CMSRN Study Guide: All-In-One Guide + 4 Exam Practice Test (1200 Questions), Latest for Certified Medical Surgical Registered Nurse (CMSRN), OrganizationName AMSN

A 68-year-old patient with severe COPD, chronic heart failure (CHF), and depression is being discharged after hospitalization for an acute exacerbation. During interdisciplinary rounds, the nurse notes the patient requires supplemental oxygen at rest (new since admission), expresses reluctance about home health services due to “strangers in my house,” and historically managed ADLs independently. The discharge coordinator plans for standard home health nursing visits. Which action by the nurse best individualizes care within the interprofessional team?

A 62-year-old Spanish-speaking patient, Mr. Alvarez, with limited English proficiency (LEP) is being discharged following an uncomplicated laparoscopic cholecystectomy on a busy medical-surgical unit. His family is unavailable. The nurse must provide written discharge instructions, including wound care, medication schedules (including a new anticoagulant), and signs of complications. Which action by the nurse best addresses Mr. Alvarez’s linguistic needs and ensures safe discharge?

When initiating conflict resolution between healthcare team members to de-escalate tension while preserving professional relationships, which communication technique is most effective according to established professional standards?

A 58-year-old male patient with Type 2 diabetes mellitus is admitted to the medical-surgical unit for cellulitis. His blood glucose is 285 mg/dL, and the provider orders subcutaneous sliding scale insulin. The patient, who follows specific religious dietary practices, expresses strong reluctance, stating, “I believe medications like insulin interfere with my body’s natural healing given by God.” The nurse recognizes the elevated glucose level requires intervention. What is the nurse’s priority action to uphold patient-centered care principles?

According to evidence-based guidelines for moderate/procedural sedation administered by a registered nurse, which physiological change observed during post-procedure monitoring necessitates immediate physician notification?

A 68-year-old patient, postoperative day 3 from a bowel resection, is recovering well physically but appears withdrawn. During morning assessment, the nurse notes the patient tearfully states, “I just don’t feel at peace… like something’s unfinished,” despite denying pain or complications. The unit chaplain is currently available, but the nurse has 10 minutes before scheduled medication administration. Based on holistic patient-centered care principles, what is the nurse’s priority action?

A 72-year-old patient admitted for pneumonia fell in their hospital room. The Medical-Surgical nurse assesses the patient, finding new-onset confusion (previously alert and oriented), a small scalp hematoma, and vital signs within baseline. The patient is prescribed warfarin for atrial fibrillation. The nurse pages the covering hospitalist but is informed they are in an emergency procedure and unavailable for at least 45 minutes. Which action by the nurse best demonstrates effective interdisciplinary collaboration integration for immediate care coordination?

A 68-year-old patient is post-op day 2 from a total hip arthroplasty. The physical therapist (PT) documented a mobility plan this morning: “Ambulate with walker, weight-bearing as tolerated (WBAT) x 3 today, supervise for safety.” During afternoon care, the patient expresses significant fear of falling and refuses to ambulate with the nurse, stating, “I only feel safe walking when the therapist is here.” The nurse assesses the patient as alert, vital signs stable, and incision clean/dry/intact. The PT has left for the day. What is the nurse’s priority action to ensure safe mobility progression and effective interdisciplinary care?

A 72-year-old patient is admitted to a medical-surgical unit post-appendectomy. The nurse notes the patient has an unsteady gait, requires an IV pole for continuous fluids, and the call light is currently clipped to the far side of the bed rail, out of immediate reach. Which environmental modification is the *priority* action by the nurse to mitigate fall risk?

When implementing a new evidence-based practice (EBP) requiring an advanced assessment skill, what primary legislative/licensure source must a medical-surgical nurse consult first to determine if performing this skill falls within their legal scope of practice?

A nurse is administering a packed red blood cell (PRBC) transfusion to a post-operative patient with thrombocytopenia via an infusion pump. Mid-transfusion, the pump alarms with an “Upstream Occlusion” alert. The nurse notes the blood bag appears full and the IV tubing leading to the patient’s 20-gauge peripheral IV site has no visible kinks. The patient reports no discomfort at the site. Which action should the nurse take *first*?

A 68-year-old male patient with diabetes mellitus and chronic kidney disease (stage 3) was admitted 48 hours ago for community-acquired pneumonia. He was started on ceftriaxone and azithromycin. His initial fever was 38.8°C (101.8°F), WBC was 14,000/mm³, and he had productive cough. On day 3, his temperature is 38.2°C (100.8°F) (down from 39.1°C/102.4°F this morning), his WBC is 16,500/mm³, and he reports feeling slightly improved. The nurse reviews the antimicrobial stewardship policy. What is the *most* appropriate nursing action regarding antibiotic therapy at this time?

A 64-year-old patient is 4 hours post-total thyroidectomy on the medical-surgical unit. Vital signs are stable, but the nurse notes new, mild inspiratory stridor and a fine tremor in the patient’s fingers. The patient denies pain or difficulty breathing but appears slightly anxious. According to post-thyroidectomy unit standards requiring frequent monitoring for complications, which action should the nurse prioritize *first*?

When managing a malnourished patient exhibiting hypophosphatemia, hypokalemia, and new cardiac arrhythmias shortly after initiating total parenteral nutrition (TPN), which action is the immediate priority based on standards for preventing complications?

A 68-year-old patient is 48 hours post-op right total knee arthroplasty. They report moderate pain (5/10) and significant swelling at the surgical site. The nurse notes diminished sensation to light touch in the right foot compared to the left. The surgeon’s post-op orders include “PRN non-pharmacological interventions for pain and edema.” Which intervention should the nurse implement *first*?

A nurse on a busy medical-surgical unit discovers that a peer consistently documents medication administration more than 24 hours after administration, violating hospital policy. The charge nurse suggests discussing this lapse during the next shift huddle for “peer accountability.” The observing nurse is concerned this public approach may damage team trust. What is the *most* appropriate action for the observing nurse to take regarding peer review?

A nurse is assessing a patient on post-operative day 2 following an open appendectomy. The patient has a midline lower abdominal incision closed with staples. Assessment reveals moderate serosanguinous drainage saturating the current gauze dressing. The surrounding skin is intact without erythema. The surgeon’s orders state “Dressing change PRN.” The nurse’s priority is to select a dressing that effectively manages drainage while minimizing disruption to the incision site to reduce infection risk. Which dressing supply is most appropriate for the nurse to select at this time?

According to best practices for culturally competent palliative care, when should a comprehensive cultural assessment primarily be integrated into the care planning process for a patient newly referred to palliative services?

A medical-surgical nurse reads a recent high-quality Cochrane systematic review concluding that sterile saline is equally effective as antiseptic solutions for cleansing clean, uncomplicated surgical wounds and reduces skin irritation. The nurse’s unit protocol mandates povidone-iodine for all post-operative wound care. When the nurse discusses the review findings with the charge nurse, the charge nurse states, “We must follow our current policy.” What is the nurse’s most appropriate *next* action to promote evidence-based practice?

A 62-year-old patient with limited health literacy is being discharged after treatment for a myocardial infarction (MI). The patient expresses anxiety about managing new medications at home, stating, “I’m not sure I can remember all these pills, and they cost so much.” The nurse observes the patient struggling to explain the purpose of clopidogrel during teach-back. Which action by the nurse best addresses the patient’s holistic health information needs within discharge planning constraints?

When addressing a key driver of patient dissatisfaction related to unmet expectations during hospital discharge, which action by the medical-surgical nurse demonstrates the most effective application of patient-centered care principles?

When prioritizing patients for enhanced Care Coordination and Transition Management (CCTM) interventions to prevent hospital readmissions, which factor is considered the strongest independent predictor based on widely accepted evidence?

A 68-year-old patient with end-stage COPD is admitted for worsening dyspnea and anxiety. Goals of care are comfort-focused. The patient is agitated, tachypneic (RR 32), using accessory muscles, and SpO2 is 88% on 2L NC. The daughter is fanning the patient vigorously but ineffectively near the face, increasing agitation. The nurse has administered prescribed PRN morphine sulfate 2mg IV and lorazepam 0.5mg IV 15 minutes ago with minimal improvement. Which resource should the nurse prioritize activating *now* to address the patient’s physical distress?

When demonstrating active listening to a patient expressing anxiety about an upcoming procedure, which action by the nurse is *most* critical for accurately understanding the patient’s perspective?

A medical-surgical nurse on a postoperative unit identifies a recurring issue: delays in administering the first scheduled analgesic dose post-admission from PACU, occurring 3 times in the past week. A colleague suggests creating a new handoff checklist. The unit has a policy requiring timely pain management but lacks a standardized handoff process for analgesic administration timing. The nurse wants to implement a sustainable improvement strategy aligned with quality principles. What is the nurse’s most appropriate initial action?

According to professional standards for nursing teamwork and career development, when should a medical-surgical registered nurse initiate a formal competence review process for a peer demonstrating unsafe practice?

When applying the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) prioritization framework in medical-surgical nursing, which patient condition identified during initial assessment necessitates the *most immediate* nursing intervention?

A 62-year-old patient is admitted to the medical-surgical unit post-appendectomy. The nurse enters the room to administer the first dose of IV antibiotics. While reviewing the medication, the nurse notices the patient frowning at the IV bag and hesitating before asking, “Is this the same one they gave me yesterday? It looks different.” The nurse recalls the patient seemed overwhelmed during the morning shift change handoff and has a history of mild hearing loss. The unit is currently busy with multiple admissions. Which action by the nurse best supports the “Speak Up” initiative for patient safety?

A registered nurse (RN) on a busy medical-surgical unit is administering 0900 medications when a certified nursing assistant (CNA) reports that Mr. Jacobs, a post-operative day 2 hip replacement patient, is newly confused and has a blood pressure of 150/90 mmHg (baseline 120/70s). The CNA asks if she should recheck his vital signs in 15 minutes. The RN has two critical medications due for other patients. Which action by the RN is *most* appropriate?

A charge nurse on a busy medical-surgical unit observes a newly licensed nurse (3 months experience) becoming visibly overwhelmed while managing four patients. The novice nurse is meticulously documenting a non-urgent dressing change while a telemetry alarm for a different patient’s new-onset atrial fibrillation with rapid ventricular response (RVR) is sounding, and a third patient’s scheduled IV antibiotic is overdue. The charge nurse recognizes the need to coach the novice nurse on prioritization. Which action by the charge nurse best applies coaching principles to foster the novice nurse’s clinical judgment development?