Free CMSRN Practice Questions PDF

Transitioning a patient from continuous enteral support to oral intake requires careful coordination to prevent nutritional deficits. Because the patient is recovering from a severe stroke and is now cleared for a pureed diet, they need a structured plan to ensure they consume adequate calories orally before the tube feeding is completely removed. Option C is correct because the registered dietitian is uniquely qualified to calculate calorie counts and design a safe transitional weaning schedule. Option A is dangerous because abruptly stopping the feeding before proving adequate oral intake risks rapid malnutrition. Option B is incorrect because maintaining a continuous rate while eating often causes fullness, nausea, and poor oral intake. Option D is incorrect because while speech therapy determines the safe diet texture, the dietitian manages the caloric weaning process.

Many insurance plans, including traditional Medicare, require a three-day qualifying stay in an acute care hospital before covering subacute or skilled nursing facility care. The nurse must collaborate with case management and the provider to safely delay the transfer, ensuring the patient meets coverage criteria without facing unexpected financial burdens. Transferring the patient and billing the family for the shortage is unethical and bypasses proper care coordination. Changing the order to an acute rehabilitation facility is inappropriate because acute rehab requires different clinical criteria, such as the ability to tolerate three hours of therapy. Discharging the patient home is unsafe given the recent bilateral knee replacements and the established need for inpatient rehabilitation.

Succession planning for charge nurses requires identifying individuals who demonstrate both clinical competence and informal leadership, such as teamwork and peer support. A nurse who frequently assists peers with complex discharges shows proactive collaboration, which is a foundational trait for a charge nurse. Consistently completing tasks independently is excellent for a staff nurse but lacks the relational leadership required for a charge role. While a graduate degree is helpful, it does not automatically translate to practical clinical leadership or peer influence on the unit. Volunteering for overtime shows dedication to the unit but does not necessarily indicate leadership capacity or the ability to manage team dynamics.

Erythema extending beyond one inch combined with a palpable cord indicates grade 3 phlebitis. The standard of care requires immediate catheter removal and the application of a warm moist compress to relieve pain and inflammation. Option A is incorrect because grade 3 phlebitis requires active intervention, not just ongoing monitoring. Option C is incorrect because flushing a phlebitic vein causes severe pain and can push potential microthrombi into the patient's systemic circulation. Option D is incorrect because while elevation and analgesics might provide comfort, they do not address the primary source of the inflammation, which is the catheter itself.

The charge nurse facilitates discharges by collaborating with the interdisciplinary team to resolve barriers. Contacting the case manager to find an alternative vendor addresses the equipment delay while promoting timely patient flow. Discharging the patient without required oxygen compromises patient safety and violates the discharge plan. Transferring a medically cleared patient to the intensive care unit is an inappropriate use of critical care resources. Revoking the discharge order unnecessarily extends the hospital stay when a logistical solution might be available today.

Formulating a hypothesis for this patient requires analyzing both systemic and local factors affecting wound healing. The low albumin level indicates malnutrition, which impairs healing, while the refusal to wear offloading footwear introduces continuous mechanical pressure to the plantar surface. Together, these cues perfectly support a hypothesis of impaired tissue integrity. Option A is incorrect because there are no specific cues indicating arterial disease, such as absent pulses or claudication. Option B is incorrect because while the patient is nonadherent with footwear, there is no data provided regarding their blood glucose trends or dietary adherence. Option D is incorrect because the patient is actively ambulating to the bathroom, and there are no cues suggesting that severe pain is limiting their physical mobility.