Your FREE Med-Surg Flashcards 2026 – 100+ Cards

Certified Medical-Surgical Registered Nurse — the most widely held med-surg credential, awarded by the MSNCB to RNs who pass the medical-surgical nursing certification exam.

Medical-Surgical Nursing Certification Board — the credentialing arm of the Academy of Medical-Surgical Nurses (AMSN), which owns the CMSRN exam.

Right patient (two identifiers), right drug, right dose, right route, and right time — expanded sets add documentation, reason, response, education, and the right to refuse.

A drug with a heightened risk of serious harm if given in error (insulin, anticoagulants, opioids, concentrated electrolytes); requires an independent double-check.

Always diluted and infused slowly by pump (≤10 mEq/hr peripherally) with cardiac monitoring — NEVER given IV push and never undiluted, because a rapid bolus can be fatal.

Infection control applied to every patient at all times; treat all blood and body fluids as potentially infectious. Hand hygiene is the single most important measure.

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

A surgical mask within about 6 feet for organisms spread by respiratory droplets — influenza, pertussis, and meningococcus.

An N95 respirator and a negative-pressure room with the door closed for airborne organisms — tuberculosis, measles, and varicella.

Use soap and water (and bleach cleaning), not alcohol-based rub — alcohol does not kill C. difficile or norovirus spores.

A last resort after least-restrictive alternatives fail; requires a provider order (never PRN), is time-limited and monitored, and is tied with quick-release knots to the movable bed frame.

A patient-safety event causing death, permanent harm, or severe temporary harm; it triggers a root cause analysis.

A safety culture that distinguishes honest human error from at-risk and reckless behavior, encouraging non-punitive reporting of errors and near-misses.

A reactive, retrospective method used after an adverse event to find the underlying system causes — 'why did this happen?'

A proactive method used before a process launches to identify and reduce risk — 'what could go wrong?'

A validated tool that predicts pressure-injury risk by scoring sensory perception, moisture, activity, mobility, nutrition, and friction/shear.

An injury whose base is obscured by slough or eschar, so its depth — and therefore its stage — cannot be determined until the wound bed is exposed.

Combining analgesics with different mechanisms (a non-opioid plus an opioid plus an adjuvant) to maximize relief and lower the opioid dose.

Sedation precedes respiratory depression — monitor sedation level and respiratory rate; naloxone is titrated to respirations.

The Joint Commission process to prevent wrong-site surgery: pre-procedure verification, site marking, and a time-out before incision.

The provider explains the procedure and obtains consent; the nurse witnesses the signature, confirms understanding, and verifies it is voluntary.

Cover the protruding viscera with sterile saline-soaked gauze, position low-Fowler's with knees flexed, keep NPO, and notify the surgeon — never push the organs back in.

Bladder-scan first to confirm distension before catheterizing; perform intermittent catheterization if needed.

An X-ray is the gold standard before first use of a blind tube; keep the head of the bed at 30–45°. Auscultating an air 'whoosh' does NOT verify placement.

Dangerous drops in phosphate, potassium, and magnesium when nutrition is reintroduced to a severely malnourished patient; start low, go slow, replace electrolytes, give thiamine.

Verifying a patient with two pieces of identifying information (name plus date of birth or MRN) before any med, procedure, specimen, or transfusion — never the room number.

In a stroke or neuro patient, screen for dysphagia and keep NPO until the swallow screen passes to prevent aspiration.

Assess the patient for injury FIRST, then notify the provider, document objectively, and file an incident report (never charted in the medical record).

Obtain a 12-lead ECG within 10 minutes; troponin is the most specific marker; a STEMI needs door-to-balloon PCI within 90 minutes.

Hold nitro if systolic BP is below 90, in right-ventricular/inferior MI, or with a PDE-5 inhibitor (e.g., sildenafil) in the past 24–48 hours.

Left-sided = pulmonary congestion (crackles, orthopnea, dyspnea); right-sided = systemic congestion (jugular venous distention, peripheral edema, ascites).

Daily weights at the same time — report a gain over 2–3 lb in a day or 5 lb in a week; restrict sodium and fluids as ordered.

Worsened by hypokalemia; shows nausea, yellow-green halos, and bradycardia. Hold for an apical pulse below 60; antidote is digoxin immune Fab.

Titrate oxygen to an SpO2 of about 88–92% to avoid suppressing the hypoxic drive; teach pursed-lip and diaphragmatic breathing.

A silent chest with diminishing wheezing signals impending respiratory failure — an ominous emergency sign.

Continuous bubbling in the water-seal chamber means an air leak; expect intermittent tidaling with respiration as normal.

If the tube is pulled out, cover the site with an occlusive dressing taped on three sides; if it disconnects, submerge the end in sterile water.

Tracheal deviation away from the affected side, absent breath sounds, and hypotension — needs immediate needle decompression.

Respiratory Opposite (pH and CO2 move opposite ways), Metabolic Equal (pH and bicarbonate move the same way).

Epigastric pain radiating to the back with elevated lipase (more specific than amylase); keep NPO to rest the pancreas.

No blood pressure or venipuncture in the fistula arm; check the thrill (palpate) and bruit (auscultate) to confirm patency.

Hyperkalemia is the most life-threatening complication of acute kidney injury and chronic kidney disease.

IV isotonic fluids first, then a continuous regular-insulin infusion, with potassium replacement (hold insulin if K is below 3.3); add dextrose at glucose ~200 mg/dL.

Onset ~15 min, peak ~1 hour, duration 3–5 hours — give with food.

Onset ~30 min, peak 2–3 hours, duration 5–8 hours; it is the ONLY insulin that can be given IV.

Onset 1–2 hours, no pronounced peak, duration up to 24 hours; do not mix with other insulins.

Draw up the clear (regular) before the cloudy (NPH) — 'clear before cloudy.'

An immediate non-contrast CT to rule out a hemorrhage before giving tPA; 'time is brain.'

A change in level of consciousness is the earliest sign; Cushing's triad (hypertension with widening pulse pressure, bradycardia, irregular respirations) is late and ominous.

Keep the head of the bed at about 30°, head midline, to promote venous drainage; avoid neck flexion and Valsalva.

Pain out of proportion and pain on passive stretch; do NOT elevate the limb above heart level — prepare for fasciotomy.

STOP the transfusion immediately, keep the line open with normal saline through new tubing, then notify the provider and blood bank.

Usually ABO incompatibility — the most dangerous reaction; fever, flank/back pain, dark urine, and hypotension within minutes.

Serum K below 3.5 mEq/L; flat T waves, U waves, muscle weakness, and worsened digoxin toxicity. Replace diluted by pump — never IV push.

Serum K above 5.0; peaked T waves → widened QRS. Order: calcium gluconate (stabilize) → insulin + dextrose/albuterol (shift) → diuretics/resin/dialysis (remove).

Positive Trousseau's and Chvostek's signs, tetany, and tingling; a positive Trousseau's sign (carpal spasm with BP cuff inflation) indicates hypocalcemia.

Measure lactate, draw blood cultures before antibiotics, give broad-spectrum antibiotics, start 30 mL/kg crystalloid, and add vasopressors (norepinephrine first) to keep MAP ≥ 65.

High-alert anticoagulant monitored by aPTT; antidote is protamine sulfate. Watch platelets for heparin-induced thrombocytopenia (HIT).

An immune platelet drop ~5–10 days into heparin therapy that paradoxically causes clotting; stop all heparin and switch to argatroban or bivalirudin.

Anticoagulant monitored by INR (target 2.0–3.0); antidote is vitamin K. Teach a consistent — not zero — vitamin-K intake.

A common post-op complication (diminished breath sounds, low fever POD 1–2); prevent with incentive spirometry, early ambulation, and splinted coughing.

An absolute neutrophil count below 500 with fever is an oncologic emergency requiring prompt broad-spectrum antibiotics and protective measures.

Paradoxical, asymmetrical chest-wall movement after blunt trauma from multiple adjacent rib fractures — a recognition clue for chest trauma.

Care that respects and responds to individual patient preferences, needs, and values, with mutual, patient-driven goals; the patient is the locus of control.

Listen and acknowledge feelings FIRST, then apologize for the experience, act to resolve it, and escalate or document — never defend the staff first.

Required for any patient with limited English proficiency or who is deaf — never family, friends, children, or untrained staff, for accuracy, confidentiality, and legal reasons.

Unconscious attitudes that can affect care; recognize it and assess each patient's actual cultural, religious, and linguistic needs rather than assuming them.

Confirm understanding by having the patient explain the instructions in their own words; a nod to 'do you understand?' is not adequate evidence of learning.

Assess it first — manage pain or anxiety before teaching — and address barriers such as language, literacy, and sensory deficits.

Facilitate the chaplain or spiritual-care visit and incorporate the patient's spiritual needs into the plan of care; accommodate rituals with privacy.

A legal document stating a patient's treatment wishes or naming a decision-maker; it takes effect only when the patient loses decision-making capacity.

A written advance directive stating which treatments a person does or does not want under specific end-of-life conditions.

An advance directive naming a health care proxy to make medical decisions once the patient loses capacity; while capable, the patient's own wishes govern.

Requires hospitals to inform adult patients of their right to make health care decisions and to formulate an advance directive, and to document whether one exists.

An order that CPR will not be attempted; it does NOT mean 'do not treat' — comfort and other care continue.

Relieves symptoms and improves quality of life at any stage of serious illness; can run alongside curative treatment, with no prognosis requirement.

Comfort-focused care for a terminal prognosis of about six months or less; curative treatment is stopped. All hospice care is palliative, but not all palliative care is hospice.

A patient's ability to obtain and understand health information; use plain language at about a 5th–6th-grade level and confirm with teach-back.

Assessment, Diagnosis, Planning, Implementation, Evaluation — a continuous cycle; assessment is always first and evaluation closes the loop.

Recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes — the NCSBN framework for safe decision-making.

Recognize and analyze the cues — gather and interpret more data before acting — except in a true airway, breathing, or circulation emergency.

An AHRQ teamwork framework: leadership, situation monitoring, mutual support, and communication, used to improve safety and reduce errors.

Voice a safety concern at least twice and escalate if it is not acknowledged — never stay silent and never follow an unsafe order.

An escalation script: 'I'm Concerned, I'm Uncomfortable, this is a Safety issue' — a TeamSTEPPS tool to stop an unsafe action.

Comparing a patient's current medications to new orders at every transition (admission, transfer, discharge) to catch omissions, duplications, and interactions.

Begins on admission; integrate PT/OT for functional status and the safest destination, and screen social determinants to prevent readmission.

Draw a single line through the error, label it 'error,' and add your date, time, and initials — never erase or obscure the original entry.

Never chart in the medical record that an incident report was filed; the report is a separate risk-management document.

Initiate the facility's downtime procedures, document care on paper forms, and enter it into the EHR once systems return.

Desensitization from frequent alarms; manage it with appropriate, individualized alarm settings — never by silencing or disabling safety alarms.

Conditions such as housing, food security, transportation, and income that affect a patient's ability to follow the plan and must inform discharge and resource planning.

The nursing profession's nonnegotiable ethical standard, organized into nine provisions with interpretive statements.

The ethical principle of respecting a patient's right to self-determination; a competent patient's informed refusal is honored even over beneficence.

The ethical principle of acting in the patient's best interest — doing good.

The ethical principle of 'do no harm,' including avoiding undue risk and reporting unsafe practice.

The ethical principle of truth-telling, including honest disclosure of an error to the patient.

The ethical principle of fairness and equitable distribution of resources — equal care regardless of ability to pay.

The ethical principle of keeping promises and being loyal — following through on what you told the patient.

Acting to protect and promote a patient's rights, values, and best interests within the health care system.

The federal law protecting the privacy and security of patient health information; PHI may be used for treatment, payment, and operations on a minimum-necessary basis.

The federal law requiring an emergency medical screening exam and stabilization regardless of ability to pay.

Defined by the state Nurse Practice Act and Board of Nursing; the nursing process and nursing judgment cannot be delegated.

The nurse must report a reasonable suspicion of abuse or neglect to the proper authority — even without proof, as required by law.

Outcomes shaped by nursing care — falls, pressure injuries, CAUTI, and CLABSI rates — benchmarked through the NDNQI.

Plan-Do-Study-Act — an iterative, small-cycle quality-improvement method to test a change before spreading it.

Integrating the best available evidence with clinical expertise and patient values to guide care; framed with a PICO(T) question.

Population, Intervention, Comparison, Outcome, Time — the framework for an answerable evidence-based-practice question.

A systematic review or meta-analysis of randomized controlled trials is the highest level of evidence.

Research generates new generalizable knowledge, EBP applies existing evidence, and quality improvement refines a local process.

Human-subjects research requires voluntary informed consent from participants and Institutional Review Board (IRB) review and approval.

Transferring the authority to perform a task while the RN retains accountability for the outcome.

Right task, right circumstance, right person, right direction/communication, and right supervision/evaluation.

Assessment, nursing diagnosis, planning, evaluation, the initial teaching, triage, and the care of an unstable patient — they require nursing judgment.

May perform ADLs, vital signs on stable patients, intake and output, daily weights, transfers, and routine specimen collection — never anything requiring judgment.

Assignment shifts tasks already within a person's existing job role; delegation transfers a specific task normally within the RN's scope while the RN keeps accountability.

Reinforces teaching the RN started, cares for stable patients, gives most routine meds (state-dependent), and does dressing changes — not the initial assessment, care plan, or unstable patient.

Feeding a patient at risk for aspiration stays with the nurse — it requires ongoing assessment and judgment and is not delegated to a UAP.

Monitor, stay available, intervene as needed, follow up to confirm the task was done correctly, and evaluate the patient's response.

Situation, Background, Assessment, Recommendation — a structured handoff and escalation format so nothing critical is omitted.

The clear request or action you need — e.g., 'I think the patient needs to be evaluated now and a 12-lead ECG ordered.'

A check-back in which the receiver repeats the message and the sender confirms it; used for verbal orders and critical values.

The hierarchy for escalating an unresolved patient-safety concern; keep escalating up until the patient is safe.

A bedside team summoned for a deteriorating, non-arrest patient to prevent a code; a 'nurse is worried' gut feeling is a valid trigger.

A style that inspires and motivates change through a shared vision; the Magnet-preferred style (autocratic is appropriate only in a true emergency).

Address the conflict directly and collaboratively, focused on the shared goal of patient safety, rather than avoiding it or going around the person.

A mentor guides long-term career growth, a coach builds a specific skill, and a preceptor guides the clinical orientation of a new nurse.

A brief team stand-up to establish a shared mental model of the unit's plan and proactively identify safety risks.

The most common med-surg care-delivery model, in which an RN leads a team (LPNs/LVNs and UAPs) caring for a group of patients.