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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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  • 💡 Key Takeaways — the one transferable rule per question
  • 🔍 Hint highlights — the decisive cue phrases in each stem
  • 📖 Full rationales — 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.

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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

On postoperative day 5 after prostatectomy, a patient with metastatic cancer develops pleuritic chest pain. D-dimer is elevated, but CT angiogram is negative for PE. Which factor most strongly suggests alternative VTE testing?

Why B is the answer

HIT increases risk for thrombosis despite negative imaging, requiring alternative diagnostics like venous ultrasound per ACCP guidelines. Option A indicates reactive thrombocytosis, not directly VTE-related. Option C reflects anticoagulation management, not diagnostic need. Option D is common in many post-op conditions. HIT necessitates further investigation for occult DVT/PE due to paradoxical hypercoagulability.

Question 2

During tornado warnings, a nurse must decide evacuation timing for a patient 12 hours post-thyroidectomy with moderate neck swelling. The patient reports tightness when lying flat. Which clinical finding necessitates immediate horizontal evacuation?

Why B is the answer

Hoarseness suggests recurrent laryngeal nerve injury or hematoma compressing the trachea, risking airway obstruction—especially when supine during evacuation. AACN guidelines prioritize airway threats in disaster triage. Option A shows mild desaturation possibly from anxiety. Option C is expected postoperative drainage. Option D indicates tachycardia but no hemodynamic instability. The recent surgery and positional symptom are key cues requiring preemptive evacuation before respiratory arrest occurs.

Question 3

A patient with low health literacy requires teaching on complex wound care dressing changes before discharge home. The patient seems disengaged during verbal explanations. Which method best promotes learning and self-efficacy?

Why C is the answer

Return demonstration actively engages the patient, assesses comprehension kinesthetically (bypassing literacy limits), and builds confidence (self-efficacy). Written instructions (A) are ineffective with low literacy. Repetition (B) remains passive and doesn't assess understanding. Online videos (D) require tech access/literacy and lack personalization/correction. Cues (low health literacy, disengaged, complex task) demand active, observable practice.

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Get the full CMSRN question bank — free

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

CMSRN · 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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