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CMSRN: Medication Management

Medication management is central to med-surg nursing and the CMSRN. These questions cover safe administration, monitoring for effects and adverse reactions, high-alert medications, and patient teaching — each with a full rationale.

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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 — this is exam-preparation material, not medical advice. Last reviewed August 2026.

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Test yourself: Medication Management

Three CMSRN practice questions on medication management — tap an answer for instant feedback. The app has 5,200+, timed and scored.

Question 1

69 of 125. On postoperative day 3, a 78-year-old with COPD on 2L O2 via NC develops sudden hypotension (82/50 mmHg) and bradycardia (48/min) 10 minutes after receiving IV hydromorphone 0.5 mg for incision pain. Which action aligns with high-alert opioid safety protocols?

▸ Why B is the answer

Bradycardia/hypotension after IV opioids suggest overdose requiring naloxone per ISMP high-alert protocols. Option B uses correct initial microdose to reverse respiratory depression without precipitating withdrawal. Option A addresses hypoxia but ignores opioid toxicity as primary cause. Option C treats hypotension but delays reversal of opioid-induced hemodynamic instability. Option D assesses but doesn't treat life-threatening symptoms. The elderly patient's COPD and recent surgery increase opioid sensitivity; slow push prevents abrupt reversal complications.

Question 2

88 of 125. During shift assessment, a nurse notes a 1.5 cm erythematous streak along a 48-hour dorsal hand IV site in a dehydrated patient. The site is warm but non-tender without swelling. What is the priority action?

▸ Why A is the answer

Localized erythema <2 cm without edema/pain suggests Grade 1 phlebitis per INS criteria. Reassessment monitors progression. Removal isn't yet indicated, eliminating B and C. Flushing (D) could worsen inflammation. Dehydration increases viscosity, predisposing to phlebitis. Topical antibiotics (B) aren't standard, and cold therapy (C) is for infiltration.

Question 3

6 of 125. A 68-year-old patient with atrial fibrillation taking warfarin 5mg daily reports new-onset bruising and fatigue. They started drinking cranberry juice daily 10 days ago and recently completed a course of sulfamethoxazole-trimethoprim for a UTI. INR today is 6.2. Which action best addresses the immediate risk?

▸ Why A is the answer

Elevated INR (6.2) with bleeding risk (bruising/fatigue) requires urgent reversal. Vitamin K IV corrects coagulopathy from warfarin potentiation by sulfamethoxazole-trimethoprim (CYP2C9 inhibition). Cranberry juice exacerbates risk but isn't the primary concern. Reducing warfarin (B) ignores acute bleeding risk. Monitoring alone (C) delays intervention. Enoxaparin (D) increases bleeding risk and doesn't address current over-anticoagulation. Guidelines prioritize reversal for INR >5 with bleeding.

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Question 1

33 of 125. During CVAD dressing change, a nurse observes purulent drainage and 2cm erythema. The patient reports tenderness but is afebrile. Which action reflects priority assessment?

  • A) A) Culture the drainage and document characteristics
  • B) B) Measure the erythema and reassess in 4 hours
  • C) C) Palpate the tunneled catheter track for cord-like thickening✓
  • D) D) Assess for systemic signs like chills or hypotension
Show rationale

Cord-like thickening indicates tunnel infection requiring urgent catheter removal. Culture (A) is secondary to assessing infection depth. Measuring erythema (B) delays intervention for advancing infection. Systemic signs (D) are absent per scenario; tunnel infection can exist without them. INS standards mandate tunnel assessment for localized symptoms.

Question 2

40 of 125. A postoperative patient's peripheral IV site has mild edema, skin tautness, and 2°C temperature difference but no pain or redness. The IV flushes easily. Which action is indicated?

  • A) A) Continue infusion and elevate the extremity✓
  • B) B) Remove the catheter and apply a warm compress
  • C) C) Slow the infusion rate and reassess in 1 hour
  • D) D) Document findings and change the dressing
Show rationale

These signs indicate grade 1 infiltration without compromise. Elevation promotes fluid absorption without catheter removal. Removal (B) is premature without pain/skin compromise. Slowing infusion (C) delays intervention for worsening symptoms. Dressing change (D) doesn't address infiltration. INS standards permit continued use for mild cases with monitoring.

Question 3

51 of 125. A patient with a prior mild rash to iodinated contrast reports itching and throat "fullness" during a CT scan. Vital signs are stable. What should the nurse do first?

  • A) A) Notify the radiology provider and prepare epinephrine✓
  • B) B) Give oral diphenhydramine and continue monitoring
  • C) C) Discontinue the contrast infusion and start normal saline
  • D) D) Apply a cool compress and reassure the patient
Show rationale

Throat symptoms suggest evolving anaphylaxis; guidelines mandate immediate provider notification and epinephrine readiness due to risk of rapid deterioration, even if vitals are initially stable. Option B may delay life-saving treatment; oral antihistamines are too slow for systemic reactions. Option C stops exposure but doesn't address potential airway compromise. Option D is inadequate for progressive allergic symptoms.

Question 4

57 of 125. A patient receiving vancomycin via a peripheral IV in the left cephalic vein reports sharp pain 30 minutes after initiation. Assessment reveals erythema extending 8 cm proximally, warmth, and a palpable cord. The infusion rate is correct. Which complication requires immediate intervention?

  • A) A) Infiltration due to catheter dislodgement
  • B) B) Phlebitis from chemical irritation✓
  • C) C) Extravasation of vesicant medication
  • D) D) Infection indicated by local inflammation
Show rationale

Vancomycin is a known irritant causing chemical phlebitis, evidenced by pain, erythema, warmth, and cord formation along the vein. Infiltration (A) lacks erythema/cord and typically presents with edema/coolness. Extravasation (C) involves vesicants (unlike vancomycin) with blistering/tissue necrosis. Infection (D) requires purulent discharge or systemic signs. CDC guidelines mandate line removal for grade ≥2 phlebitis to prevent progression.

Question 5

65 of 125. While assisting with hospice discharge, a nurse notes unused liquid morphine in a patient's home. The family mentions frequent visits by grandchildren and asks about safe disposal. No drug take-back sites exist locally. Which method balances safety and regulatory compliance?

  • A) A) Pour liquid into absorbent material before trash disposal✓
  • B) B) Dilute with water before flushing down the sink
  • C) C) Store in original container with child-resistant cap
  • D) D) Return to hospice for witnessed disposal
Show rationale

Absorbent material neutralizes liquid drugs per FDA household disposal guidelines, reducing ingestion risk for children. Flushing (B) contaminates water and violates DEA rules for controlled substances. Storage (C) maintains diversion risk. Returning to hospice (D) is ideal but impractical without staff availability. Discriminating cues: presence of children and controlled substance require immediate, secure disposal. Option A addresses both while meeting DEA exceptions for home disposal.

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CMSRN · Exam Simulator

33 of 125. During CVAD dressing change, a nurse observes purulent drainage and 2cm erythema. The patient repor…

A) A) Culture the drainage and document cha
B) B) Measure the erythema and reassess in
C) C) Palpate the tunneled catheter track f
D) D) Assess for systemic signs like chills
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