Patient/Care Management
32%of exam
Holistic Patient Care
15%of exam
Patient-Centered CareDiversity + InclusionHealth LiteracyFamily TeachingPalliative Care
Elements of Interprofessional Care
17%of exam
Clinical JudgmentTeam RoundsCare CoordinationDocumentationTechnologyTransition Management
Professional Concepts
15%of exam
Chain of CommandSBAR HandoffEthicsQuality ImprovementEBPSafety Culture
Nursing Teamwork + Collaboration
21%of exam
DelegationSupervisionScopeStaffingConflictDisaster Planning
Quick Facts
- Exam
- CMSRN
- Credential
- Medical-Surgical RN
- Owner
- MSNCB
- Format
- 150 multiple-choice
- Scored
- 125 scored + 25 pilot
- Time
- 3 hours
- Pass
- Standard score 95
- Fee
- $267 member / $394 standard
- Eligibility
- RN + 2,000 hours
- Delivery
- Pearson VUE / OnVUE
- Validity
- 5 years
- Blueprint
- May 15 2023
ADPIE
Assess Diagnose Plan Implement Evaluate
Assess: gatherDiagnose: judgePlan: goalsImplement: actEvaluate: response
Warfarin vs Heparin
Warfarin
- INR
- Oral anticoagulant
- Vitamin K
Heparin
- aPTT/PTT
- IV/SQ anticoagulant
- Protamine
INR vs PTT
Isolation Picker
- C diff diarrhea→Contact(Soap/water)
- Active TB→Airborne(N95/AIIR)
- Influenza symptoms→Droplet(Mask)
- Unknown blood exposure→Standard(PPE)
- Neutropenia→Protective care(Limit exposure)
- Draining wound→Contact(Gown/gloves)
Exam Frame
- Questions
- 150 MCQ
- Scored Items
- 125 count
- Pilot Items
- 25 unscored
- Time
- 3 hours
- Pass Score
- Standard 95
- Pacing
- 72 sec/item
- Validity
- 5 years
- ATT
- 90 days
ABCs
Airway before breathing before circulation
A: airwayB: breathingC: circulationSafety: always
Contact vs Airborne
Contact
- Gown/gloves
- Surfaces
- C diff
Airborne
- N95
- Negative pressure
- TB
Touch vs aerosol
Escalation Picker
- Severe allergy→Remove trigger(Stop exposure)
- Unstable vitals→Reassess personally(RN role)
- Acute dyspnea→ABCs + RRT(Escalate)
- High heparin PTT→Follow protocol(Hold/reduce)
- Peaked T waves→Notify provider(Hyperkalemia)
- New neuro deficit→Stroke protocol(Time critical)
Patient Safety
- ADPIE
- Nursing process
- Falls
- Slow position changes
- Restraints
- Last resort
- Near Miss
- Report for learning
- RCA
- Retrospective analysis
- FMEA
- Prospective risk
- RRT
- Acute decline
- HAI
- Prevent transmission
Five Rights
Right patient drug dose route time
PatientDrugDoseRouteTime
Infection
- Standard
- All patients
- Contact
- Gown/gloves
- Droplet
- Mask
- Airborne
- N95 + AIIR
- C diff
- Soap/water
- TB
- Negative pressure
- MRSA
- Contact precautions
- Neutropenic
- Protect patient
Meds + Labs
- Warfarin
- INR
- Heparin
- aPTT/PTT
- Digoxin
- Apical pulse
- Furosemide
- Low potassium
- Opioids
- Respiratory depression
- Insulin
- Never simply skip
- ACE inhibitors
- Cough/hyperkalemia
- DOACs
- No routine INR
Resp + Cardiac
- COPD
- Target 88-92%
- PE
- Pleuritic chest pain
- Hyperkalemia
- Peaked T waves
- Hypokalemia
- U waves
- HF
- Daily weights
- Chest Pain
- Assess first
- Shock
- Perfusion failure
- Stroke
- Time critical
Palliative vs Hospice
Palliative
- Symptom focus
- Any stage
- With treatment
Hospice
- End-of-life
- Comfort only
- Prognosis
Relief vs terminal
Holistic Care
- Pain
- Self-report rules
- Culture
- Ask preferences
- LEP
- Professional interpreter
- Spirituality
- Offer chaplain
- Grief
- Listen first
- Family
- Assess patient wishes
- Palliative
- Comfort goals
- End-of-life
- Advance directives
Interpreter vs Family
Interpreter
- Accurate terms
- Confidentiality
- Legal support
Family
- Support role
- Bias risk
- Privacy risk
Accuracy vs convenience
Consult Picker
- Warfarin discharge→Pharmacy(INR plan)
- CKD diet→Dietitian(Renal limits)
- Dysphagia risk→Speech therapy(Swallow safety)
- Mobility decline→PT(Gait plan)
- ADL barriers→OT(Home function)
- Home services→Case manager(Discharge support)
- Complex wound→Wound nurse(Dressing plan)
Interprofessional Care
- SBAR
- Structured escalation
- Rounds
- Shared plan
- Pharmacy
- Medication safety
- Dietitian
- Renal diet
- PT
- Mobility plan
- Case Manager
- Discharge barriers
- Wound Nurse
- Dressing expertise
- EHR
- Objective charting
Documentation + Tech
- Charting
- Specific objective data
- Downtime
- Follow policy
- Read-back
- Verify orders
- Handoff
- Transfer risk
- Telemetry
- Trend changes
- Equipment
- Troubleshoot early
- Outcome Measures
- Track quality
- Informatics
- Data supports care
SBAR
Situation Background Assessment Recommendation
Situation: nowBackground: contextAssessment: concernRecommendation: ask
Incident Report vs Charting
Incident
- Quality system
- Near misses
- Confidential route
Charting
- Patient record
- Objective facts
- Care response
System vs record
Professional Concepts
- Ethics
- Patient rights
- Scope
- Know limits
- Chain
- Escalation path
- EBP
- Evidence + expertise
- QI
- Improve systems
- IRB
- Research oversight
- Just Culture
- Systems learning
- Diversion
- Report promptly
SBAR vs Handoff
SBAR
- Escalation
- Recommendation
- Concise ask
Handoff
- Continuity
- Full care
- Next shift
Request vs transfer
Delegation Rights
Task circumstance person direction supervision
TaskCircumstancePersonDirectionSupervision
Delegation vs Assignment
Delegation
- Task transfer
- RN accountable
- Supervise
Assignment
- Workload distribution
- Whole patient
- Acuity match
Task vs patient
Delegation Picker
- Needs assessment→RN(Cannot delegate)
- Sterile dressing→Competent LPN(Stable patient)
- Stable ambulation→UAP(Routine task)
- Patient teaching→RN(Evaluate learning)
- Unclear order→RN clarifies(Never guess)
- Unstable transport→Delay/communicate(Safety first)
- New admission→RN(Initial assessment)
Teamwork + Delegation
- RN
- Assess/evaluate
- LPN
- Stable tasks
- UAP
- Routine tasks
- Delegation
- Right task/person
- Supervision
- RN accountability
- Assignment
- Match acuity
- Mentoring
- Gradual complexity
- Conflict
- Private first
Prioritize vs Delegate
Prioritize
- What first
- Unstable risk
- ABCs
Delegate
- Who can
- Stable routine
- Scope check
First vs who
Clinical Priority
- ABC
- Airway first
- Safety
- Immediate harm
- Unstable
- RN assesses
- New Onset
- Higher priority
- Unexpected
- Higher priority
- Education
- Teach-back
- Discharge
- Medication reconciliation
- Sepsis
- Escalate early
Common Traps
Unscored is not optional
Pilot items use time ≠ All items deserve effort
Stable vs unstable
Stable can be delegated ≠ Unstable needs RN
Interpreter vs child
Interpreter handles discharge ≠ Child supports only
INR vs PTT
Warfarin uses INR ≠ Heparin uses PTT
Contact vs sanitizer
C diff needs soap ≠ Alcohol misses spores
Restraint vs fall prevention
Restraints require orders ≠ Rails can restrain
Charting vs incident report
Chart objective care ≠ Report system events
Palliative vs hospice
Palliative any stage ≠ Hospice end-of-life
Scope vs convenience
Scope controls delegation ≠ Convenience cannot override
Family request vs autonomy
Patient decides disclosure ≠ Family shares concerns
RRT vs provider
RRT for deterioration ≠ Provider for orders
Last Minute
- 1.Blueprint: 32/15/17/15/21
- 2.150 items; 125 scored
- 3.Pass = standard score 95
- 4.Pacing = about 72 seconds
- 5.Warfarin = INR; heparin = PTT
- 6.TB = airborne; C diff = contact
- 7.Pain is subjective
- 8.Use professional interpreters
- 9.RN assesses unstable patients
- 10.Delegate stable routine tasks
- 11.Near-misses feed QI
- 12.Escalate unclear orders
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