Medical MSNCB : MSNCB Medical-Surgical Nursing Certification Exam Dumps

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Exam Number : MSNCB
Exam Name : MSNCB Medical-Surgical Nursing Certification
Vendor Name : Medical
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MSNCB Exam Format | MSNCB Course Contents | MSNCB Course Outline | MSNCB Exam Syllabus | MSNCB Exam 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 exam 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 exam.

- 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 exam 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 exam, 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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Medical Nursing braindumps

Simulations help nursing students deal with patient deaths

Nursing students Kayla Croom (far right) and Brianna Churakos (center) practice caring for a dying patient as simulation coordinator James Cozza (left) checks the patient's vital signs. Photo: Douglas Levere

School of Nursing senior Rafael Diaz was caring for a patient in the Intensive Care Unit at Buffalo General Medical Center. “The next thing” he knew, “she was unresponsive,” he recalls.

“I didn’t really know how to handle it,” says Diaz. “I had never experienced a patient die in front of me at the time.”

Before graduating from the traditional nursing program in May, Diaz underwent patient death simulation training, one of the latest examples of how the nursing school is using simulation to prepare students for actual patient care. It’s now part of the required curriculum.

“Before this simulation, I didn’t truly know how health care providers handled situations like this,” says Diaz, who will soon be working as a nurse in a New York City hospital.

“Having done this simulation, I believe the way I approach patient deaths has changed significantly. I was able to make mistakes with no true consequences and learn from them. I was able to ask questions after our simulation and understand why certain things are done in events like this,” he says. “A few months after, I took the knowledge I had learned in the simulation and applied it to real-world scenarios, where I had patients die in front of me, and without the simulation, I believe I wouldn’t have handled those events as well.”

Diaz is not alone, say nursing administrators and faculty, who understand patient death is a universal experience. Patients die, and what happens then?

Kelly Foltz-Ramos, assistant professor and director of simulation for the nursing school, can relate. Foltz-Ramos clearly knows where the idea came from for the student simulation program she designed, and Diaz and other UB students took part in: It was the first time Foltz-Ramos experienced death working as a medical/surgical nurse.

Kelly Foltz-Ramos, assistant professor and director of simulation, runs the nursing simulation. Photo: Douglas Levere

“I remember not feeling prepared, not knowing what to do — for my patient, the patient’s family or even myself,” she says.

Years later, as a nurse educator and simulation expert, Foltz-Ramos searched the professional literature and found that education about patient death was “universally lacking,” even outside of nursing.

“In the health care simulation realm, it was frowned upon to let the patient die during simulation, with the reasoning that it could decrease student self-confidence, something we are trying to boost in simulation,” says Foltz-Ramos. “I felt strongly that simulation in a controlled, safe environment was a perfect place to better prepare students for patient death.”

That was then. Foltz-Ramos has become a prominent expert and advocate of teaching nurses through simulation. She says most nursing educators agree that simulation — including using standardized patient actors and virtual reality experiences — will play a greater role in nursing education in the future. The training Diaz and other UB nursing students received is now part of the senior course “Wellness & Illness: Concepts with Individuals, Families and Communities II.”

“In simulation, you can give students opportunities to collaborate with other professionals and teach skills like communication and conflict resolution, which we know leads to lower patient mortality,” Foltz-Ramos says.

“There is also research showing nursing students are lacking in clinical judgment skills needed for decision-making during an event, and that affects their retention rate,” she explains. “If we can increase their judgment skills prior to graduation, they will be better-equipped, and we will do a better job of retaining them.”

While clinical experience will always be important, there’s no guarantee a student’s hours spent in a hospital setting will include a high-pressure event like a difficult birth or a cardiac arrest, Foltz-Ramos notes. And even if it does, their role would be as an observer, not a decision-maker.

“Using high-tech simulation, we can make those experiences possible ahead of time, so all of our students will have experienced a crisis situation that they know how to respond to if it occurs when they are caring for a patient,” she says.

Research reinforces value of simulation

Foltz-Ramos’ views regarding patient death simulation are reinforced by a study she led that found that debriefing following a patient death improved the emotional state of nursing students.

“In debriefing immediately following the scenario for the students who experienced patient death, the first thing I stressed was that no matter what they had done during the scenario, the patient was going to die,” Foltz-Ramos says.

“The results of the study, to me, showed that simulation can be an effective method to teach students how to handle patient death, stressing the importance of debriefing,” she says.

The benefits of simulation are far-reaching. In the current state of nursing education — with a shortage of clinical placements and changing patient population — simulation can bridge the gap, giving students the experience they need to be successful.

“I would argue that simulation is better than a bridge though, because the experiences are guaranteed, in a safe environment, with students making clinical decisions, followed by self-reflection. Practice in the clinical setting is critical and necessary, but I believe learning in simulation is just as critical and necessary.”

Simulations stressful for students

Her students agree.

Brianna Churakos, who graduated this May with a BS in the traditional nursing program, was in the Hospice rotation and had experienced deaths in her family. “So the concept of death was not all that new to me,” she says.

“Nevertheless, going into any simulation is stressful,” Churakos adds. “And having your patient decompensate quickly like ours did is even more so.”

The students were told their simulated patient was a DNR/DNI (do not resuscitate/intubate), giving them some idea how to care for them.

“Regardless of having an idea, the simulation brought high feelings of stress and emotions, as our patient decompensated and passed away,” says Churakos, who plans on working in the pediatric ICU at Oishei Children’s Hospital.

She says the simulation was especially helpful for those who haven’t experienced much death in their personal or professional lives.

“The simulation showed us the importance of having a moment with our patient to give them and ourselves that much needed emotional validation, as we sat with the patient for a few moments following their death.

“Should I experience this event in real life, I feel that I will have just a bit more insight as to how I go about caring for the patient, addressing other health care professionals, and then reaching out to the family,” Churakos says.

“Death is inevitable and unfortunately the health care field sees a lot of it. It is so important to at least become acquainted with events such as this so you can realize what you know, don’t know and how to address your thoughts and feelings.”

Medical and nursing college on the cards

ISLAMABAD: The Capital Development Authority (CDA) board is likely to approve the establishment of a medical and nursing institute, namely Capital Medical College, during a meeting likely to be held in a few days.

The CDA board headed by Noorul Amin Mengal will discuss 27 items on the agenda, including the formulation of regulations to stop tree culling as well as policies to end the practice of dumping garbage in public spaces, particularly nullahs. The meeting was supposed to be held on Wednesday but it was postponed due to other commitments.

The CDA board will also take up the issue related to posts of directors in the planning wing. In the 90s, it had approved several new posts of directors in the planning wing keeping in view the expanding boundaries of the city. However, the positions were not notified, putting a strain on the key wing of the civic agency.

Medical and nursing college

The board will likely give approval to the establishment of a medical and nursing college to be set up on abandoned premises of the Art and Craft Village near Aabpara. This college will be affiliated with Capital Hospital in G-6, commonly known as CDA Hospital.

Meanwhile, the board will also discuss setting up an archery club in F-9 Park and formulating regulations regarding parking. It will also formulate a policy to discourage the practice of throwing rubble in public spots, particularly nullahs.

After facing resistance from the board members, the CDA chief agreed to review his decision to co-opt two private members – heads of the Islamabad Chamber of Commerce and Industry and Islamabad Industrial Association – to the board and said the matter would be referred to the federal government.

In order to put the controversy to rest, it was decided that instead of the co-opt members, a working group would be formed having representation of traders and CDA officials. This group headed by the chairman will propose suggestions to the management for the betterment of the city. It will also have representation of the chambers of commerce, traders’ bodies, and development associations.

“Coordination with traders’ community and other stakeholders is imperative for making good policies for the betterment of the city. Instead of making policies behind closed doors, I want to get input from all relevant stakeholders; therefore, I have decided to form this working group,” Mr Mengal told Dawn.

He clarified that this group had nothing to do with the working of the CDA board.” Let me make it clear, the co-opted members also had no voting rights and they were supposed to attend meetings whenever required … now I [have] decided that instead of co-opting appointments, we will form a working group,” he said.

Meanwhile, the CDA chief also decided to re-designate the post of “honorary” member inspection to the director general of inspection, who will have three directors under her command.

The office of DG Inspection headed by Roomana Gul Kakar will “bring transparency to the public body” and will scrutinise controversial cases and refer them to the Federal Investigation Agency (FIA) if required.

Published in Dawn, June 8th, 2023

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