CPNRE / REx-PN Exam Flashcards

Q: What is the difference between the CPNRE and the REx-PN?

Both are entry-to-practice exams for Canadian licensed/registered practical nurses. The CPNRE, used in most provinces and territories, is a fixed-form 160-170 question exam developed with Yardstick Assessment Strategies. The REx-PN, used in Ontario and British Columbia, is an NCSBN-developed computerized adaptive test of 90-150 items delivered via Pearson VUE.

Q: How long do I have to write the exam?

Both exams allow a maximum of 4 hours (240 minutes). For the REx-PN this total includes the tutorial and any optional breaks; there is no per-question time limit.

Q: What is the passing score?

Both exams are pass/fail and do not report a fixed percentage. The CPNRE pass mark is set by a Standard Setting Committee using the modified Angoff method; the REx-PN compares your measured ability against a fixed NCSBN logit passing standard.

Q: How many questions are on the CPNRE and REx-PN?

The CPNRE has 160-170 multiple-choice questions, some of which are unscored experimental items. The REx-PN delivers 90-150 items (60-120 scored plus about 30 unscored pretest items) and adapts in real time based on your responses.

Q: What content does the exam cover?

Both exams are organized around NCSBN Client Needs: Safe and Effective Care Environment (28-40%), Health Promotion and Maintenance (6-12%), Psychosocial Integrity (8-14%), and Physiological Integrity (34-58%), which includes pharmacological and parenteral therapies, basic care, risk reduction, and physiological adaptation.

Q: What is the exam fee?

CPNRE fees vary by province and generally range from about CA$350 to CA$650. The REx-PN registration fee is approximately US$360 plus applicable taxes.

Question 1

Delegation vs. assignment

Accepted Answer

Delegation transfers responsibility for a regulated nursing task to another regulated provider while the nurse keeps accountability for the outcome. Assignment matches existing scope-of-practice tasks to the right provider without transferring professional judgment. Assessment, teaching, and evaluation cannot be delegated to unregulated care providers.

Question 2

Five rights of delegation

Accepted Answer

Right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. Use them before asking an unregulated care provider to perform a task: each one confirms the task is safe, predictable, and within their role, and that you will remain available to monitor and intervene.

Question 3

Scope of practice and competence

Accepted Answer

A nurse may legally perform only activities within the regulatory scope for their province AND within their personal competence (education, training, skill). Being legally permitted does not mean being competent. Decline untrained procedures, communicate the gap, and seek education rather than attempt a task that could harm the client.

Question 4

Professional accountability for a colleague's unsafe act

Accepted Answer

When you witness falsified documentation or unsafe practice, the first step is usually to speak privately with the colleague so they can correct the record. If the behaviour continues or the client is at risk, escalate through the chain of command. Reporting to the regulatory college is a later step, not the first.

Question 5

Practical nurse role on the interprofessional team

Accepted Answer

The PN contributes nursing knowledge and observations while respecting each member's distinct scope, including regulated and unregulated colleagues. The PN does not act only on physician direction, does not supervise all team members, and does not work in isolation. Collaborative, client-centred practice is the expected standard.

Question 6

Matching clients to care providers

Accepted Answer

Safe assignment matches client acuity and care needs to the competence, scope, and skill of the provider. Higher-acuity or unstable clients go to regulated nurses; stable, predictable clients may be cared for by less specialized staff. Seniority and equal client numbers are not safe criteria.

Question 7

When informed consent must be re-obtained

Accepted Answer

Consent is procedure-specific. If the nature, scope, or surgical approach changes significantly, the original consent is invalid and a new consent must be obtained. Rescheduling the same procedure, routine questions, or family presence do not require re-consent because the procedure itself has not changed.

Question 8

Confidentiality and need-to-know access

Accepted Answer

Under provincial privacy legislation, a nurse may access a client's personal health information only when there is a legitimate care-related reason. Curiosity-driven access to a record of a non-assigned client (even a celebrity or neighbour) is a privacy breach, regardless of intent.

Question 9

Honouring a DNR order

Accepted Answer

A valid do-not-resuscitate order means CPR is not initiated when the client has no pulse and is not breathing. The nurse provides comfort measures and notifies the team and family. Family permission is not required to withhold resuscitation once a valid order is in place; starting CPR would violate the client's documented wishes.

Question 10

Mandatory reporting of vulnerable adult abuse

Accepted Answer

Nurses have a duty to protect vulnerable clients. If financial, physical, or other abuse is suspected, document objective findings and report through the legislated channels and facility policy. Do not keep the suspicion private, wait for the client to ask, or confront the suspected abuser directly, which can escalate risk.

Question 11

Verbal and telephone orders

Accepted Answer

Verbal orders should be avoided except in genuine emergencies. After the situation stabilizes, the nurse must document the order, read it back to the prescriber for verification, and have the prescriber authenticate (sign) it within the timeframe set by facility policy. Family members cannot co-sign prescriber orders.

Question 12

Objective vs. subjective documentation

Accepted Answer

Professional documentation records what is observed and measurable: distance walked, assistance level, vital signs, and quoted statements. Labels such as 'uncooperative,' 'fine,' or 'as usual' are subjective, judgmental, and not useful. Chart facts that another nurse could act on without guessing.

Question 13

Soap and water vs. alcohol-based hand rub for C. difficile

Accepted Answer

Alcohol-based hand rub does not kill C. difficile spores. Soap and water is required because the mechanical friction physically removes spores from the hands. Use ABHR for most routine care, but switch to soap and water after caring for a client with suspected or confirmed C. difficile infection.

Question 14

Airborne precautions

Accepted Answer

Required for pathogens transmitted by small droplet nuclei that linger in air, such as tuberculosis, measles, and chickenpox. Use a negative-pressure (airborne infection isolation) room and a fit-tested N95 respirator. A standard surgical mask does not filter these tiny nuclei.

Question 15

Droplet precautions

Accepted Answer

Required for pathogens spread by large respiratory droplets travelling short distances, such as seasonal influenza, mumps, and rubella. Place the client in a single room (or cohort) and wear a surgical mask within about 2 metres. N95 is not required because the droplets are too large to reach the alveoli.

Question 16

Contact precautions

Accepted Answer

Used for organisms spread by direct client contact or contaminated surfaces, such as MRSA, VRE, scabies, and lice. Wear gown and gloves for all interactions, dedicate equipment to the client, and clean the room frequently. Combine with standard precautions for all clients.

Question 17

PPE doffing order

Accepted Answer

Remove the most contaminated items first: gloves, then eye protection or face shield, then gown, and finally the mask or respirator after leaving the room. Gloves carry the highest bioburden. Removing the mask last protects the airway while other items are taken off and the hands are freed to perform hand hygiene.

Question 18

Sterile field 2.5 cm border rule

Accepted Answer

The outer 2.5 cm (1 inch) edge of a sterile drape is considered unsterile because microorganisms from the underlying surface can wick inward. Sterile items must not touch this border, and sterile gloves or instruments that touch it are contaminated. Keep sterile items above waist level and in view at all times.

Question 19

Safe sharps disposal

Accepted Answer

Used needles and syringes go directly into a puncture-resistant sharps container without recapping, breaking, or bending the needle. Recapping is the most common cause of needlestick injuries. Sharps containers must not be filled above the marked line and must be sealed and replaced before transport.

Question 20

RACE fire-response acronym

Accepted Answer

R = Rescue/Remove clients in immediate danger. A = Alarm (activate the fire alarm and call for help). C = Contain (close doors and windows to limit smoke and fire spread). E = Extinguish if safe, or Evacuate. The nurse rescues clients first, not runs out alone or restrains clients in bed.

Question 21

Oxygen fire hazard

Accepted Answer

Oxygen vigorously supports combustion but does not itself ignite. Smoking, candles, heating pads with sparks, or petroleum-based lip balm near an oxygen source create a serious fire risk. The priority when ignition is present is to remove the ignition source and the oxygen, then document and educate.

Question 22

Least-restrictive fall prevention

Accepted Answer

Keep the bed in the lowest locked position, call bell within reach, and a clear path to the bathroom. Consider bed alarms, non-slip footwear, and toileting schedules. Physical restraints are a last resort, not a first-line measure: they increase injury risk and dignity loss and require an order and ongoing reassessment.

Question 23

Restraints as last resort

Accepted Answer

Before applying restraints, try reorientation, distraction, family presence, relocating the client near the station, and removing triggers (e.g., covering IV sites). If restraints are unavoidable, use the least restrictive type, obtain a prescriber order within a defined window, and reassess at frequent intervals.

Question 24

Mechanical lift safety

Accepted Answer

Before each use, confirm the sling is the correct size and properly positioned, straps are not frayed, and the client's weight is within the lift's rated capacity. Many lifts require two staff for safety. Do not lift quickly; smooth, controlled movement prevents falls and client fear.

Question 25

WHMIS and Safety Data Sheets

Accepted Answer

WHMIS (Workplace Hazardous Materials Information System) requires that hazardous chemicals have a Safety Data Sheet available. For a chemical spill, consult the SDS for hazards, PPE, spill cleanup, and first aid. The SDS is the authoritative source, not the MAR, care plan, or staffing schedule.

Question 26

Routine childhood immunization starting point

Accepted Answer

In Canada's routine schedule, the first DTaP-IPV-Hib combination dose is given at 2 months of age, followed by doses at 4 and 6 months and boosters later. Hepatitis B may begin at birth in some provinces. Knowing the schedule lets the nurse teach parents and identify under-immunized children early.

Question 27

Safe sleep to reduce SIDS risk

Accepted Answer

Place infants on their back on a firm, flat surface free of pillows, bumper pads, soft bedding, and toys. Room-sharing on a separate surface lowers SIDS risk; bed-sharing increases suffocation risk. Stomach (prone) sleeping is contraindicated for sleep in infancy.

Question 28

Folic acid in prenatal care

Accepted Answer

Adequate folic acid (folate) before conception and during early pregnancy significantly reduces the risk of neural tube defects such as spina bifida and anencephaly. It is a cornerstone of preconception counselling and prenatal health promotion, ideally started before pregnancy confirmation.

Question 29

Colorectal cancer screening for average-risk adults

Accepted Answer

Canadian programs commonly recommend a fecal immunochemical test (FIT) every two years starting around age 50 for average-risk adults, with colonoscopy follow-up if positive. Chest X-ray, skin biopsy, and CBC are not colorectal screening tools. Early detection improves outcomes dramatically.

Question 30

Osteoporosis prevention in perimenopausal women

Accepted Answer

Adequate calcium and vitamin D intake plus regular weight-bearing exercise maintain bone density. Avoiding all activity, strictly limiting dairy and protein, or excess caffeine and sodium worsen bone loss. Weight-bearing loading signals bone to maintain density.

Question 31

Smoking cessation and the Stages of Change

Accepted Answer

Effective cessation support assesses the client's readiness to change (precontemplation, contemplation, preparation, action, maintenance) and builds a collaborative quit plan that may include nicotine replacement, behavioural counselling, and follow-up. Fear-based warnings and 'use willpower' messages reduce engagement.

Question 32

Active listening in therapeutic communication

Accepted Answer

Active listening uses silence, reflection of feelings, paraphrasing, and attentive body language to encourage the client to express themselves. It conveys empathy without imposing the nurse's opinions. Giving advice, changing the subject, or using cliches such as 'everything happens for a reason' block communication.

Question 33

Direct suicide risk assessment

Accepted Answer

When a client expresses suicidal ideation with means (e.g., 'pills at home'), ask directly and calmly whether they have a specific plan and intent. Direct questioning does not increase suicide risk. Do not change the subject, offer vague reassurance, or delay to the next appointment: this is an immediate safety situation.

Question 34

Kubler-Ross denial stage

Accepted Answer

Statements such as 'the lab mixed up my results' or 'there must be a mistake' reflect denial, typically the first grief stage. The nurse supports by listening and staying present without arguing or forcing acceptance. Bargaining, depression, and acceptance come later; the client sets the pace.

Question 35

Alcohol withdrawal timeline and delirium tremens

Accepted Answer

Mild withdrawal starts within hours of the last drink, but delirium tremens (confusion, hallucinations, autonomic instability, seizures) peaks around 48-72 hours and can be fatal. Close monitoring during this window is essential. Constipation and increased appetite are not dangerous withdrawal features.

Question 36

Responding to hallucinations

Accepted Answer

Do not pretend to hear the voices or argue that they are not real. Acknowledge the client's experience ('I don't hear them, but I understand you do') and ask what they are saying. This builds trust and lets you assess command hallucinations for safety risk, especially if voices instruct harm.

Question 37

Sundowning in dementia

Accepted Answer

Late-afternoon agitation in dementia is managed by a consistent daily routine, reduced evening stimulation (noise, lighting, visitors), reassurance, and adequate but not harsh lighting. Bright lights, loud TV, frequent room changes, and restraints tend to worsen agitation.

Question 38

Acetaminophen daily limit

Accepted Answer

The maximum recommended total daily dose for most healthy adults is 4000 mg to avoid hepatotoxicity. Lower limits (e.g., 2000-3000 mg) apply for clients with liver disease, chronic alcohol use, or older adults with frailty. Teach clients to count acetaminophen from all sources, including combination cold products.

Question 39

Dosage calculation formula (D/H)

Accepted Answer

Dose to administer = Desired dose divided by dose on Hand (D/H). For example, 500 mg ordered with 250 mg tablets gives 500/250 = 2 tablets. Always convert units first (1 g = 1000 mg) before dividing; unit mismatch is a leading cause of medication error.

Question 40

IV flow rate calculation

Accepted Answer

Drops per minute = (Total volume in mL x drop factor in gtt/mL) divided by total time in minutes. Example: 1000 mL over 8 hours with 15 gtt/mL tubing = (1000 x 15) / (8 x 60) = 31 gtt/min. Verify the drop factor on the specific tubing, because it varies (10, 15, 60 gtt/mL).

Question 41

Opioid respiratory depression

Accepted Answer

A respiratory rate below 12 (and certainly 8) breaths per minute in an adult receiving opioids is a hold-the-dose event: monitor closely, notify the prescriber, and have naloxone available. Mild drowsiness that resolves with stimulation and chronic constipation are expected and do not require holding.

Question 42

Warfarin monitoring (INR vs. aPTT)

Accepted Answer

Warfarin's anticoagulant effect is tracked with the International Normalized Ratio (INR); a typical therapeutic target is 2.0-3.0 for many indications. The aPTT monitors heparin (unfractionated), not warfarin. Blood glucose and potassium are unrelated to warfarin monitoring.

Question 43

Digoxin and apical pulse hold parameter

Accepted Answer

Before giving digoxin, count the apical heart rate for one full minute. If the adult rate is below 60 bpm, withhold the dose and notify the prescriber to prevent bradycardia and toxicity. Respiratory rate, blood pressure, and oxygen saturation are not the hold parameters for digoxin.

Question 44

Intravenous potassium safety

Accepted Answer

Potassium chloride must always be diluted and infused slowly via a controlled infusion pump, never as an IV push. Rapid administration can cause fatal cardiac dysrhythmias. Recheck the serum potassium level and the infusion rate; never 'double the rate' to correct a low value quickly.

Question 45

Rights of medication administration

Accepted Answer

The core rights include right client, right medication, right dose, right route, right time, right reason, and right documentation. Confirm the right client using at least two unique identifiers (e.g., full name and date of birth) checked against the MAR and ID band. Room number alone is never an identifier.

Question 46

Acute hemolytic transfusion reaction

Accepted Answer

Fever, chills, low back pain, and dark urine within the first ~15 minutes of a blood transfusion suggest acute hemolysis from ABO incompatibility. Stop the transfusion immediately, maintain IV access with normal saline and new tubing, notify the prescriber and blood bank, and save the blood bag for analysis. Slowing the rate or giving antipyretics continues a fatal reaction.

Question 47

Hypoglycemia rule of 15

Accepted Answer

For a conscious client who can swallow with blood glucose below 4.0 mmol/L and symptoms, give 15 grams of fast-acting carbohydrate (e.g., 4 oz juice, glucose tablets), wait about 15 minutes, then recheck. If still low, repeat. Never give insulin or encourage exercise during hypoglycemia; both lower glucose further.

Question 48

Heart failure fluid overload signs

Accepted Answer

A sudden weight gain (e.g., 2 kg over two days), worsening dyspnea, and peripheral edema signal decompensating heart failure from fluid retention. Teach daily weights at the same time, same clothing, same scale. Dehydration and allergy do not cause this pattern; this is volume excess, not deficit.

Question 49

COPD oxygen caution

Accepted Answer

Some clients with advanced COPD chronically retain CO2 and rely partly on a hypoxic respiratory drive. Excessively high oxygen can blunt that drive and worsen hypoventilation and CO2 narcosis. Titrate oxygen to the lowest flow that maintains the target saturation; do not automatically apply high-flow oxygen.

Question 50

Diabetic ketoacidosis (DKA) classic triad

Accepted Answer

Marked hyperglycemia, Kussmaul (deep, rapid) respirations, and fruity acetone breath indicate DKA, a medical emergency requiring IV insulin, fluids, and electrolyte replacement (especially potassium). A panic attack does not cause fruity breath or severe hyperglycemia. Untreated DKA progresses to coma and death.

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Canadian Practical Nurse Registration Examination (CPNRE) / Regulatory Exam