Medical MSNCB : MSNCB Medical-Surgical Nursing Certification Exam

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MSNCB test Format | MSNCB Course Contents | MSNCB Course Outline | MSNCB test Syllabus | MSNCB test 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 test 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 assessment.
- 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 assessment 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 assessment, 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 Certification answers

Maryland’s longtime medical examiner wouldn’t call George Floyd’s dying a murder. It has prompted a reckoning. | MSNCB real Questions and Real test Questions

because the trial approached for Derek Chauvin in Minneapolis, the pathologist Dr. Emily Duncanson wondered who would testify in defense of the ex-cop.

the realm had watched cell phone video of Chauvin kneeling on George Floyd’s neck. What medical professional wouldn’t name that murder?

Duncanson anticipated one of the crucial movie star docs popular greater for tv appearances than medical opinions. The identify on the witness listing surprised her: Dr. David R. Fowler.

“Dr. Fowler become not a type of,” she pointed out. “He become very smartly revered.”

indeed, the retired chief scientific examiner for Maryland become particularly viewed in the small world of forensic pathologists. Maryland’s workplace ranks among the main associations within the uniqueness box; Fowler ran it for essentially two many years. He’s published greater than one hundred scientific journal articles and lectured all over the world on every little thing from the possibility of crib bumpers to homicides by using kitchen knife.

even though protection attorneys challenged Fowler’s rulings over the years, his friends elected him president of the national affiliation of medical Examiners in 2015. Then he served as chairman of the board.

during this photo from video, Dr. David Fowler, a retired forensic pathologist and former chief medical examiner for the state of Maryland testifies as Hennepin County decide Peter Cahill presides April 14 in the trial of former Minneapolis police Officer Derek Chauvin at the Hennepin County Courthouse in Minneapolis. (AP)

With someday of testimony, his recognition turned into in tatters.

“all and sundry who i was speakme to changed into taken aback by how baseless his testimony turned into,” pointed out Duncanson, of St. Paul, Minnesota. “Like, ‘Have we dominated out aliens?’ I suggest, it become to date out there.”

In Baltimore, Dr. Joshua Sharfstein, the previous Maryland health secretary and city health commissioner, watched with confusion.

The Minnesota medical examiner, Dr. Andrew Baker, carried out the autopsy of Floyd and found severe heart disorder. throughout the trial, he testified that Chauvin’s knee “became simply greater than Mr. Floyd may take.” His conclusion: “homicide.”

On the witness stand, Fowler blamed a mixture of Floyd’s unhealthy coronary heart and reticence by using police, all of it worsened by way of drugs within the man’s system. Fowler testified that the tailpipe of the police car may also have leaked carbon monoxide into Floyd’s face and contributed to his loss of life.

When asked to classify the method of Floyd’s demise, Fowler observed he would “fall again to ‘undetermined.’”

That spark off a firestorm.

Buzz Merrick appears at a rally on West Baltimore road annoying that instances overseen by means of former scientific examiner Fowler be investigated. April 28, 2021 (Amy Davis / Baltimore solar)

Seldom heard changed into the opinion of medical examiners who did not locate Fowler’s conclusion outlandish. Some informed The Baltimore solar his testimony changed into grounded in science, no longer dangerous religion. Forensic pathologists often attain distinctive conclusions on the equal proof, some observers referred to.

“medicine is more of an art than a science,” mentioned Dr. Randall Frost, a former chief medical examiner in San Antonio. “if you ask 10 forensic pathologists a few reason behind demise on anything aside from a fine looking easy case, you’re going to get 10 different solutions.”

in short, it’s complex. And on account that the history of the Maryland clinical Examiner’s office, Fowler’s testimony turned into no surprise. The workplace has classified deaths “undetermined” for decades — extra so than just about anywhere else.

most effective this time, the world changed into watching.

more right than wrong?

Open-air carbon monoxide poisoning doesn’t appear a long way-fetched to Dr. James Claude united states Downs, a forensic pathologist in Georgia. He recalled the demise of a 12-year-old boy who inhaled carbon monoxide while using on the lower back of a boat through mobile Bay.

“It’s not distinct, because of the character of what we do, that sometimes individuals aren’t chuffed with the effects,” he said.

Fowler discusses gadget and techniques at the office’s toxicology lab in November 2012. His testimony within the Derek Chauvin trial this year has develop into a flashpoint in the debate about bias in forensic pathology. Ben Weathers/The Capital

Fowler’s testimony within the Chauvin case represented the consensus opinion of 14 clinical consultants — in pathology, pulmonology, toxicology, cardiology, emergency medicine — recruited by using The Forensic Panel, a brand new York consulting firm. It changed into hired with the aid of Chauvin’s protection attorneys to evaluate the evidence for trial.

Prosecutors supplied the company’s certified with verify consequences displaying just insignificant ranges of carbon monoxide in Floyd’s gadget — but did so only after Fowler’s testimony, mentioned Dr. Michael Welner, chairman of the company.

In Virginia, former chief clinical examiner Dr. Marcella Farinelli Fierro considers Fowler a professional friend.

“He wasn’t accessible on a limb,” she referred to. “He became more appropriate than incorrect. You’re dealing with a video, ok. And that video looks lousy. but if you get down to the physiology of it and also you say to yourself, ‘What’s operational here in terms of physiology?’ there are a lot of questions.”

nevertheless, Fowler’s testimony has turn into a flashpoint within the debate about bias in forensic pathology. In February, the Journal of Forensic Sciences published a analyze finding racial bias in loss of life investigations. The authors offered 133 forensic pathologists with the hypothetical case of a child with a fractured skull.

About half the medical doctors were informed the little one become Black and the mother’s boyfriend become the caretaker. For the other half, the toddler changed into white and the grandmother changed into the caretaker. Researchers discovered the docs 5 times extra more likely to rule the Black newborn’s death a “homicide” than an “accident.”

The outcomes caused a stir. greater than ninety forensic examiners, together with Fowler, signed a letter to the journal editor, traumatic the analyze be retracted, referred to Dr. Brian Peterson, the Milwaukee County scientific examiner who wrote the letter.

The doctors who signed blanketed Dr. Christopher Milroy, a forensic pathologist in Canada and former chair of the Pathology/Biology component to the American Academy of Forensic Sciences. He stated key eventualities in a examine should be similar: white baby with mom’s boyfriend; Black newborn with mom’s boyfriend.

“Boyfriends are more seemingly than grandmothers to kill. Non-biological family members are more seemingly than organic relations to kill,” Milroy pointed out. “I signed it not because I don’t accept as true with there’s bias; I signed it since it’s a terrible piece of science.”

The controversy changed into smoldering when Fowler took the witness stand two months later and called the method of Floyd’s demise undetermined.

Fowler is pictured in September 2005. Maryland medical examiners classify a more robust percentage of deaths “undetermined” than in many different jurisdictions in the united states, a practice that predates his arrival here. Elizabeth Malby/Baltimore sun

Critics accused Fowler of obfuscating. regardless of the unhealthy coronary heart and drugs, Floyd would be alive but for 9 1/2 minutes of the cop’s knee on his neck. How can that be categorised as anything apart from murder?

“Many scientific examiners for a long time were ignoring police-connected deaths, attempting to find essentially the most minute, insignificant findings to clarify a demise like George Floyd,” said Dr. Cyril Wecht, a nationally recognized forensic pathologist from Pittsburgh.

Alumni of Fowler’s tuition in South Africa petitioned directors to sentence the medical professional’s testimony and censure him. college of Cape city school issued a statement announcing they support a evaluate of his historical situations.

Fowler’s testimony led to scathing comments online.

In a racially charged murder case, the individuals requested, who trusts a white medical professional expert in apartheid South Africa?

reputation for independence

The U.S. has a patchwork of state and local places of work accountable for dying investigations. In rural Texas, for instance, elected justices of the peace fill out dying certificates after a number of weeks of training.

Maryland is among a handful of states with out county offices, but one statewide medical examiner. The office investigates deaths from the japanese Shore to Western Maryland. the chief is a board-certified forensic pathologist.

a local of the African land once known as Rhodesia, Fowler attended clinical faculty in South Africa and got here to Baltimore in 1991 for a residency on the university of Maryland clinical center. He accomplished a two-yr fellowship within the clinical examiner’s workplace and labored his approach up to deputy chief.

In 2001, Chief clinical Examiner Dr. John Smialek died suddenly in his office. The oversight board promoted Fowler to be triumphant him. He would go on to function Maryland’s chief clinical examiner except stepping down in 2019.

Fowler took over some of the busiest places of work within the country. at the moment, group of workers performed greater than four,000 autopsies a yr, in keeping with a heritage written by Bruce Goldfarb, the office spokesman. The count has on account that climbed to more than 5,600 autopsies a 12 months, in line with workplace reports.

Goldfarb and the latest chief, Dr. Victor W. Weedn, declined to remark for this article. Fowler declined, too.

Fowler, pictured in September 2005, had a popularity for being fiercely impartial and insulating his workforce from interference by executive officials. Elizabeth Malby/Baltimore solar

Fowler grew to become neatly known as a researcher and lecturer. He co-authored a analyze within the Journal of Forensic Sciences that found 202 individuals died in the custody of police, prisons and psychiatric hospitals in Maryland from the late Nineteen Thirties to the early 2000s.

His later analysis into the suffocation risks for little ones helped persuade state lawmakers to ban crib bumpers. Fowler, meanwhile, had a acceptance for being fiercely impartial and insulating his workforce from interference by executive officers.

medical college students coveted a residency there. About 10% of all medical examiners working in the U.S. educated in Baltimore, according to the office.

“They commonly get the cream of the crop,” pointed out Dr. James Gill, Connecticut’s chief clinical examiner and president of the countrywide affiliation. “There are best a handful of places of work across the country that do this quantity of training and analysis.”

When investigating a loss of life, clinical examiners may also conduct interviews, seek advice from crime scenes and operate autopsies. They are looking to investigate the reason behind dying and classify the method, even if murder, herbal, unintentional, suicide or undetermined.

Most offices can’t check a manner in fewer than 5% of situations, Gill said. New Mexico, Connecticut, D.C. and la settled for “undetermined” in less than 2% of cases, based on office reports there.

Maryland scientific examiners classified 13% of deaths “undetermined” in 2018, the most fresh yr available.

“We’ve all the time variety of had a mandate that you wish to, to the better of your potential, answer questions to the manner an individual died. you probably have a large number of ‘undetermined,’ that’s no longer helping anyone,” noted Dr. Joye Carter, a former chief medical examiner of Washington, D.C., Indianapolis and Houston. She consulted with the prosecution in Chauvin’s case.

The Maryland tendency predates Fowler, however he’s defined the reason, above all in instances of drug overdoses. clinical examiners always don’t know whether the deceased intentionally injected a lethal volume of heroin to commit suicide, unintentionally took a foul dose, or had someone else inject the medicine. with out the data, they choose undetermined.

Drug overdoses brought about basically 90% of deaths categorized “undetermined” in the office’s annual file for 2018, essentially the most fresh accessible. excluding these deaths, the price of “undetermined” cases drops from 13% to 1.three%.

Fowler, pictured in January 1997 as an assistant medical examiner within the workplace of the chief clinical Examiner, got here to Baltimore in 1991 for a residency at the school of Maryland medical core. Chiaki Kawajiri/Baltimore solar

The formula is “intellectually sincere,” Fowler has referred to. In police killings, although, the ruling has huge implications.

The deceased can also have medication in his or her system, causing some clinical examiners to classify “unintended.” Others believe the mix of factors — medicine, police restraint, underlying fitness circumstances — and accept “undetermined” in place of elevating one aspect. The association recommends “murder” for “demise at the hands of another.”

That’s how Fowler’s workplace categorized the dying of Freddie grey in 2015, concluding he suffered a “high-power harm” to his neck and spine. The ruling introduced Baltimore State’s legal professional Marilyn Mosby with likely cause to file crook fees against the officers.

The workplace of the chief scientific Examiner ruled “undetermined” in the death of Tyrone West in 2013. He died after a site visitors cease and violent struggle with police, in keeping with witnesses and officers. medical examiners concluded his demise turned into caused by means of a coronary heart condition advanced through dehydration and police restraint. No officers were charged.

medical examiners dominated the 2016 death of Tawon Boyd “unintentional.” He died after a battle with Baltimore County police. The examiners listed the reason for his dying as organ failure introduced on through his use of medicine referred to as bathtub salts. None were charged.

In each cases, legal professional A. Dwight Pettit represented the households and sued police. He employed private forensic investigators who in every case reached a special conclusion than the scientific examiners: mainly, asphyxiation caused via police restraint. metropolis officers settled the lawsuit over West’s death for $1 million; county officials settled with Boyd’s household for $1.15 million.

The fiercest criticism of the Maryland office during Fowler’s tenure came after the loss of life of Anton Black in 2018. His household has filed a federal lawsuit accusing the office of misrepresenting the teenager’s death to supply protection to police.

They labeled his loss of life as an “accident.”

requires a evaluation

Fowler’s testimony last month in Minneapolis renewed consideration to the Maryland situations. Former Washington, D.C., scientific examiner Dr. Roger Mitchell circulated a letter calling for authorities to evaluate all deaths in custody right through Fowler’s tenure. Mitchell serves as chair of the pathology department at Howard school.

because it happens

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“Dr. Fowler’s cited opinion that George Floyd’s death all over active police restraint should still be certified with an ‘undetermined’ method is outdoor the standard apply and conventions for investigating and certification of in-custody deaths,” Mitchell wrote.

Mitchell stated 431 different doctors signed his letter online. however the men and ladies self-mentioned their professions. About 25 referred to as themselves forensic pathologists. The listing included names reminiscent of “Poop Marmelade” and the infamous Nazi health professional Josef Mengele.

Many medical examiners say they have got a crucial responsibility to function skilled witnesses for the protection. They make sure prosecutors show a case past an inexpensive doubt. In San Antonio, Frost concerns the backlash in opposition t Fowler has despatched a kick back in the course of the profession. Will medical doctors feel force to rule deaths in custody as “homicides?” he asked.

And who will be inclined to testify within the next police killing?

Baltimore sun librarian Paul McCardell contributed to this text.


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