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Certified Medical-Surgical Registered Nurse (CMSRN) Sample Questions And 100% Correct Answers
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Certified Medical-Surgical Registered Nurse (CMSRN) SampleQuestions And 100% Correct Answers
Christine Warren, 45 years of age, has had ulcerative colitis for many years and medical
treatment was no longer effective in controlling her symptoms. She had a total
proctocolectomy and a permanent ileostomy 12 hours ago.
The nurse should notify the physician immediately if Mrs. Warren exhibits which of the
following?
1) The stoma is pale and dry.
2) The stoma is red and shiny.
3) The stoma output is dark green and 200 mL.
4) The stoma output is serosanguinous and 50 mL. - ANSWER 1) The stoma is pale and
dry.
Rationale: An adequate blood supply to the stoma results in a pink or red color. The
stoma is moist due to mucous production. A pale dry color indicates ischemia of the
stoma or bowel and should be immediately reported to the physician. With an ileostomy
the initial output after surgery is a loose dark green liquid that may contain some blood.
The ileostomy usually starts to drain within 24 hours of surgery at a rate of more than
one liter per day.
The nurse changing Mrs. Warren's ileostomy bag notes irritation of the peristomal skin.
Which of these actions by the nurse would be appropriate before reapplying the
appliance?
1) Wash the area with antiseptic soap and water.
2) Clean the site with Dakin's solution.
3) Use a solid skin barrier.
4) Obtain an order for a topical antibiotic. - ANSWER 3) Use a solid skin barrier.
,Rationale: The drainage from the stoma will quickly excoriate the surrounding tissue.
Thus, the nurse should apply a solid skin barrier with a pectin base or karaya wafer that
has a measurable thickness and hydrocolloid adhesive properties.
Which of the following statements by Mrs. Warren, preoperatively, would you recognize
as indicating that she is concerned about her body image?
1) "I will have to stop my aerobics classes."
2) "I'm so afraid I may not survive the surgery."
3) "I need to go shopping for some loose, baggy clothes."
4) "I'm concerned that this may be only the first of many surgeries." ANSWER 3) "I need
to go shopping for some loose, baggy clothes."
Rationale: Body image relates to a person's perception of self and dictates how the
person will interact with others. One does not need to purchase special clothing after
ileostomy surgery although some minor adjustments may be needed for comfort, e.g.,
stretch underwear or pantyhose for support.
Lewis Palmer is 45 years of age and has had multiple myocardial infarctions. He is a
heavy smoker, taking warfarin sodium (Coumadin) daily. The patient underwent a right
femoral-popliteal bypass two weeks ago; this became occluded 24 hours ago. He is
admitted following an angioplasty of the femoral-popliteal bypass graft. Mr. Palmer is
receiving continuous IV heparin.
Considering that Mr. Palmer is receiving heparin therapy, it is important for the nurse to
1) have his prothrombin time monitored.
2) watch him closely for pulmonary embolism.
3) restrict his intake of foods containing vitamin K.
4) check the femoral puncture site frequently. - ANSWER 4) check the femoral puncture
site frequently.
Rationale: Bleeding is a frequent complication of heparin. It is essential to monitor the
,operative site, the area used for the femoral puncture, for bleeding.
Attempts at revascularizing Mr. Palmer's leg are not successful, and Mr. Palmer
undergoes a below-knee amputation (BKA) of his right extremity and is returned to the
medical-surgical unit with an intravenous infusion in place. His orders include: heparin
drip, morphine sulfate 10 mg IV push q4h prn for pain, and ampicillin sodium g 1 IV q6h.
Twelve hours postoperatively, Mr. Palmer is discovered to be experiencing shortness of
breath and diaphoresis. He says, "My chest hurts." His pulse is 140/min from a baseline
of 80/min. His blood pressure is 105/60 mm Hg from a baseline of 138/70 mm Hg. His
respirations are 32/min from a baseline of 16/min. His O2 saturation is 85%. The nurse
immediately calls for assistance. Which of the following questions is most important for
the nurse to ask?
1)"Have you ever had this type of chest pain before?"
2 "How long have you had this pain?"
3"What pain medication do you usually take?"
4"What - ANSWER 1)"Have you ever had this type of chest pain before?"
Rationale: Based on the patient symptoms and history of myocardial infarctions, the
nurse should find out if the patient has had this time of pain previously.
The nurse gets all of the following stat orders for Mr. Palmer. For which of these orders
should the nurse call for clarification?
1) Oxygen per nasal cannula at 4 L per minute.
2) Enoxaparin (Lovenox) 40 mg subcutaneously.
3) Troponin level.
4) CT angiogram. - ANSWER Rationale: The nurse should questions the order for
Lovenox because the patient is receiving a heparin drip.
Maggie Clark, a 42-year-old female, was admitted with newly diagnosed type 2 diabetes
mellitus. Her blood glucose has been stabilized, and the nurse is preparing her for
discharge. Her discharge orders will include metformin (Glucophage). Mrs. Clark is also
being treated for hypertension.
Because Mrs. Clark is to take Glucophage on a regular basis it is important to
1) monitor her glomerular filtration rate.
, 2) check her serum amylase routinely.
3) have her red blood cell count from time to time.
4) check her urine for casts. - ANSWER 1) monitor her glomerular filtration rate.
Rationale: Estimated glomerular filtration rate is one of the ways by which renal function
is measured. Glucophage is excreted through the kidneys, and an impaired renal
function increases the risk of lactic acidosis. This drug can be used if the eGFR falls
between 45 to 60 mL/ minute/1.73 m2, i.e., during mild chronic kidney disease. If the
eGFR is less than 30 mL/minute/1.73 m2, Glucophage is absolutely contraindicated.
Mrs. Clark is prescribed metoprolol tartrate (Lopressor) for hypertension. Which
symptom of hypoglycemia would be masked by Lopressor?
1) Diaphoresis.
2) Tingling.
3) Diplopia.
4) Tachycardia. - ANSWER 4) Tachycardia.
Rationale: A side effect of Lopressor, a beta blocker, is bradycardia. The
Lopressor-induced bradycardia can mask tachycardia, a symptom of hypoglycemia.
Charles Haverford is diagnosed with prostate cancer and is to have a radical
prostatectomy.
Mr. Haverford has been reading about his diagnosis and now asks the nurse to suggest
a reliable web source for accurate information related to prostate cancer. The nurse
should recognize which of these websites as most reliable?
1) www.wikipedia.org.
2) www.cancer.gov.
3) www.caringbridge.org.
4) www.google.com. - ANSWER 2) www.cancer.gov.
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