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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.

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 July 2026.

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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

An oncology medical-surgical nurse with 5 years' experience develops palpitations before shifts and avoids bereaved families. They report adequate staffing and supportive leadership. Which intervention directly addresses compassion fatigue?

▸ Why B is the answer

Peer debriefing (B) mitigates compassion fatigue by processing trauma, fitting this nurse's avoidance behavior and physical symptoms. Mandatory overtime (A) exacerbates stress. CBT (C) addresses insomnia but not trauma avoidance. Transferring (D) avoids rather than resolves trauma responses. The absence of systemic issues (adequate staffing/support) and trauma cues (palpitations, avoidance) confirm compassion fatigue. AMSN guidelines emphasize peer support for trauma-related symptoms.

Question 2

During medication shortages, a nurse allocates the last remdesivir dose to a 45-year-old with moderate COVID-19 on high-flow oxygen rather than a 50-year-old with mild symptoms but coronary disease. What ethical principle justifies this?

▸ Why A is the answer

Utility maximizes overall benefit by preventing progression to ICU. High-flow oxygen indicates higher decompensation risk than mild symptoms, aligning with CDC crisis protocols. Option B misapplies autonomy, which governs consent, not allocation. Option C is incorrect; neither patient is specified as immunocompromised. Option D misrepresents fidelity, which concerns promises, not guidelines. Discriminating cues: Moderate severity with oxygen support versus mild symptoms with chronic disease.

Question 3

A 68-year-old Vietnamese patient with metastatic bone cancer rates pain as 8/10 but refuses morphine, stating it "isn't necessary." The nurse notes stoic demeanor and family nodding in agreement. Which barrier most likely explains this response?

▸ Why B is the answer

The key cues—Vietnamese heritage, stoicism, family agreement, and refusal despite high pain—indicate cultural norms valuing quiet endurance. Option A lacks supporting evidence (no media mention). Option C is unsupported (insurance not discussed). Option D focuses on side effects without patient expression of cognitive concerns. Cultural competence standards (ANA) emphasize recognizing cultural pain expression variations. Distractors miss cultural context cues.

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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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