CMSRN Practice Questions (2026) — Free Sample Questions with Answers

Answer: C

Serum potassium 5.8 mEq/L: Refeeding syndrome drives potassium into cells, causing hypokalemia, not hyperkalemia.

Serum calcium 11.2 mg/dL: Hypercalcemia is not a feature of refeeding syndrome.

Serum phosphorus 1.2 mg/dL: Correct. Refeeding syndrome happens when nutrition restarts after starvation: insulin release shifts phosphorus, potassium and magnesium into cells. Severe hypophosphatemia causes weakness, respiratory failure, confusion and heart failure. Prevention: start feeds slowly, give thiamine, and monitor and replace electrolytes.

Serum magnesium 3.1 mg/dL: Refeeding causes hypomagnesemia, not elevated magnesium.

Refeeding syndrome (first 72 hours of feeding in a malnourished patient): low phosphorus is the hallmark, with low potassium and magnesium, fluid retention and thiamine deficiency. Start low, go slow.

Answer: D

Take no further action, since no harm reached the patient: Near misses reveal the same system weaknesses as harmful errors. Not reporting them wastes the chance to prevent a future event.

Mention it informally to the charge nurse only: Informal reports are not tracked or analyzed, so system-level causes (such as pharmacy labeling or delivery) go unaddressed.

Document the error in the patient's medical record: Safety event details belong in the organization's reporting system, not the patient's chart. No error reached this patient.

Report the near miss in the safety event system: Correct. Just culture encourages nonpunitive reporting of near misses so the organization can find and fix process failures (such as mislabeled or misdelivered bags) before harm occurs.

Just culture: report errors and near misses, console human error, coach at-risk behavior, and reserve discipline for reckless behavior. Near-miss reports drive system fixes.

Answer: A

Book a qualified ASL interpreter or VRI: Correct. The ADA requires effective communication through qualified interpreters (on-site or video remote interpreting) for complex information such as consent and teaching.

Write all of the teaching on a whiteboard: English may be a second language for ASL users, and written exchanges are too limited for complex consent discussions.

Speak slowly and clearly so she can lip-read: Only a small fraction of spoken English can be reliably lip-read, so understanding of the content would be poor.

Ask her hearing spouse to sign the explanation: Family members are not qualified interpreters and may filter or alter information. This risks invalid consent and violates privacy.

For Deaf patients who use ASL, a qualified medical interpreter (live or VRI) is required for consent and teaching. Do not rely on lip-reading, notes or family.

Answer: B

Give printed discharge instructions at departure: Written instructions alone, given at the last minute, are among the weakest transition interventions, especially with limited health literacy.

Schedule follow-up within 7 days, plus a call: Correct. Early follow-up (within about 7 days) and a post-discharge phone call, along with medication reconciliation and teach-back, are evidence-based ways to reduce heart failure readmissions.

Ask the patient to call if any problems come up: Relying on the patient to start contact misses early decompensation, which patients often do not recognize.

Keep the patient one extra day for observation: A longer stay without a transition plan does not address the post-discharge gaps that drive readmissions.

Strong care transitions: medication reconciliation, teach-back, a follow-up appointment within 7 days, a post-discharge call and home health or community resources as needed.

Answer: C

A patient 2 days after hip replacement with pain 6/10, due for oral analgesia: Moderate expected postoperative pain is important but not immediately life-threatening, and the analgesic can be given right after the priority assessment.

A patient with COPD whose SpO2 is 89% on 2 L/min, which is her baseline: An SpO2 of 88-92% is often the target for chronic hypercapnic COPD. A stable baseline value is not a new change.

A patient 1 day after thyroidectomy who reports tingling around the mouth: Correct. Perioral tingling after thyroidectomy suggests acute hypocalcemia from parathyroid injury, which can progress quickly to tetany, laryngospasm, seizures and dysrhythmias. Assess for Chvostek and Trousseau signs and the airway, and notify the surgeon.

A patient with type 2 diabetes whose glucose is 212 mg/dL before lunch: Hyperglycemia at this level needs correction-scale insulin but is not an immediate threat in an otherwise stable patient.

Prioritize new, unexpected changes that threaten airway, breathing or circulation (such as post-thyroidectomy hypocalcemia) over expected, stable or chronic findings.

Answer: B

Make the calls for the new nurse until she gains confidence: Taking over removes the chance to practice and delays the new nurse's independence and competence.

Role-play SBAR, then observe and debrief after a real call: Correct. Practicing in a safe setting, coaching during a real call, and debriefing afterward with reflective feedback build both skill and confidence, in line with preceptor best practices.

Have the new nurse read the provider-notification policy: Reading the policy provides knowledge but not the practice and feedback needed to overcome hesitancy.

Report the hesitancy to the manager as a performance issue: Hesitancy is expected in a new graduate and is a coaching opportunity, not a performance problem at this stage.

Effective precepting: model, practice, observe, give feedback and reflect, gradually building the orientee's independence.