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CMSRN: Non-Pharmacological Interventions

Not every intervention is a medication. This CMSRN area covers non-pharmacological care — pain management, positioning, wound care, and comfort measures — with questions and rationales that show when and why to use them.

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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: Non-Pharmacological Interventions

Three CMSRN practice questions on non-pharmacological interventions — tap an answer for instant feedback. The app has 5,200+, timed and scored.

Question 1

Four hours after abdominal surgery, a patient on therapeutic anticoagulation requests an ice pack for incisional pain. The incision has minimal serosanguinous drainage without ecchymosis. Which action is clinically appropriate?

▸ Why B is the answer

Intermittent cold therapy reduces inflammation without impairing healing. Option B limits exposure time and verifies coagulation status, crucial for anticoagulated patients. Option A's continuous application risks tissue damage. Option C provides inadequate targeted therapy. Option D's prolonged direct pressure may disrupt the incision. Per AMSN protocols, cold therapy duration should be minimized with bleeding risks.

Question 2

On post-op day 1 after abdominal surgery, a patient with opioid-naïve status and chronic back pain develops shallow respirations (RR 10/min) and rates pain 8/10. The nurse notes guarding and grimacing. Which relaxation technique aligns with ASPAN guidelines for early mobilization?

▸ Why C is the answer

Incentive spirometry promotes lung expansion and pain control through controlled inspiration, directly supporting post-op mobilization per ASPAN guidelines. Guarding indicates splinting, which IS counters by encouraging deep breaths. Muscle relaxation (A) risks incisional strain during tensing. Guided imagery (B) and mindfulness (D) lack immediate physiological impact on alveolar recruitment. Sustained inspiration in IS improves oxygenation and pain perception without opioid use, critical for opioid-naïve patients.

Question 3

A veteran with phantom limb pain and PTSD describes burning sensations when seeing wheelchair-bound peers. Which imagery technique addresses trauma associations while avoiding triggers?

▸ Why C is the answer

Neutral sensory imagery (C) addresses pain descriptors (burning) without triggering trauma memories. Pre-injury running (A) risks evoking loss grief. Medication visualization (B) may reinforce biomedical fixation. Combat rescues (D) could exacerbate PTSD. VA/DoD guidelines recommend non-associative imagery for comorbid pain/PTSD to avoid retraumatization.

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Question 1

During post-knee-replacement rehab, a patient develops a hematoma with moderate edema. Physical therapy is scheduled in 45 minutes. Which immediate intervention optimizes participation?

  • A) A) Ice massage directly on hematoma for pain modulation
  • B) B) Cold compression unit set to 50°F for continuous cooling
  • C) C) Contrast therapy alternating heat and cold applications
  • D) D) Cryocuff with intermittent cycles and elevation✓
Show rationale

Cryocuff combines cold therapy with compression, reducing edema without excessive vasoconstriction. Elevation enhances fluid shift, preparing for mobility. Option A's direct massage may displace clots. Option B's continuous cooling impedes blood flow needed for healing. Option C's contrast therapy is contraindicated in acute hematoma. AMSN protocols support intermittent cold-compression for acute post-op edema management.

Question 2

An elderly COPD patient with delirium tremens refuses medication due to paranoia. The nurse notes the patient fixating on ceiling tiles and mumbling about "spiders." Which immediate imagery intervention aligns with perceptual disturbances?

  • A) A) Redirecting to count respiratory droplets in a nebulizer
  • B) B) Suggesting transformation of tiles into calming cloud shapes✓
  • C) C) Describing a locked medication box visualization
  • D) D) Guiding a protective shield imagery against hallucinations
Show rationale

Redirecting fixation through positive transformation (B) uses existing perceptual focus (tiles) while avoiding confrontation. Nebulizer counting (A) ignores visual fixation cues. Medication-box imagery (C) may escalate paranoia. "Shield" imagery (D) reinforces threat perception. Delirium management guidelines prioritize non-confrontational sensory redirection over reality orientation during acute psychosis.

Question 3

A diabetic patient with peripheral neuropathy and a Wagner Grade 2 foot ulcer reports heel pain. Which repositioning strategy balances pressure redistribution and ulcer protection?

  • A) A) Supine with heel suspension boots✓
  • B) B) Lateral position with pillows between ankles
  • C) C) Chair sitting with footrest elevation
  • D) D) Trendelenburg with calf elevation
Show rationale

Heel suspension boots offload pressure completely, critical for neuropathic ulcers to prevent deterioration. Option B risks ankle friction on pillows. Option C increases pressure during sitting, delaying healing. Option D elevates legs but lacks heel-specific offloading. The cue combination (neuropathy + existing ulcer) requires maximum pressure redistribution per Wound, Ostomy and Continence Nurses Society guidelines, making A optimal.

Question 4

A diabetic patient with chemotherapy-induced neuropathy reports 7/10 burning foot pain and states, "I can't relax." Vital signs are stable. Which technique combines breath control and sensory focus per NCCN distress guidelines?

  • A) A) Breath-focused meditation with cool compress application✓
  • B) B) Paced breathing while visualizing pain dissolving
  • C) C) Clenching fists during inhalation then rapid release
  • D) D) Abdominal breathing with progressive toe tension
Show rationale

NCCN guidelines recommend combining sensory interventions (cool compress for neuropathic pain) with breath meditation for synergistic distress reduction. Paced breathing alone (B) lacks sensory modulation. Fist clenching (C) may increase sympathetic arousal. Toe tension (D) exacerbates neuropathic pain. Cool compresses target peripheral neuropathy while breath meditation lowers central pain processing, addressing both physiological and cognitive aspects.

Question 5

A postoperative patient with a history of seizure disorder reports severe nausea. The nurse considers aromatherapy. Which essential oil choice demonstrates appropriate clinical judgment?

  • A) A) Peppermint oil applied to a wristband
  • B) B) Lavender oil in a bedside diffuser✓
  • C) C) Rosemary oil on a tissue for inhalation
  • D) D) Bergamot oil mixed with carrier oil for temple massage
Show rationale

Lavender is safe for nausea management and has low seizure risk, aligning with AMSN guidelines for neurological comorbidities. Peppermint (A) may lower seizure threshold. Rosemary (C) is contraindicated in seizure disorders due to neurostimulant effects. Bergamot (D) causes photosensitivity and lacks strong anti-nausea evidence. The diffuser method minimizes direct contact risks while addressing nausea.

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CMSRN · Exam Simulator

During post-knee-replacement rehab, a patient develops a hematoma with moderate edema. Physical therapy is sch…

A) A) Ice massage directly on hematoma for
B) B) Cold compression unit set to 50°F for
C) C) Contrast therapy alternating heat and
D) D) Cryocuff with intermittent cycles and
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