NIH) — Delirium
• CDC — Tuberculosis Infection Control

Written by the Castleport Test Prep Editorial Team with AI assistance. Last source-checked: September 23, 2026 — the exam facts and the passages cited in the question explanations. This version has no documented named professional review; source checking is not clinical or psychometric review. See how we verify exam claims, our reviewer status, and our corrections log.

Castleport Test Prep is an independent exam prep publisher and is not affiliated with, endorsed by, or approved by the Medical-Surgical Nursing Certification Board (MSNCB) or the Academy of Medical-Surgical Nurses (AMSN). CMSRN and other exam and credential names are used only to identify the exam discussed; trademarks belong to their respective owners. These practice questions are original and unofficial, not actual exam questions. Passing, a particular score, and certification are not guaranteed.