Patient safety falls under the Patient/Care Management domain, which accounts for 32% (40 items) of your test. You must know how to assess fall risks, manage restraints safely, and mitigate environmental hazards on the medical-surgical unit. Test your knowledge with these free CMSRN questions from our bank of 4100+ items.
Question 1
61 of 125. A confused patient with a urinary catheter falls attempting to ambulate to the bathroom. Post-fall neuro checks are normal, but the catheter is dislodged with minor bleeding. Which documentation element is legally essential?
- A) A) The family's notification about the incident
- B) B) Integrity of the catheter system pre-fall
- C) C) Staff response time to the fall event
- D) D) Patient's mental status during the attempt✓
Show rationale
Altered mentation is a critical cue for foreseeability. Documenting cognitive status (D) establishes whether standard precautions (like supervision) were indicated, which is central to negligence determinations per legal standards. Catheter integrity (B) relates to equipment but isn't the primary fall contributor. Response time (C) matters less than preventive actions for confusion. Family notification (A) is important but not the core legal factor. The confusion and attempted ambulation make cognitive assessment documentation vital.
Question 2
36 of 125. A homeless patient with schizophrenia is admitted for cellulitis. They resist shelter referrals due to paranoia. Which interdisciplinary action minimizes safety risks during antibiotic treatment?
- A) A) Coordinating directly supervised daily medication administration
- B) B) Prescribing long-acting injectable antibiotics before discharge✓
- C) C) Arranging transportation to daily outpatient infusion appointments
- D) D) Requesting social work for permanent housing solutions
Show rationale
Homelessness and untreated psychosis (cues) create adherence barriers. Injectable antibiotics (B) ensure treatment completion without relying on environmental stability or appointments. Supervised administration (A) is impractical without housing. Outpatient appointments (C) assume transportation access and symptom stability. Housing solutions (D) are vital long-term but don't address immediate infection control. IDSA guidelines prioritize assured adherence for serious infections when SDOH limit follow-up.
Question 3
41 of 125. An immobile patient with a BMI of 18 and albumin of 2.0 g/dL develops non-blanchable erythema over the heels. Which intervention is most critical for preventing progression?
- A) A) Applying a hydrocolloid dressing to the erythema site
- B) B) Placing the patient on a pressure-redistributing mattress✓
- C) C) Massaging the erythematous area twice daily
- D) D) Increasing oral protein supplements to three times daily
Show rationale
Pressure redistribution is paramount for prevention in immobile patients. While nutrition (D) addresses a risk factor, it doesn’t directly relieve pressure. Dressings (A) treat early injury but don’t prevent mechanical stress. Massaging (C) can cause shear injury. NPIAP guidelines prioritize pressure offloading over localized treatments for intact skin. Low BMI/albumin heightens urgency for mechanical intervention.
Question 4
42 of 125. During renovation near a medical-surgical unit, construction noise consistently exceeds 85 decibels. A patient with heart failure reports anxiety and insomnia. Which action best mitigates this environmental stressor?
- A) A) Administering PRN anxiolytics and providing white-noise machines
- B) B) Relocating the patient and sealing windows with acoustic panels
- C) C) Scheduling quiet hours and offering noise-canceling headphones✓
- D) D) Documenting noise levels and escalating to facility management
Show rationale
Headphones provide immediate personal noise reduction while scheduled quiet periods align with hospital noise control policies—directly addressing physiological stress triggers. A medicates without environmental modification. B is impractical mid-renovation. D delays relief. WHO hospital noise guidelines prioritize patient-centered interventions for sustained >65dB exposure, especially for cardiac patients where stress exacerbates symptoms.
Question 5
15 of 125. A nurse observes a colleague consistently omitting hand hygiene between non-isolation patients, citing skin irritation. How should the nurse apply Just Culture principles?
- A) A) Report the colleague anonymously to management
- B) B) Remind the colleague about infection control policies
- C) C) Provide barrier cream samples and discuss alternatives✓
- D) D) Document observations in the safety reporting system
Show rationale
The colleague’s skin irritation (cue) and consistent omission suggest at-risk behavior, not recklessness. Just Culture encourages addressing barriers: offering solutions (barrier cream) while discussing safety alternatives (C) fosters accountability without shame. Anonymous reporting (A) undermines trust and learning. Policy reminders (B) ignore the physical barrier. Formal reporting (D) is premature before peer intervention; AMSN guidelines support addressing at-risk behaviors collaboratively first.
Question 6
80 of 125. An 80-year-old with advanced dementia and dysphagia is placed in a vest restraint after repeated attempts to climb over bedrails. The nurse notes gurgling sounds during hourly rounding. What action aligns with restraint safety principles?
- A) A) Perform immediate suctioning while maintaining restraint placement
- B) B) Release the restraint to position the patient laterally✓
- C) C) Administer prescribed PRN glycopyrrolate for secretions
- D) D) Document the finding and reassess in 15 minutes
Show rationale
B is correct because aspiration risk (dysphagia cue) requires immediate restraint release for repositioning—a life-threatening complication takes priority. A is unsafe (restraint impedes airway access). C delays intervention for a mechanical problem. D ignores acute respiratory compromise. CMSRN protocols mandate releasing restraints for airway emergencies, emphasizing that safety overrides restraint use. The dementia diagnosis increases aspiration risk, requiring vigilant response to respiratory cues.
Question 7
11 of 125. An 85-year-old with a history of syncope falls in the dining area 30 minutes after receiving lisinopril and metoprolol. They are alert with stable vitals but report dizziness. Which intervention best addresses the likely contributing factor?
- A) A) Apply a yellow fall-risk bracelet immediately
- B) B) Conduct orthostatic blood pressure measurements✓
- C) C) Place the patient on NPO status for 4 hours
- D) D) Schedule physical therapy for balance training
Show rationale
Timing (post-antihypertensive) and dizziness cue suggest orthostatic hypotension. Checking orthostatic BP (B) directly investigates medication-related syncope risk per CMSRN protocols. Fall bracelets (A) should already be in place for high-risk patients. NPO status (C) is unrelated to medication effects. Balance training (D) addresses long-term prevention but not the acute pharmacological cause. The intervention must target the modifiable, immediate factor indicated by the temporal relationship and symptoms.
Question 8
36 of 125. A nurse assesses a 68-year-old patient with diabetes and osteoarthritis living alone in a third-floor walk-up apartment with uneven stairs. The patient reports increased knee pain limiting grocery shopping. Which safety risk warrants priority intervention based on social determinants?
- A) A) Hypoglycemia from inconsistent meal timing
- B) B) Falls during stair navigation while carrying groceries✓
- C) C) Diabetic foot ulcer from inadequate foot inspections
- D) D) Hyperglycemia from limited access to fresh produce
Show rationale
The key cues are housing barriers (uneven stairs) and functional limitation (knee pain), creating high fall risk when carrying items. While hypoglycemia (A) and hyperglycemia (D) relate to food access, the immediate safety threat is falls. Foot ulcers (C) are important but less urgent than acute fall risk. Falls align with CDC guidelines prioritizing environmental hazards over chronic complications. Distractors miss the combined impact of physical environment and mobility limitations on immediate safety.
Question 9
92 of 125. A 72-year-old patient with COPD and osteoporosis becomes agitated post-hip replacement, attempting to pull out his IV line despite redirection. Soft wrist restraints are applied per protocol. Which documented observation BEST indicates compliance with monitoring standards?
- A) A) \Patient's respiratory rate 20/min, SpO₂ 95% on 2L NC; restraints intact, skin warm/pink\✓
- B) B) \Restraints reapplied after toileting; patient calmer after PRN lorazepam given\
- C) C) \CMS guidelines reviewed; restraint order renewed for next 4 hours\
- D) D) \Family educated on restraint necessity; no signs of distress noted\
Show rationale
A is correct because it addresses two critical monitoring requirements: respiratory status (vital for COPD patients) and neurovascular checks (skin integrity/circulation per osteoporosis/immobility risks). B omits physiological metrics despite sedation risks. C focuses on documentation compliance, not direct assessment. D substitutes family education for physical evaluation. Joint Commission mandates continuous physiological monitoring every 15-30 minutes, prioritizing airway/breathing/circulation in restrained patients with comorbidities.
Question 10
58 of 125. Post-hip replacement, a dementia patient keeps sliding out of her chair despite alarms. Her daughter reports she responds well to hand massages. The nurse notes stage 2 sacral pressure injury. What intervention is optimal?
- A) A) Use a lap tray with sensor alarm for seated positioning✓
- B) B) Apply ankle restraints to limit standing ability temporarily
- C) C) Position in a Geri-chair with scheduled massage breaks
- D) D) Administer risperidone to reduce mobility attempts
Show rationale
The lap tray provides physical cueing without restraint (addressing sliding risk) and allows massage (cue: family input). Ankle restraints (B) compromise skin integrity (cue: pressure injury) and increase fall risk. Geri-chairs (C) are restrictive and limit mobility. Risperidone (D) has black-box warnings for dementia-related psychosis mortality. The tray meets safety goals while preserving autonomy per AMSN standards.
Question 11
49 of 125. During shift change, a nurse realizes a diabetic patient received 5 units of regular insulin instead of 2 units 4 hours ago. The patient’s glucose is 82 mg/dL without symptoms. What fulfills institutional reporting obligations?
- A) A) Monitor glucose hourly and adjust next insulin dose per sliding scale
- B) B) Submit an adverse event report since the error reached the patient✓
- C) C) File a near-miss report as no clinical consequences occurred
- D) D) Document the variance and evaluate medication dispensing processes
Show rationale
Medication errors reaching patients qualify as adverse events regardless of harm. Option B complies with WHO reporting standards. Option A addresses clinical needs but ignores mandatory reporting. Option C misclassifies the event—actual administration occurred. Option D focuses on process improvement without formal reporting. Hypoglycemia risk demands accountability for dosing errors.
Question 12
10 of 125. Four hours after restraint application for severe agitation, a patient with heart failure develops +2 pedal edema. What assessment finding warrants restraint discontinuation?
- A) A) Restraint-related skin irritation on the wrist
- B) B) Agitation replaced by lethargy and confusion✓
- C) C) Mild bruising at restraint sites
- D) D) Blood pressure increase from 130/80 to 150/90 mmHg
Show rationale
B is correct as altered mental status (heart failure cue) may indicate hypoxia or encephalopathy, necessitating restraint removal for reassessment. A/C are local issues managed without discontinuation. D requires monitoring but isn’t directly restraint-related. AMSN protocols require discontinuation when restraints exacerbate medical conditions or clinical status changes. Heart failure increases vulnerability to fluid/electrolyte imbalances, making neurological changes high-risk.
Question 13
12 of 125. While transferring a patient using a ceiling lift, the nurse hears a grinding noise from the motor. The patient has osteoporosis and a recent lumbar fusion. Which action prioritizes safety per Safe Patient Handling guidelines?
- A) A) Complete the transfer slowly while supporting the patient's back manually
- B) B) Lower the patient immediately and activate the lift emergency release✓
- C) C) Pause the transfer and manually crank the lift to its lowest position
- D) D) Proceed to nearest safe surface and document the malfunction
Show rationale
Grinding noises indicate mechanical failure risk. Emergency release prevents catastrophic drops, especially critical with spinal precautions. Option A continues unsafe transfer. Option C delays securing the patient. Option D risks injury during movement. OSHA standards mandate halting equipment at malfunction signs. The cues (osteoporosis, spinal fusion) heighten injury risk from falls, making B the safest immediate action.
Question 14
17 of 125. A 78-year-old patient admitted for COPD exacerbation uses a rolling walker independently. Morse Fall Scale assessment shows: history of falling (25), secondary diagnosis (15), uses walker (15), IV infusion (20), normal gait (0), oriented (0). Which nursing action aligns with Morse scoring guidelines?
- A) A) Implement hourly rounding and place fall alert signage at bedside
- B) B) Apply a bed alarm and assign to a room near nurses' station✓
- C) C) Initiate a toileting schedule and provide non-slip footwear
- D) D) Conduct physical therapy evaluation for gait training exercises
Show rationale
The Morse score of 75 (high risk) requires intensive interventions. Option B addresses environmental safety and monitoring per guidelines for scores >45. A (hourly rounding) is insufficient for high-risk patients. C (toileting/non-slip) targets common risks but ignores the IV infusion cue contributing to instability. D (PT referral) is valuable but not the priority immediate action for fall prevention with current risk factors.
Question 15
50 of 125. A confused patient with heart failure nearly receives furosemide 80 mg IV instead of 40 mg when two vials are incorrectly prepared. The error is caught during the independent double-check. Which response supports safety culture?
- A) A) Discard the extra vial and document the correct dose as administered
- B) B) Report the near miss to the unit’s quality improvement committee✓
- C) C) Review high-alert medications with the involved staff member privately
- D) D) Re-educate the team about diuretic dosing at tomorrow’s huddle
Show rationale
Reporting near misses promotes systemic learning. Option B ensures organizational review of double-check failures. Option A omits reporting and misses prevention opportunities. Option C addresses individual performance without system analysis. Option D delays education without documenting the event. The patient’s confusion and high-risk medication increase potential harm, requiring proactive reporting per IHI guidelines.