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Certified Medical-Surgical Registered Nurse Practice Test

CMSRN exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

- Nursing process - assessment, diagnosis, planning, implementation, evaluation
- Patient safety protocols
- skin
- falls
- restraints
- rounding
- suicide
- Risk factors
- pharmacological
- environment
- equipment
- demographics
- Patient safety culture
- near miss reporting
- "just culture"
- "speak up"
- high accountable organizations
- Care bundles
- checklist
- algorithms

- Patient safety assessments and reporting
- abuse
- human trafficking
- social determinants
- Risk assessment methods
- Root Cause Analysis [RCA]
- Failure Mode and Effects Analysis [FMEA]
- safety rounds, safety huddles
- Universal and transmission-based precautions
- Infection control practices and standards

- Current evidence-based practice for infection control and prevention procedures
- Antimicrobial stewardship
- surgical scrub
- antibiotics
- probiotics
- Safe medication administration practices
- interaction
- adverse reaction
- intravenous therapy
- Patient medication education
- Polypharmacy

- Safe drug management and disposal (e.g., stewardship, home medication management)
- Advanced access devices (i.e., ports, central lines, epidurals)
- Financial implications to patients
- Chronic and/or acute pain management (e.g., pharmacological, non-pharmacological, multimodal)

- Patient pain management expectations
- Patient advocacy Non-Pharmacological Interventions
- Non-pharmacological interventions (e.g., repositioning, heat or cold)
- Complementary and alternative therapies (e.g., acupuncture, aromatherapy)
- Pre- and post-procedural unit standards (e.g., consent, timeout, frequent monitoring)

- Pertinent potential complications and management
- Scope of practice related to procedures (e.g., moderate/procedural sedation)
- Supplies, instruments, and equipment
- Individualized nutritional needs (e.g., malnutrition, disease processes, complications, cultural)

- Nutrition administration modalities (e.g., enteral, parenteral)
- Resources for alternate nutrition administration (e.g., speech consultation, dietary consultation)
- Indications for alternate nutrition administration

- Patient-centered care (e.g., active listening, communication preferences, family involvement, health goals.
- Resources for patient-centered care
- Patient advocacy
- Patient satisfaction management (e.g., grievances, concerns regarding practices, second opinion, service recovery)
- Cultural and linguistic needs (e.g., sign, oral, and written languages)
- Cultural and linguistic resources (e.g., translated materials, interpreter services)
- Implicit bias
- Health maintenance and disease prevention
- Health literacy
- Teaching methods

- Health promotion goals
- Resources available for patient/family
- Health information to meet patient needs
- Palliative or end-of-life patient/caregiver resources (e.g., hospice, spiritual, cultural, physical)

- End-of-life preferences (e.g., advance directives, code status)
- Post-mortem care
- Organ donation process
- Regulatory requirements for reporting death (e.g., coroner's case)

- Nursing process - assessment, diagnosis, planning, implementation, evaluation
- Strategies to individualize care
- Role within the interdisciplinary team (e.g., teamwork, communication skills)
- Interprofessional rounding
- Care coordination
- Collaborative problem solving

- Community resources
- Interdisciplinary collaboration integration methods (e.g., discharge planning, mobility, physical therapy)
- Health history assessment from multiple sources
- Discharge procedures (e.g., medication reconciliation)
- Patient/family centered care

- Care coordination and transition
- Interprofessional roles and responsibilities
- Continuum of care
- Patients at risk for readmissions
- Social determinants of health
- Quality patient outcome measures

- Documentation of patient care
- Electronic health records
- Downtime procedures
- Coaching for documentation performance improvement
- Technology, equipment use, and troubleshooting
- Technology trends in health care
- Nursing informatics

- Chain of command
- Communication skills (e.g., active listening, verbal, non-verbal, written, conflict resolution, mediation)
- Information sharing (e.g., Situation, Background, Assessment, Recommendation [SBAR], hand-off, closed-loop, check- back, read-back, huddle, verbal orders, bedside report, interdisciplinary)

- Communication barriers (e.g., need for interpreter/translator, physical and cognitive limitations)
- De-escalation techniques (e.g., verbal intervention, calm communication)
- Time management and prioritization of care
- Crisis situations and resources (e.g., rapid response team, deteriorating patients, early warning systems)
- Crisis management

- Critical thinking
- self-regulation
- problem solving
- analysis
- interpretation
- inference
- Workplace safety
- physical
- emotional
- environmental
- Nurse resiliency and well-being
- Unintended consequences
- moral distress
- moral injury
- compassion fatigue
- burnout

- Resource allocation (e.g., staffing, equipment)
- Peer accountability
- Scope of practice and code of ethics for nurses per local and regional nursing bodies
- Code of Ethics for Nurses with Interpretive Statements
- Standard V of the AMSN Scope and Standards
- local governing Scope of Practice
- Patients’ rights and responsibilities

- Professional reporting and resources (e.g., ethics, scope of practice, unsafe practice)
- Policies, procedures, regulatory and licensure requirements, standards of practice, and applicable state, federal, and local laws
- Evidence-based guidelines for nursing sensitive indicators
- Quality standards and policies
- Continuous quality and process improvement
- Nursing professional practice model

- Adverse event reporting
- Patient customer experience based on data results (e.g., surveys, value-based purchasing)
- Service recovery
- Project development
- Legislative and licensure requirements
- Evidence-based practice principles
- Research process

- Delegation and/or supervision practices
- Scope of practice (e.g., licensed and unlicensed team members)
- Prioritization skills (e.g., disease process)
- Budgetary considerations (e.g., supplies, staffing, fiscal efficiency)

- Professional engagement
- Mentoring and coaching resources
- Reflective practice
- Roles and responsibilities
- Coaching and learning theories
- Professional empowerment

- Orientation planning and preceptor best practices
- Career development resources (e.g., education, training)
- Professional nursing practice and individual competencies
- Professional behaviors (e.g., network, participate in professional organization)

- Clinical judgement
- Peer review methods
- Educational needs assessment
- Regulatory and compliance standards
- Organizational structure
- Shared decision-making
- Nursing philosophy
- Leadership models
- Nursing care delivery systems
- Change management (e.g., Awareness, Desire, Knowledge, Ability, Reinforcement [ADKAR])
- Recruitment and retention
- Employee engagement
- Staff advocacy
- Conflict management
- Financial stewardship
- Emergency procedures
- Hospital incident command structure

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Question: 1046
When discussing end-of-life preferences, which of the following documents should be emphasized to ensure patients' wishes are respected? (Select All That Apply)
1. Living wills outlining treatment preferences
neral hospital admission forms vance healthcare directives
er: A, B, D
nation: Living wills, POLST forms, and advance healthcare directives are crucial for ensurin s' end-of-life preferences are honored. General hospital admission forms do not provide spe ves regarding treatment preferences.
ion: 1047
nurse is reviewing the discharge procedures for a patient with diabetes who has been hospitalize ection. Which of the following actions is most critical during medication reconciliation to pr
outcomes after discharge?
suring the patient understands the purpose and dosage of each medication viding the patient with a printed list of medications
ifying the patient's allergies to medications before discharge heduling a follow-up appointment with the primary care provider
er: A
nation: Ensuring the patient understands the purpose and dosage of each medication is crucial nce and preventing medication errors, which can lead to adverse outcomes after discharge.
Physician Orders for Life-Sustaining Treatment (POLST)
2. Ge
3. Ad
Answ
Expla g that
patient cific
directi
Quest
A d for
an inf event
adverse
1. En
2. Pro
3. Ver
4. Sc
Answ
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adhere
Question: 1048
While preparing for organ donation, the nurse must consider the ethical implications of the process. Which of the following statements reflects an ethical consideration that must be taken into account?
1. Organ donation is always in the best interest of the donor's family
2. The process of organ donation should only be discussed after the family has grieved
3. All healthcare providers must advocate for organ donation regardless of personal beliefs
4. The donor�s wishes must be prioritized over family opinions Answer: D
Explanation: The ethical principle of autonomy dictates that the wishes of the donor must take precedence, highlighting the importance of honoring the individual's preferences regarding organ donation.
ion: 1049
of your unit's focus on improving patient safety, you learn about a latest study suggesting rounding by nursing staff can reduce falls. What is your first step in implementing this evid ractice?
cuss the findings with the nursing team aluate existing fall rates to establish a baseline nduct a pilot program on one shift
velop a schedule for hourly rounding er: B
nation: Evaluating existing fall rates establishes a baseline, allowing for measurable comparis mplementing the hourly rounding practice to assess its effectiveness.
ion: 1050
a care coordination meeting, which two factors should the nurse emphasize to address the ex needs of a patient with mental health issues?
importance of medication adherence and routine follow-ups necessity of avoiding discussions about the patient's feelings
Quest
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hourly ence-
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1. Dis
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3. Co
4. De
Answ
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after i
Quest
During compl
1. The
2. The
3. The role of community resources in supporting recovery
4. Relying on family members to manage the patient�s care Answer: A, C
Explanation: Emphasizing medication adherence and the role of community resources fosters a comprehensive approach to managing both mental and physical health needs.
Question: 1051
A nurse is caring for a patient who has just been diagnosed with a chronic illness. The patient expresses feelings of hopelessness and uncertainty about their future. How should the nurse prioritize their approach to address these emotional concerns?
1. Refer the patient to a mental health specialist immediately
2. Encourage the patient to focus on positive aspects of their life
3. Provide information about the illness and treatment options to empower the patient
nation: Providing information about the illness and treatment options empowers the patient a ses their feelings of hopelessness by giving them a sense of control over their health journey
ion: 1052
nurse is caring for an elderly patient who has multiple comorbidities and is at risk for malnutriti assessment finding would be the most significant indicator of impending malnutrition in thi
patient?
reased appetite and weight gain
nsistent dietary intake with no reported symptoms rmal laboratory values for albumin and prealbumin intentional weight loss and muscle wasting
er: D
nation: Unintentional weight loss and muscle wasting are significant indicators of impending trition, particularly in elderly patients with comorbidities, and warrant immediate interventio
Schedule a follow-up appointment to reassess the patient's emotional state Answer: C
Expla nd
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2. Co
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Question: 1053
Which of the following are crucial considerations for nurses when addressing implicit bias in patient care? (Select All That Apply)
1. Regularly attending workshops on diversity and inclusion
2. Assuming a universal approach to patient care
3. Engaging with patients to understand their unique backgrounds
4. Reviewing and reflecting on personal biases during patient interactions
Answer: A, C, D
Explanation: Ongoing education and engagement with patients help reduce implicit bias, while assuming a universal approach can alienate patients and lead to suboptimal care.
Question: 1054
What are the critical considerations for nurses when implementing infection control standards in a facility, particularly concerning transmission-based precautions? (Select All That Apply)
uming droplet precautions are unnecessary if the patient is not exhibiting symptoms
uring proper signage is posted on the door of patients requiring transmission-based precauti viding appropriate PPE to all staff and visitors entering the patient�s room
er: A, C, D
nation: Contact precautions are essential for patients with multi-drug resistant infections, and ensures awareness of precautions. Providing appropriate PPE is critical for protecting staff
s. Assuming droplet precautions are unnecessary without symptoms is incorrect, as transmis cur even before symptoms appear.
ion: 1055
naging multiple patients, a nurse must prioritize care for a patient who is exhibiting signs of hould the nurse do first?
minister prescribed antibiotics
ify the healthcare provider immediately ain blood cultures before antibiotics nitor vital signs every 15 minutes
er: C
nation: Obtaining blood cultures before administering antibiotics is vital for accurate diagnos
Utilizing contact precautions for patients with known or suspected multi-drug resistant infections
Ass
Ens ons
Pro Answ
Expla proper
signage and
visitor sion
can oc
Quest
In ma sepsis.
What s
1. Ad
2. Not
3. Obt
4. Mo
Answ
Expla is and
treatment of sepsis, as it allows for identification of the causative organism, which is critical for effective antimicrobial therapy.
Question: 1056
During a coaching session, a nurse expresses that she feels unprepared to handle complex patient situations. What is the most effective response a coach can provide to empower her to develop her skills?
1. Advise her to avoid such situations until she feels ready
2. Reassure her that many nurses feel the same way and it's normal
3. Suggest specific resources and strategies to build her confidence and skills
4. Discourage her from pursuing complex cases in the future Answer: C
ion: 1057
paration for a patient�s discharge to home health care, which two actions should the nurse ta continuity of care?
vide generic discharge instructions without personalization nfirm that home health services are scheduled and ready to begin
cuss the patient's post-discharge needs with the home health nurse sume the patient will remember all verbal instructions given
er: B, C
nation: Confirming home health services and discussing needs with the home health nurse ar al for continuity of care and ensuring the patient receives appropriate follow-up.
ion: 1058
nurse is providing post-mortem care and needs to ensure the patient's body is prepared for transf orgue. Which action should the nurse take to maintain the body�s dignity?
tify the family that they cannot view the body until after transfer ve the body uncovered until the family arrives
Explanation: Providing specific resources and strategies empowers the nurse to take proactive steps toward skill development, enhancing her confidence and preparedness for complex situations.
Quest
In pre ke to
ensure
1. Pro
2. Co
3. Dis
4. As
Answ
Expla e
essenti
Quest
A er to
the m
1. No
2. Lea
3. Place the body in a standard hospital gown without any additional care
4. Close the eyes and place a clean cloth over the face Answer: D
Explanation: Closing the eyes and placing a clean cloth over the face helps to maintain the dignity of the deceased, preparing them respectfully for transfer to the morgue.
Question: 1059
In the context of patient advocacy, which of the following scenarios best illustrates the nurse's role in ensuring informed consent is adequately obtained?
1. The nurse ensures the patient has all their questions answered before signing.
2. The nurse witnesses the patient signing the consent form without discussing the procedure.
3. The nurse explains the procedure to the patient before they see the physician.
nation: Ensuring that the patient has all their questions answered before signing the consent f for patient advocacy and informed consent, allowing the patient to make an informed decisi
ion: 1060
a routine assessment, a nurse discovers that a patient has not been following their diabetes ement plan. The patient cites confusion over dietary recommendations as the primary reason
ost effective intervention the nurse can implement to address this issue?
vide a comprehensive diet manual for the patient to read
edule a one-on-one teaching session focused on dietary management ume the patient understands and move on to medication education er the patient to a dietitian without further discussion
er: B
nation: A one-on-one teaching session allows for personalized education, addressing the spec ion the patient has regarding dietary recommendations and improving management.
The nurse summarizes the procedure only after the patient has consented. Answer: A
Expla orm is
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Question: 1061
In the context of abuse reporting in healthcare, which of the following practices are essential to ensure effective intervention? Select All That Apply.
1. Training staff to recognize signs of various types of abuse.
2. Establishing a clear protocol for reporting and documentation.
3. Discussing suspected abuse cases openly in staff meetings.
4. Providing support resources for victims of abuse.
Answer: A, B, D
Explanation: Training, clear protocols, and support resources are vital for effective intervention. Open discussions about cases can violate confidentiality.
Question: 1062
ntact the physician to confirm the medication cessation
ucate the patient about the risks of discontinuing the medication cument the medication change in the patient�s chart
nitor the patient for any signs of clotting issues er: A
nation: Contacting the physician to confirm the medication cessation is critical to ensuring th receives appropriate care and management of their anticoagulant therapy prior to the proced
ion: 1063
two elements are critical in the documentation of patient care to ensure compliance with leg standards?
ng subjective language to enhance the narrative uring accuracy and timeliness of entries
cumenting only significant events and ignoring routine care gularly updating documentation based on new assessments
er: B, D
A nurse is reviewing a patient's chart and notices that the patient's medications include a high-risk anticoagulant. The patient is scheduled for a procedure that requires temporary discontinuation of the medication. What should the nurse prioritize to ensure patient safety before the procedure?
1. Co
2. Ed
3. Do
4. Mo
Answ
Expla at the
patient ure.
Quest
Which al and
ethical
1. Usi
2. Ens
3. Do
4. Re
Answ
Explanation: Ensuring accuracy and timeliness protects against legal issues, while regularly updating documentation reflects the current status of the patient and supports continuity of care.
Question: 1064
In reviewing a medication list for a patient experiencing polypharmacy, which of the following should the nurse prioritize in their assessment?
1. Ensuring that all medications are taken at the same time daily.
2. Identifying potential drug-drug interactions and assessing the patient's understanding of their medications.
3. Advising the patient to stop taking all medications that are not effective.
4. Focusing solely on prescription medications and disregarding over-the-counter drugs. Answer: B
ion: 1065
nurse is assessing a patient�s pain level using the Numeric Rating Scale. The patient rates their p ut of 10. What is the most appropriate nursing intervention based on this assessment?
nsult the physician for potential changes in the pain management plan. cument the pain level and continue with the care plan.
assure the patient that pain will diminish with time.
minister the prescribed pain medication and reassess in 30 minutes. er: D
nation: Administering prescribed pain medication and reassessing ensures that the patient's ac managed promptly and effectively.
ion: 1066
onducting a patient satisfaction survey, your department receives feedback indicating sfaction with wait times. What is the most effective approach to enhance patient customer ence based on this data?
Explanation: Assessing for potential drug-drug interactions and evaluating the patient's understanding of their medications are critical for ensuring safe medication management in patients experiencing polypharmacy.
Quest
A ain as
an 8 o
1. Co
2. Do
3. Re
4. Ad
Answ
Expla ute
pain is
Quest
After c dissati experi
1. Increase the number of staff during peak hours
2. Reduce appointment slots to manage time better
3. Conduct follow-up interviews with dissatisfied patients
4. Implement a patient tracking system to provide real-time updates Answer: D
Explanation: Implementing a patient tracking system can significantly enhance the customer experience by keeping patients informed about their wait times, thereby reducing frustration and improving overall satisfaction.
Question: 1067
During a routine assessment, the nurse notes that a patient on parenteral nutrition has developed signs of hyperglycemia. What is the most appropriate nursing intervention?
1. Increase the rate of parenteral infusion
continue the parenteral nutrition immediately minister insulin as prescribed
er: D
nation: Administering insulin as prescribed is the appropriate intervention for managing glycemia in patients receiving parenteral nutrition, ensuring blood glucose levels are maintai
a safe range.
ion: 1068
ent is prescribed a new medication regimen that includes an opioid analgesic and an antibioti the most critical nursing assessment for this patient?
sessing the patient's pain level frequently. nitoring for signs of constipation.
uring the patient understands how to take the medications. aluating renal function due to potential drug interactions. er: D
nation: Monitoring renal function is critical because both opioids and certain antibiotics can function. Adverse interactions can occur, especially in patients with preexisting conditions.
Switch to enteral nutrition
2. Dis
3. Ad
Answ
Expla
hyper ned
within
Quest
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What is
1. As
2. Mo
3. Ens
4. Ev
Answ
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kidney
Question: 1069
In preparing a care plan for a patient with chronic pain, which component is essential to include in the evaluation phase to measure the effectiveness of the interventions?
1. Assessment of the patient's range of motion.
2. Documentation of medication administration times.
3. Review of the patient's medical history for previous treatments.
4. Patient's report of pain level post-intervention. Answer: D
Explanation: The patient's self-report of pain level post-intervention directly measures the effectiveness of the pain management strategies implemented in the care plan.
Question: 1070
onducting a patient hand-off, which two practices are essential to minimize the risk of mmunication and ensure safety?
gaging the receiving nurse in an interactive discussion of the patient�s status viding information solely through electronic documentation
mmarizing key points and inviting questions for clarity miting the hand-off duration to avoid taking too much time
er: A, C
nation: Engaging the receiving nurse and summarizing key points with opportunities for ques clear communication and reduces the likelihood of errors.
When c misco
1. En
2. Pro
3. Su
4. Li
Answ
Expla tions
fosters

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