Your FREE CMSRN Flashcards 2026 – 200+ Cards

The nursing process: Assessment, Diagnosis, Planning, Implementation, Evaluation.

Certified Medical-Surgical Registered Nurse — the credential awarded by the MSNCB (the credentialing arm of AMSN) to RNs who pass the med-surg certification exam.

MSNCB — the Medical-Surgical Nursing Certification Board, the credentialing arm of the Academy of Medical-Surgical Nurses (AMSN).

150 multiple-choice items (125 scored + 25 unscored pretest), with a 3-hour (180-minute) time limit.

A criterion-referenced scaled score of 95, which is approximately 71% of the 125 scored items correct.

Active, unencumbered RN license plus 2,000 medical-surgical practice hours within the past 3 years.

5 years; renew by contact hours or by re-examination (requires 1,000 med-surg hours during the 5-year period).

Patient/Care Management (32%), Holistic Patient Care (15%), Elements of Interprofessional Care (17%), Professional Concepts (15%), Nursing Teamwork & Collaboration (21%).

Assessment — collect and verify cues before acting; you cannot intervene safely without data.

Airway, Breathing, Circulation — the first priority framework; an airway problem outranks everything else.

Meet physiologic needs before safety, then psychosocial — physical needs come before emotional ones.

Address acute, unstable, or unexpected problems before chronic, stable, or expected ones.

An organizational environment that prioritizes safety, encourages near-miss/error reporting, and treats events as system-learning opportunities.

A safety culture that distinguishes honest human error and at-risk behavior from reckless behavior; encourages reporting without blame.

An organization that sustains near-zero error rates through preoccupation with failure, sensitivity to operations, and deference to expertise.

An unplanned event that did NOT reach the patient but could have caused harm; it must still be reported so the system can learn.

A patient-safety event causing death, permanent harm, or severe temporary harm; it triggers a Root Cause Analysis.

A retrospective method to find the underlying system causes AFTER an adverse event has occurred.

Failure Mode and Effects Analysis — a PROSPECTIVE method to find and reduce risk BEFORE harm occurs.

A serious, largely preventable error such as wrong-site surgery, a retained foreign object, or a Stage 3/4 hospital-acquired pressure injury.

Verify identity with two identifiers (name plus DOB or MRN) before any med, procedure, specimen, or transfusion — never the room number.

A validated fall-risk tool scoring history of falls, secondary diagnosis, ambulatory aid, IV access, gait, and mental status.

Use the least-restrictive option; needs a provider order (not PRN), is time-limited, requires q2h checks (circulation, skin, ROM, toileting), and a quick-release knot to the bed frame.

Columbia Protocol (C-SSRS) and the ASQ; ensure environmental safety and one-to-one observation for at-risk patients.

Non-medical conditions (income, housing, food security, transportation) that affect health outcomes; screen and refer to resources.

Inconsistent history, a controlling companion who answers for the patient, fearful affect, and lack of personal ID or documents.

Applied to ALL patients all the time: hand hygiene plus gloves/PPE chosen by anticipated exposure; treat all blood and body fluids as infectious.

Gown + gloves and dedicated equipment for organisms spread by touch — MRSA, VRE, C. difficile, RSV, scabies.

A surgical mask within ~6 ft for influenza, pertussis, meningococcus, mumps, and group A strep.

An N95 respirator and a negative-pressure (AIIR) room with the door closed for TB, measles, varicella, and disseminated zoster.

Contact precautions PLUS soap-and-water handwashing and bleach cleaning — alcohol rub does not kill spores.

Alcohol-based rub is preferred EXCEPT when hands are visibly soiled or caring for C. difficile/spores/norovirus — then use soap and water.

Hand hygiene, maximal barrier precautions, chlorhexidine skin prep, optimal site selection, and daily review of line necessity.

Insert a urinary catheter only when necessary, use aseptic technique, keep a closed system, and remove the catheter as soon as possible.

For ANC < 500: private room, strict hand hygiene, no fresh flowers or raw produce; a fever is a medical emergency.

Using the right drug, dose, and duration to limit resistance; de-escalate antibiotics based on culture results.

Right patient, drug, dose, route, and time — plus documentation, reason, response, education, and the right to refuse.

Drugs with a high risk of serious harm if misused: insulin, anticoagulants (heparin/warfarin), opioids, concentrated electrolytes (esp. KCl), and neuromuscular blockers (ISMP list).

NEVER give IV push. Always dilute and infuse via pump (no faster than 10 mEq/hr peripheral); monitor the cardiac rhythm and the IV site.

The use of multiple medications, raising interaction and adverse-event risk — a special concern in older adults.

A published list of potentially inappropriate medications to avoid or use cautiously in older adults.

Tip sits in the superior vena cava; confirm placement by X-ray before first use. Risks: CLABSI, air embolism, pneumothorax.

Access only with a non-coring (Huber) needle using sterile technique.

Watch for respiratory depression, hypotension, and motor block; avoid systemic opioids without an order.

Combining drugs with different mechanisms (opioid + acetaminophen/NSAID + adjuvant) to improve relief and reduce the opioid dose.

A pain-assessment tool for nonverbal adults with advanced dementia (breathing, vocalization, facial expression, body language, consolability).

Sedation precedes respiratory depression — use a sedation scale (POSS/RASS) and monitor respiratory rate and SpO2.

The opioid antidote (reversal agent); it has a short half-life, so repeat dosing may be needed — monitor for re-sedation.

A stepwise pain-treatment framework progressing from non-opioids to weak then strong opioids as pain severity increases.

Causes vasoconstriction; reduces acute swelling and inflammation in the first 24–48 hours after injury.

Causes vasodilation; relieves chronic muscle stiffness — avoid over an acute injury or active bleeding.

The provider explains the procedure, risks, and alternatives and obtains consent; the nurse witnesses the signature and verifies understanding.

A pre-procedure pause to verify the correct patient, correct procedure, and correct site (The Joint Commission).

Incentive spirometer, early ambulation, deep breathing, and coughing to re-expand the lungs.

Partial or total separation of surgical wound layers; cover with sterile saline-moistened gauze and notify the provider.

Protrusion of viscera through the wound; cover with sterile moist dressing, position low-Fowler's with knees flexed, keep NPO — a surgical emergency.

Requires continuous monitoring of LOC, respiratory rate, SpO2, and capnography, with reversal agents (naloxone, flumazenil) available.

Feeding via the GI tract (NG/PEG tube); verify placement, keep the head of the bed at 30 degrees or higher, and check residuals per policy to prevent aspiration.

IV nutrition given through a central line; monitor glucose and electrolytes — infection and refeeding risk.

Dangerous electrolyte shifts (drops in phosphate, potassium, magnesium) when refeeding a malnourished patient; start slow and monitor labs.

High aspiration risk — obtain a swallow evaluation, position upright, and use thickened liquids as ordered.

Aspirin, oxygen if hypoxic, nitroglycerin, and morphine (MONA-modified); obtain a 12-lead ECG and troponin.

The most specific cardiac biomarker for myocardial injury; rises 3–6 hours after an MI.

Percutaneous coronary intervention (PCI) within 90 minutes of arrival.

Pulmonary congestion: dyspnea, crackles, orthopnea, and pink frothy sputum.

Systemic congestion: jugular venous distention, peripheral edema, ascites, and hepatomegaly.

B-type natriuretic peptide — elevated in heart failure from volume/pressure overload.

Daily weights (report a gain over 2–3 lb/day or 5 lb/week), low-sodium diet, fluid limits, diuretics, and monitor for worsening dyspnea/edema.

Nausea/vomiting, yellow-green visual halos, and bradycardia; antidote is digoxin immune Fab. Hypokalemia worsens it.

Clot formation leading to stroke; manage rate/rhythm and provide anticoagulation.

Monitor aPTT; antidote is protamine sulfate; watch for heparin-induced thrombocytopenia (HIT).

Monitor INR (target ~2–3 for most indications); antidote is vitamin K; keep vitamin-K food intake consistent.

Dabigatran is reversed by idarucizumab; apixaban/rivaroxaban by andexanet alfa.

A vasodilator for angina; causes headache and hypotension; hold if systolic BP < 90.

Lower BP and protect kidneys; watch for a dry cough, hyperkalemia, and angioedema.

Lower heart rate and BP; hold for bradycardia/hypotension and never stop abruptly (rebound).

Titrate oxygen to an SpO2 of about 88–92% to avoid suppressing the hypoxic drive.

Pursed-lip and diaphragmatic breathing, low-flow oxygen (88–92%), bronchodilators, energy conservation, and infection prevention (vaccines).

A short-acting beta-2 agonist (albuterol) for acute bronchospasm.

Fever, productive cough, crackles, consolidation on chest X-ray, and an elevated WBC count.

Refractory hypoxemia with bilateral infiltrates and non-cardiac pulmonary edema; treated with low-tidal-volume ventilation.

Drains air/fluid from the pleural space; keep the system below the chest, expect tidaling, and report continuous bubbling (an air leak).

Tracheal deviation AWAY from the affected side, absent breath sounds, and hypotension; emergency needle decompression.

pH 7.35–7.45, PaCO2 35–45 mm Hg, HCO3 22–26 mEq/L, PaO2 80–100 mm Hg.

Low pH with a high PaCO2 — from hypoventilation (e.g., COPD, opioid overdose).

Low pH with a low HCO3 — from DKA, renal failure, or severe diarrhea.

Hematemesis and melena; monitor H/H, give fluids/blood, and prepare for possible endoscopy.

Elevated amylase and lipase (lipase is more specific); pain radiates to the back — keep NPO to rest the pancreas.

Elevated ammonia from liver failure; treat with lactulose to excrete ammonia.

Abrupt drop in GFR with rising BUN/creatinine and hyperkalemia; monitor I&O, manage fluids, and avoid nephrotoxins.

Protect the access arm: no BP or venipuncture in it; check for a thrill (palpate) and bruit (auscultate).

Hyperglycemia + ketones + metabolic acidosis (type 1 DM); treat with IV fluids, an insulin drip, and potassium replacement before/with insulin.

Restore fluid volume first, then begin insulin; replace potassium because insulin drives K into cells (risking hypokalemia); monitor glucose and ketones.

Hyperosmolar hyperglycemic state — severe hyperglycemia with profound dehydration but NO significant ketosis (type 2 DM); aggressive fluids.

Lispro/aspart/glulisine: onset ~15 min, peak ~1 hr; give with food at the start of the meal.

Onset ~30 min, peak 2–3 hr; the ONLY insulin that may be given IV.

Glargine/detemir: lasts ~24 hr with no pronounced peak; do not mix with other insulins.

Give 15 g of fast-acting carbohydrate, recheck glucose in 15 minutes; if unconscious, give IV dextrose or glucagon.

Life-threatening hyperthyroidism: high fever, tachycardia, agitation; treat with beta-blockers, antithyroid drugs, and cooling.

Acute adrenal insufficiency: hypotension, hyponatremia, hyperkalemia; treat with IV hydrocortisone and fluids.

Too much ADH causes water retention and dilutional hyponatremia; treat with fluid restriction.

ADH deficiency causes massive dilute urine and hypernatremia; treat with desmopressin (DDAVP).

Give within the window (3 to 4.5 hr or less) only if a CT rules out hemorrhage and there are no contraindications.

Use the NIH Stroke Scale; 'time is brain' — establish the last-known-well time.

Decreased LOC, headache, vomiting, and Cushing's triad (rising/widening pulse pressure, bradycardia, irregular respirations).

In SCI at/above T6: severe hypertension, pounding headache, flushing; SIT THE PATIENT UP and remove the trigger (often a full bladder) — an emergency.

The 6 P's: pain out of proportion, pallor, pulselessness, paresthesia, paralysis, poikilothermia; emergency fasciotomy.

After a long-bone fracture: dyspnea, petechiae, and confusion; provide supportive oxygen.

STOP the transfusion, keep the line open with normal saline (new tubing), reassess, and notify the provider/blood bank.

Fever, flank pain, dark urine, and hypotension within minutes — the most dangerous reaction, usually from ABO incompatibility.

ANC < 1500 (severe < 500); high infection risk — a fever is a medical emergency.

Post-chemo release of cell contents: high potassium, phosphate, and uric acid with low calcium; hydrate and give allopurinol/rasburicase.

Intact skin with non-blanchable erythema over a bony prominence.

Partial-thickness skin loss with exposed dermis (a shallow open ulcer or intact/ruptured blister).

Full-thickness skin loss with visible subcutaneous fat.

Full-thickness loss with exposed bone, tendon, or muscle.

Full-thickness loss where the wound base is obscured by slough or eschar.

Reposition every 2 hours, offload bony prominences, keep skin clean/dry, and optimize nutrition.

Life-threatening organ dysfunction from a dysregulated response to infection; recognize early and treat fast.

Measure lactate, draw blood cultures BEFORE antibiotics, give broad-spectrum antibiotics, give 30 mL/kg crystalloid for hypotension or lactate of 4 or higher, and add vasopressors for refractory hypotension.

Peaked T waves and muscle weakness; give IV calcium gluconate (cardiac protection), insulin + D50 to shift K, then kayexalate/diuresis/dialysis to remove it.

Flat T waves with U waves, weakness, and dysrhythmias; replace potassium (oral or diluted IV — NEVER IV push).

'Bones, stones, groans, and moans'; treat with hydration and calcitonin or bisphosphonates.

Positive Chvostek's and Trousseau's signs, tetany, and tingling; give calcium.

Decreased deep tendon reflexes, hypotension, and respiratory depression; antidote is IV calcium gluconate.

135–145 mEq/L.

3.5–5.0 mEq/L.

8.5–10.5 mg/dL.

Causes hypokalemia, dehydration, and ototoxicity; monitor potassium and hold for hypotension.

Restore perfusion: hypovolemic = fluids/blood; cardiogenic = improve pump function; distributive/septic = fluids + vasopressors; anaphylactic = epinephrine.

Intramuscular epinephrine, given immediately into the vastus lateralis (mid-outer thigh).

Care that respects and responds to the patient's values, preferences, and expressed needs.

Use a QUALIFIED medical interpreter; do NOT use family members, friends, or minors to interpret.

National Standards for Culturally and Linguistically Appropriate Services (HHS) for equitable, understandable, respectful care.

Unconscious attitudes that can affect clinical decisions and the equity of care delivered.

Have the patient restate the instructions in their own words to confirm understanding.

The capacity to obtain, process, and understand health information; teach using plain language at a ~5th–6th-grade level.

Prevent disease before it occurs — immunizations, education, seat belts, healthy diet.

Early detection through screening — blood-pressure checks, mammograms, Pap tests, blood glucose.

Reduce complications and disability of established disease — rehabilitation, support groups, disease management.

Symptom and comfort care that can be provided at ANY disease stage, alongside curative treatment.

Comfort-focused care for a prognosis of about 6 months or less; curative treatment is stopped.

A legal document stating care wishes if the patient cannot decide (living will and/or healthcare proxy).

An order directing that resuscitation not be attempted; verify and honor it before a code event.

Provider Orders for Life-Sustaining Treatment — portable medical orders that travel with the patient across settings.

Provide dignity, follow cultural/religious practices, allow family time, and document; prepare the body per policy.

Notify the Organ Procurement Organization (OPO); the nurse does not initiate the donation request — trained OPO staff do.

A death (unexpected, violent, or within 24 hr of admission) requiring legal reporting; do not remove lines/tubes until cleared.

Restoring patient trust and satisfaction after a service failure (acknowledge, apologize, fix, follow up).

Six steps: recognize cues → analyze cues → prioritize hypotheses → generate solutions → take action → evaluate outcomes.

The five-step nursing process: Assessment, Diagnosis, Planning, Implementation, Evaluation.

Identify the relevant and important patient data from the situation — the first step of clinical judgment.

Organizing patient care across providers and settings to ensure safe, effective transitions.

Comparing the patient's current medications to new orders at every transition of care to prevent errors and omissions.

Begins on admission; ensure understanding, follow-up, equipment/resources, and a safe transition home.

High-risk handoff points (admission, transfer, discharge) where errors and readmissions are most likely.

Polypharmacy, poor health literacy, lack of follow-up, social determinants of health, and multiple comorbidities.

Working with other disciplines (PT, pharmacy, social work, providers) toward shared patient goals via rounds and communication.

Integrates nursing science with information and analytical sciences to manage data, information, and knowledge.

A planned paper-backup process to keep documenting safely when the electronic record is unavailable.

Accurate, timely, objective, and factual — 'if it wasn't documented, it wasn't done.'

Situation, Background, Assessment, Recommendation — a structured handoff communication format.

The hierarchy for escalating unresolved patient-safety or clinical concerns.

The receiver repeats the message back and the sender confirms it — reduces order and handoff errors.

Read the verbal or telephone order back to the prescriber to verify accuracy before acting.

Calm, verbal techniques (low voice, personal space, choices, limits) to reduce agitation and prevent violence.

A bedside team called for a deteriorating, non-arrest patient to prevent a code.

A vital-sign scoring tool that flags clinical deterioration early.

Knowing the ethically right action but being constrained from taking it.

Emotional exhaustion from caregiving stress; affects patient safety and nurse retention.

Six standards: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.

The profession's foundational ethical standards and obligations for nurses, with Interpretive Statements (currently 9 provisions).

Respecting the patient's right to self-determination and to make their own decisions.

Acting in the patient's best interest — doing good.

'Do no harm' — avoiding actions that injure the patient.

Fair, equitable treatment and distribution of resources.

Keeping commitments and promises made to patients.

Truth-telling — being honest with patients.

The federal law protecting the privacy and security of patient health information.

Requires emergency medical screening and stabilization regardless of the patient's ability to pay.

Outcomes reflecting nursing care quality: falls, pressure injuries, CAUTI, and CLABSI rates.

Plan-Do-Study-Act — an iterative quality-improvement method.

A standardized patient-experience survey tied to value-based purchasing reimbursement.

Population, Intervention, Comparison, Outcome (and Time) — the framework for an answerable EBP question.

A hierarchy from systematic reviews and RCTs (strongest) down to expert opinion (weakest).

EBP applies the best existing evidence; research generates new knowledge; quality improvement refines local processes.

Use ABCs, then Maslow, then acute-before-chronic; cluster care and delegate appropriately to manage a heavy assignment.

Right task, right circumstance, right person, right direction/communication, right supervision/evaluation (NCSBN).

Assessment, nursing judgment, the initial teaching, evaluation, and the care of an unstable patient.

Stable vital signs, ADLs, ambulation, hygiene, intake & output, and routine specimen collection — no assessment or judgment.

Care of stable patients, medication administration (varies by state), and data collection — not the initial assessment, teaching plan, or care of the unstable.

The RN who delegates retains accountability for the outcome even though the task is performed by someone else.

Adult learning theory — adults are self-directed, draw on experience, and learn best from problem-centered, relevant content.

An experienced nurse who guides the orientation and competency development of a new nurse.

Learning by deliberately analyzing one's own clinical experiences to improve future practice.

Evaluation of a nurse's practice by colleagues to improve quality and competency.

A decision-making structure that gives bedside nurses formal input into practice and policy.

Inspires and motivates change through a shared vision — the leadership style behind the Magnet model.

A reward-and-punishment style focused on tasks, structure, and supervision.

A style in which the leader prioritizes the growth and needs of the team.

Adapting the leadership style to the follower's readiness and competence.

Awareness, Desire, Knowledge, Ability, Reinforcement — an individual-focused change-management model.

Three stages: Unfreeze → Change (move) → Refreeze.

An ANCC designation honoring nursing excellence and superior patient outcomes.

A leader supporting nurses' needs, safety, and professional voice.

Ways to organize patient care: team nursing, primary nursing, and total patient care.

A longer-term developmental relationship in which an experienced nurse supports a colleague's professional growth.

Best-practice onboarding that pairs new hires with preceptors and competency validation before independent practice.