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CMSRN Exam Format and Question Count

The exam contains 150 multiple-choice questions, and you have exactly 180 minutes to finish. Out of these, 125 questions count toward your final score, while 25 are unscored pretest items.

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  • πŸ’‘ Key Takeaways β€” the one transferable rule per question
  • πŸ” Hint highlights β€” the decisive cue phrases in each stem
  • πŸ“– Full rationales β€” why every option is right or wrong

Every CMSRN question is written to the current exam outline for quick learning and a clear pass strategy.

Written and reviewed by the LexPort exam-prep team, led by our Founder & Exam-Prep Lead. LexPort builds certification practice questions β€” this is exam-preparation material, not medical advice. Last reviewed July 2026.

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5,200+ practice questions with rationales on iOS & Android

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How many questions are on the exam?
You will face 150 total multiple-choice questions. Only 125 of these are scored. The remaining 25 are unscored pretest items used to evaluate questions for future tests.
How much time do I have to complete the test?
You have 180 minutes to finish the exam. This gives you just over one minute per question, so pacing is critical.
What types of questions are on the test?
All items are multiple-choice with a single best answer. You will also see case studies that require you to apply clinical knowledge to specific patient scenarios.
How is the test delivered?
You take the exam through Pearson VUE. You can choose to test in person at a physical test center or use their OnVUE remote proctoring system from your home.
How are the scored questions divided by topic?
The 125 scored items are split across five domains. Patient/Care Management is the largest section with 40 items, making up 32% of your score.
What are the other domain question counts?
Nursing Teamwork and Collaboration has 26 items (21%). Elements of Interprofessional Care includes 21 items (17%). Holistic Patient Care and Professional Concepts each have 19 items (15%).
How many questions do I need to get right to pass?
You must achieve a standard scaled score of 95 to pass. This translates to answering approximately 71% of the scored questions correctly.
Can I tell which questions are the unscored pretest items?
No, the 25 unscored items are mixed randomly throughout the test. You must treat every question as if it counts toward your final score.
Where can I find more details on the specific case study formats?
Review the Medical-Surgical Nursing Certification Board (MSNCB) official handbook for exact details on how clinical scenarios are presented on test day.
Are there any fill-in-the-blank or alternate format questions?
The verified format relies entirely on single-best-answer multiple-choice items and case studies. If you need updates on alternate item types, check the MSNCB candidate guide.

What the questions actually look like

The format is one thing; the questions are another. Here are three realistic examples. The app has 5,200+, timed and scored.

Question 1

A nurse questions a unit policy for postoperative nausea management after encountering conflicting meta-analyses. One favors ondansetron, another aprepitant. The patient has prolonged QT interval. How should the nurse resolve this evidence conflict?

β–Έ Why C is the answer

Patient-specific risk (prolonged QT) necessitates checking if trials excluded cardiac comorbidities, directly addressing safety cues. Option A ignores evidence contradictions. Option B neglects clinical relevance to individual patients. Option D increases arrhythmia risk. EBP principles require appraising evidence applicability to patient context before application.

Question 2

During catheter care, a nurse notes sediment in tubing of a patient with neurogenic bladder. The catheter was placed 7 days ago for postoperative retention. Which action reflects CAUTI bundle maintenance standards?

β–Έ Why D is the answer

Routine catheter irrigation or replacement increases infection risk and is contraindicated for sediment without obstruction (IDSA guidelines). Neurogenic bladder requires cautious management; hydration may resolve sediment. Option A introduces pathogens via irrigation. Option B is unnecessary without flow issues. Option C is only indicated with infection symptoms. CAUTI bundles emphasize minimizing manipulation, making observation optimal here.

Question 3

A postoperative patient needs heparin injections. The unit has prefilled syringes ($1.80/dose) and vials requiring nurse-drawn doses ($0.30/dose). The nurse has 12 high-acuity patients. Which method optimizes fiscal and clinical efficiency?

β–Έ Why A is the answer

High patient acuity increases error risks with vial draws (discriminating cue: 12 high-acuity patients). Prefilled syringes enhance safety despite higher cost, aligning with Joint Commission med safety goals. Option B risks dosage inaccuracies and contamination. Options C/D create inconsistent practices. Safety justifies added expense when cognitive load threatens precision.

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CMSRN Β· Exam Simulator

A cancer patient with neutropenia and home IV antibiotics requires discharge. Their apartment has visible mold…

A) A) Teach fever monitoring twice daily
B) B) Coordinate temporary housing relocati
C) C) Provide N95 masks for home use
D) D) Arrange daily nurse visits for labs
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