Free CPNRE / REx-PN Exam Flashcards

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.