Medical-Surgical Nursing Certification Practice Test

MSNCB test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Our affiliated professional association- the Academy of Medical-Surgical Nurses- offers the Medical-Surgical Nursing Certification Review Course. It is a 2-day course designed for nurses preparing to take the Certified Medical-Surgical Registered Nurse (CMSRN®) Certification Exam.

In order to meet the varied needs of nurses and facilities- AMSN offers the course in a number of live and independent study formats- including bringing it to your facility or accessing it through the AMSN Online Library.

An alternative to nurses preparing for the CMSRN test is the Focused CE Series- a collaboration between AMSN and nurse.com. The Focused CE Series is a blended learning model that combines weekly online CE course readings- weekly live webinar presentations- and an online forum for information exchange and networking with peers.

1. Helping Role
- Maintain an environment in which patient confidentiality is assured.
- Assess patient's level of comfort/pain.
- Act as an advocate to help patient meet needs/goals.
- Acknowledge- respect- and support emotional state of patient and/or family as they experience and/or express their emotions.
- Assist patients to achieve optimal level of comfort- using an interdisciplinary approach.
- Modify plan of care to achieve patient's optimal level of comfort- i.e.- pharmacological interventions- heat- cold- massage- positioning- touch- etc.
- Provide a therapeutic environment- considering privacy- noise- light- visitors'/providers' interaction with patients.
- Provide culturally competent patient care- including education.
- Support family involvement in accordance with patient's wishes regarding caregiving and decision making.
- Assess for potential for self-harm.
- Identify need of patient/family for support systems/resources and make appropriate referrals.
- Work on behalf of patient/family to help resolve ethical and clinical concerns.
- Coordinate care across multiple settings.
- Identify- acknowledge- support- and facilitate patient/family decisions regarding end-of-life care.
- Identify signs of domestic or intimate partner violence.
- Assess and provide for spiritual needs of patients and families.
- Identify ethical issues in clinical practice and facilitate a resolution with patient- family- and staff.

2. Teaching/Coaching Function
- Assess the patient's and family's readiness and ability to learn.
- Identify barriers to learning.
- Prepare/educate patient for transition in care- e.g.- discharge to home or other facility.
- Provide information and rationales related to diagnosis- procedures- self-care- prognosis- wellness- and modifiable risk factors.
- Utilize opportunities for spontaneous education.
- Encourage patient's and family's participation in establishing educational goals.
- Develop and implement an individualized teaching plan for patient and/or family.
- Evaluate and modify teaching plan based on achievement of pre-established and ongoing learning needs.
- Assist staff in identifying educational needs of patients and their families.
- Assist staff in selecting/developing educational materials appropriate for intended learner(s).
- Teach patient and family about available community resources.

3. Diagnostic and Patient Monitoring
- Conduct and document a comprehensive baseline assessment.
- Anticipate patient's response to treatment and monitor for potential problems.
- Reassess patient based on established standards of care at appropriate intervals.
- Interpret results of laboratory and diagnostic studies and take appropriate action.
- Use invasive and non-invasive methods to collect data.
- Analyze all patient data in formulating a plan of care.
- Participate in medication reconciliation at transitions of care.
- Anticipate the patient's response and needs related to physiological- psychosocial sexual- spiritual- and cultural aspects of his/her illness.
- Prioritize identified problems and modify the plan of care to achieve the best possible outcomes.
- Develop an individualized plan of care congruent with patient goals.
- Identify purpose and appropriateness of diagnostic studies.

4. Administering and Monitoring Nursing Interventions
- Administer medications accurately and safely.
- Identify subtle changes in patient's assessment to prevent deterioration of patient status.
- Assess patient's level of consciousness.
- Monitor patients for therapeutic responses- reactions- untoward effects- toxicity- and incompatibilities of administered medications.
- Implement measures to ensure adequate oxygenation and gas exchange.
- Monitor and implement measures to prevent alterations in skin integrity.
- Initiate- maintain- and monitor intravenous therapy.
- Identify- document- and report deviations from expected findings.
- Monitor for signs and symptoms of complications of disease processes.
- Implement measures to address threats to patient safety- e.g.- falls- seizures.
- Maintain patent airway.
- Maintain integrity and prevent infection of invasive drainage systems- e.g.- catheters- percutaneous drains.
- Implement measures to maintain adequate hydration and electrolyte balance.
- Provide care to patients on continuous cardiac monitoring.
- Use adaptive/assistive devices for mobility- immobility- positioning- and comfort.
- Interpret cardiac rhythm strips.
- Monitor for complications of musculoskeletal trauma and surgical procedures.
- Perform a neurovascular assessment- e.g.- extremities- flaps- grafts.
- Provide optimum nutrition during hospitalization- allowing for cultural and individual preferences.
- Identify and implement transmission-based precautions based on patient's history and symptoms.
- Monitor effectiveness of nutritional interventions.
- Develop and implement a wound management strategy.
- Care for patient receiving IV patient-controlled analgesia
- Perform central line dressing change.
- Administer heparin drip
- Apply and/or monitor devices used to immobilize affected area- e.g.- cast- splint- collar- etc.
- Care for patient receiving epidural analgesia
- Provide care for patients who have chest drainage systems.

5. Effective Management of Rapidly Changing Situations
- Recognize signs that a patients condition is deteriorating and take appropriate action.
- Obtain appropriate orders to address a change in the patients condition-
- Determine priorities in rapidly changing situations.
- Use existing guidelines/protocols/policies to respond to changing patient situations- e.g.- hypoglycemia- wound dehiscence.
- Use existing guidelines/protocols/policies to respond to urgent and emergent situations- e.g.- acute chest pain- stroke.
- Initiate basic life support.

6. Monitoring/Ensuring Quality Health Care Practices
- Communicate effectively to the healthcare team.
- Question/clarify orders as appropriate.
- Incorporate evidence-based practice into the patient's plan of care.
- Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes- e.g.- core measures.
- Report system failures- e.g.- chain of command- equipment- safety- medication administration- computer systems.
- Assist nursing staff in incorporating evidence-based practice and quality improvement into practice.
- Participate in quality improvement activities.
- Identify clinical problems for further investigation.

7. Organizational and Work-Role Competencies
- Practice in accordance with the rules and regulations of the state board of nursing in state(s) of licensure.
- Adhere to the Scope and Standards of Medical-Surgical Nursing Practice.
- Utilize electronic/computer resources to optimize patient care.
- Set priorities based on assignment- unit- and institutional needs.
- Act as a professional role model.
- Participate as an active member of the interdisciplinary healthcare team.
- Delegate patient care assignments based on competency levels and scope of practice of healthcare team members.
- Act as a resource for other nurses on the unit.
- Provide collaborative- interdisciplinary- coordinated care.
- Incorporate strategies that support effective team dynamics in a caring and nurturing environment.
- Evaluate own practice based on established standards of care.
- Evaluate nursing care based on outcome criteria.
- Recognize unsafe work practices (nurse/patient ratio- ergonomics- standard precautions- etc.) and intervene appropriately.
- Identify- develop- and implement strategies to reduce readmissions.
- Use the chain of command appropriately.
- Serve as consultant to nursing staff and other disciplines.
- Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes- e.g.- core measures.
- Identify- develop- and implement strategies to decrease length of stay while improving patient/family/staff satisfaction and patient care.
- Provide expert support to unit educators- preceptors- and nurse managers.
- Follow institutional policies and procedures in response to an internal or external crisis or event.
- Serve as preceptor/mentor for students and staff.
- Assist with data collection (e.g.- patient outcomes- nurse-sensitive indicators).

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Question: 64
Two hours ago the client had a left thoracotomy with a lobe resection. The
sanguineous drainage in the chest tube collection chamber is 325 mL. The nurse
recognizes that this is:
A. Normal chest tube drainage
B. Indicative of a pneumothorax
C. Chyle drainage
D. A sign of hemorrhage
Answer: D
Sanguineous drainage of greater than 100 mL/hr in the client who is in the
immediate postoperative period following a thoracotomy indicates hemorrhage.
The physician should be notified immediately. Normal chest tube drainage should
be less than 100 mL/hr. A pneumothorax occurs when there is air between the
visceral and the parietal pleura, which causes compression of the lung and results
in acute respiratory distress. Chyle drainage is a milky color that results from
disruption of the lymphatic drainage system.
Question: 65
65. In a client with right lung pneumonia, the nurse should encourage which
position to facilitate optimal oxygenation?
A. Prone position
B. Supine position with head elevated at 30 degrees
C. Positioned with the right side dependent
D. Positioned with the left side dependent
Answer: D
Positioned with the left side dependent. With unilateral lung disease, the example
to remember is "good lung down." Since ventilation and perfusion are gravity
dependent, enhancing ventilation and perfusion to healthy lung tissue and alveoli
will enhance oxygenation. Supine positioning would provide near equal
ventilation and perfusion to both lungs. In the diseased lung, excess fluid and
fibrosis inhibit gas exchange at the pulmonary capillary membrane, thereby
diminishing oxygenation.
Question: 66
What is a normal tidal volume for a client on a ventilator?
A. 5-7 ml/kg
B. 7-9 ml/kg
C. 9-11 ml/kg
D. 11-13 ml/kg
Answer: B
Normal tidal volume is 7-9 ml/kg or about 500 ml for an average-sized man
(approximately 75 kg).
Question: 67
67. A client with a left leg fracture is to be taught the three-point gait before
discharge. Which instruction should the nurse give to this client?
A. "your right crutch, swing the left foot forward, advance the left crutch, and
then bring the right foot forward."
B. "Move your right crutch and left foot forward together, and then swing the
right foot and left crutch in one movement."
C. "While partially bearing weight on your left leg, advance both crutches and
then bring your right leg forward."
D. "Using one movement, advance your left foot and both crutches and then bring
right leg forward."
Answer: D
In the three-point gait, both crutches and the affected "bad�" leg and foot move
together, with the unaffected "good"� leg and foot following. Choices A and B
are incorrect because the crutches are moved simultaneously, not independently.
Choice C is incorrect because the client should not bear weight on the fractured
leg when using the three-point gait.
Question: 68
68. Which assessment finding by the nurse has the most serious implication for a
70-year-old client with emphysema?
A. Increased anterior-posterior diameter of the chest
B. Bilateral crackles throughout the lung fields
C. Pursed-lip breathing
D. Circumoral cyanosis
Answer: B
Bilateral crackles throughout the lung fields indicate excessive pulmonary fluid
requiring acute intervention. Increased anterior-posterior diameter of the chest,
pursed-lip breathing, and circumoral cyanosis are chronic findings in clients with
emphysema. They do not indicate acute changes in the client's condition.
Question: 69
The nurse is encouraging a client who has undergone an amputation to
immediately fit a prosthesis. The advantage for this immediate action is:
A. Ability to ambulate sooner
B. Less chance of phantom limb sensation
C. Dressing changes are not necessary
D. Better fit of the prosthesis
Answer: A
When the prosthesis is in place immediately following surgery, the client can
stand up several hours postoperatively and walk the next day. The operative site is
closed to outside contamination and benefits from improved circulation due to
ambulation.
Question: 70
Mr. Sanchez visited a clinic for his timely medical check-up and brought with
him his hematology result. He informed the nurse that his physician is trying to
assess him for polycythemia vera. The laboratory findings for a client with
polycythemia vera include major and minor criteria. What is the major or defining
hematological finding?
A. Leukocytosis >12,000/mm3
B. Thrombocytosis >400,000/mm3
C. RBC count >6 million/mm3
D. Elevated leukocyte alkaline phosphatase
Answer: C
Polycythemia vera is a chronic myeloproliferative disorder characterized mainly
by erythrocytosis (increased RBC mass). Hemoglobin and hematocrit will be
elevated. Choices A, B, and D are also laboratory findings, but they are
considered minor criteria in this condition.
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