Canadian Nurses Association, 2013

Get Ready for

the CRNE

Canadian Nurses Association
Our Vision:
Registered nurses: Leaders and
partners working to advance
nursing and health.

CNA is a federation of 11 provincial
and territorial nursing associations
and colleges representing 146,788
registered nurses.

Our Mission:
CNA is the national professional voice of
registered nurses, advancing the practice
of nursing and the profession to improve
health outcomes in a publicly funded,
not-for-profit health system by:
unifying the voices of registered nurses;
strengthening nursing leadership;
promoting nursing excellence and a
vibrant profession;
advocating for healthy public policy and
a quality health system; and
serving the public interest.
Canadian Nurses Association
Workshop Agenda
Objectives of the workshop
Background on the Canadian Registered
Nurse Exam (CRNE)
Makeup of the exam
Fundamental exam concepts
Exam development process
How the exam is scored
Studying for the exam
Cheating
Scheduling your exam
Quiz on CRNE-type questions

Workshop Objectives
This workshop is intended to
provide you with information about:
the format of the exam
what the exam is designed to test
how to study for the exam

The workshop is NOT intended to:
substitute for studying for the exam
enable you to pass the exam

Definition of an Entry-Level RN
The registered nurse at the point
of initial registration is a
generalist and graduate of a
nursing education program. As a
generalist, the entry-level
registered nurse is prepared to
practice safely, ethically and
effectively along the continuum of
care in situations of health and
illness across the clients
lifespan.

Registered Nurse
CNA published Framework for the
Practice of Registered Nurses in
Canada, which defines registered nurses
as self-regulated health-care
professionals who work autonomously
and in collaboration with others. RNs
enable individuals, families, groups,
communities and populations to achieve
their optimal level of health.
Registered Nurse
RNs coordinate health care,
deliver direct services and
support clients in their self care
decisions and actions in
situations of health, illness,
injury and disability in all stages
of life. RNs contribute to the
health-care system through their
work in direct practice,
education, administration
research and policy in a wide
array of settings.
Becoming an RN
You must
be a graduate of an
approved school of nursing
complete the required
application forms
pass the CRNE

Background on
the CRNE

Purpose of the CRNE
To protect the public by
ensuring that the entry-level
registered nurse possesses
the competencies required to
practise safely, ethically and
effectively

(CRNE Blueprint, 2009)

The CRNE is
a paper-and-pencil exam

administered three times
per year in testing centres
across Canada:

February 6, 2013
June 5, 2013
October 2, 2013
CRNE 2010-2015
One writing session of four
hours duration
scheduled in the a.m. in
most jurisdictions
Based on 2010-2015 CRNE
blueprint
Questions based on 148
competencies
180-200 multiple-choice questions
Offered in English and French
CRNE Facts
The CRNE is...
The national exam that RN candidates are required to pass
before they can practise as RNs in all Canadian provinces/
territories (except Quebec)
Owned by the Canadian Nurses Association
Developed with input from:
nurses from across the country and the provincial/territorial
nursing regulatory bodies
utilizing the testing expertise (development, scoring,
maintenance, security) of Assessment Strategies Inc (ASI)
Administered by the provincial/territorial regulatory licensing
bodies
More Facts
The CRNE is:
developed in a systematic way that follows rigorous testing
standards
fair, reliable and valid
developed by nurse experts under the guidance of testing
experts
The pass mark is set by the Exam Committee.
Recommendations about the CRNE come from the CRNE
Council to the Executive Exam Council (EDs of the
provincial/territorial licensing bodies and CNAs CEO).
Final decisions about the exam are made by the Executive
Exam Council.


Makeup of the
CRNE

Exam Composition
180-200 multiple-choice questions
(+ experimental questions)
Each question on the
exam is designed to
measure a specific
competency required of
entry-level RNs.

Context of Questions
Typical cases
Unique situations to the
profession
Allows assessment of
core knowledge and skills
demonstrated by entry-
level RNs

Multiple Choice Questions
The Stem
Presents the question or problem

The Options
Alternatives (e.g., words, statements, numbers) from
which the examinee must select the correct or best
answer to the question/problem posed in the stem:
1 correct response: represents the correct or best
answer
3 distractors: plausible but incorrect (or less
adequate) options intended to distract the examinee
who is uncertain of the correct response

Example MC Question
Mr. J ackman, 69 years old, had a recent right
cerebrovascular accident with sensory-perceptual
deficits. Which of the following nursing interventions is
an appropriate strategy to address Mr. J ackmans
deficits?

1. Identify Mr. J ackmans previous strengths.
2. Refer Mr. J ackman to a speech pathologist.
3. Approach Mr. J ackman from the unaffected
side.
4. Minimize auditory sensory stimulation.

Why Use MC Format?
Excellent coverage of content
High reliability and validity
Statistical information on test performance can be
readily obtained
Format lends itself to the presentation of realistic and
practical situations
Able to measure:
basic knowledge (e.g., definition, recall)
higher-order knowledge (e.g., prediction,
evaluation, problem-solving)
Accuracy and ease of scoring

Question Presentation
MC questions can be either case-based or independent:
Case-based
A brief introductory text accompanied by 3-5
questions
Answers are dependent upon the information
contained in the opening scenario
Questions are independent of other test questions
Independent
Stand-alone questions that are not specifically
connected with any other text or questions

Example Case-Based Question
Case 1

Mr. Hume, 64 years old, is a retired
university professor. He has insulin-
dependent diabetes and has required
hemodialysis three times per week for the
past year. He has been admitted for an
exacerbation of his condition.

QUESTIONS 1 to 4 refer to this case.
Example Case-Based Question
1. A nurse has been assigned to care for Mr. Hume for
the first time. How should the nurse establish an
effective nurse-client relationship?

1. Ask him how he is feeling today.
2. Identify herself by name and role.
3. Use humour to break the ice.
4. Tell him she will return after reviewing his chart.

Taxonomies of Questions
Cognitive Domain

Level 1: Knowledge/Comprehension
(minimum 10%)
Level 2: Application (minimum 40%)
Level 3: Critical Thinking (minimum 40%)

Knowledge/Comprehension
Ability to recall previously learned materials and to
understand its meaning
Knowing and understanding definitions, facts and
principles; interpreting data
Given a situation, test taker must identify the correct
fact, concept, principle or procedure from a list of
plausible facts, concepts, etc.
Questions deal with manifestations of client illnesses,
anticipating consequences or cause and effect
relationships, understanding concepts

Example Knowledge Question
Evelyn, 7 years old, who has asthma, is admitted
to hospital. She is coughing and appears restless.
What does Evelyn's behaviour indicate?
1. Manifestations of a viral infection
2. Need for respiratory assessment
3. Response to the warm, dry air
4. Fatigue

Application
Ability to apply knowledge and learning to new or
practical situations
Applying rules, methods, principles and nursing
theories in providing care to clients
Applying principles of therapeutic communication to
the nursing care of clients
Identifying consequences from a given situation
Questions are realistic and drawn from typical
situations encountered at work

Example Application Question
An attending physician has requested that the nurse
suture a scalp laceration. What should the nurse do?
1. Explain the nurse's roles and responsibilities to
the physician.
2. Ask the physician to be present during the
procedure.
3. Request that the nursing educator assist with the
procedure.
4. Review the policy and procedure manual.

Critical Thinking
Higher-level thinking process; requires test taker to make a
correct diagnosis and identify correct treatment protocol,
based upon information given
Ability to judge the relevance of data, to deal with
abstractions and to solve nursing problems
Identify priorities of care, evaluate the effectiveness of
nursing actions
Formulate valid conclusions, make judgments concerning
the needs of clients
Questions deal with making a nursing diagnosis and
identifying the most appropriate intervention

Example Critical Thinking
Question
Mrs. Wakim, 51 years old, is admitted with unstable
angina. Her electrocardiogram (ECG) was normal on
admission. The nurse notes that she is diaphoretic and
dusky in appearance and reporting some epigastric
discomfort. What should the nurse do first?
1. Administer oxygen via nasal cannula.
2. Contact the ECG technician to perform an ECG.
3. Use a numeric pain scale to rate her level of
pain.
4. Administer sublingual nitroglycerin.

Summary of Exam Make-up
Number of Questions
Operational: 180-200
Experimental: approximately 20

Question Presentation
Case-based / Independent

Taxonomies for Questions
Knowledge/Comprehension (minimum 10%)
Application (minimum 40%)
Critical Thinking (minimum 40%)

Contextual Variables
Type of Client:

Individual
Family
Group, population, and communities

Contextual Variables (contd)
Age and Gender:

From preconception through to advanced age,
including end of life:
preconception to birth
newborn and infants (birth-12 months)
young child (1-6 years)
older child (7-12 years)
adolescent (13-18 years)
young adult (19-35 years)
middle adult (36-64 years)
older adult (65-79 years)
adult of advanced age (80+ years)


Fundamental
Exam Concepts

What the Exam Tests
Competencies
Competencies are the
behaviour statements that
reflect the integrated
knowledge, abilities, skills,
attitudes and judgment
required of an entry-level
registered nurse.

Competency Categories
148 different competencies in 4 categories
Professional Practice
(14-24%) (28 comp.)
Nurse-Client Partnership
(9-19%) (14 comp.)
Health and Wellness
(21-31%) (27 comp.)
Changes in Health
(40-50%) (79 comp.)

Exam Competencies Measured
All RN competencies
required to practice

Entry-level
CRNE

Exam Development
Process
CRNE Development
Framework
Blueprint Development
Question Development
Monitoring of Experimental
Questions by Exam Committee
Monitoring of Operational
Questions by Exam Committee
Revision of Questions
Question Banking
Setting of Pass Mark
Administration of Exam
Scoring and Reporting

Experimental
Testing and
Item Analysis

Test Fairness
Review Panel
Competency Development
Experimental Questions

What are experimental questions?
Questions that are being considered for future exams
Statistically analyzed based on candidate performance
Determine those that work well and those that require
revision
Experimental questions do NOT count in examinees
overall score on the CRNE
BUT, examinees will NOT be able to identify which items
on the exam are experimental


How is the Exam
Scored?

Scoring the CRNE
Computer-scored
For each question, a score of 1 (correct) or
0 (incorrect) is calculated

Scoring the CRNE
How your pass/fail status is determined
Your score is compared to the pass mark (i.e., cut
score)
Scores that fall above the cut score are given a pass
Scores that fall below the cut score are given a fail
Quality assurance checks
Scores for borderline candidates are rescored manually
Scoring the CRNE
Receiving your result:
Your pass/fail result on the exam will be sent to
your provincial/territorial regulatory authority within
3 to 5 weeks.
The regulatory authority will then mail your result to
you.
How long it takes for you to receive your result from
the regulatory authority varies depending on the
jurisdiction.

Scoring the CRNE
Appeals process:
J urisdiction provides information about
deadlines for appeals
Manually scored


Studying for
the Exam

Why do people fail the CRNE?
Lack of preparation for the exam
Did not understand:
What would be tested on the
exam
How it would be tested
Where to find info regarding
the exam
Test-taking anxiety
Other reasons?

Test-taking Errors
Missed important information in question
Misread the question
Failed to identify key
words
Did not relate the
question to information
in the case section
Made assumptions
about the case or
question
Test-taking Errors
Focused on insignificant details and missed key
issues
Selected more than
one answer
Did not answer the
question guess!
Filled in the wrong
oval on the computer
response sheet
Answering MC Questions
Read each question thoroughly.
Concentrate on what is being asked.
Do not make any assumptions beyond what the
question asks.
Become familiar with certain words: action,
appropriate, except, first, greatest, major, significant,
useful.
Choose and record the correct answer.
When in doubt, guess.

Helpful Hints for Studying
Read the CRNE Prep Guide (5
th
edition)
thoroughly.
Take the practice test in the prep
guide several times!
Look up the answers and rationales
for each question.
Make sure you understand which of
your answers were incorrect and why.
Take the LeaRN CRNE Readiness Test.


About 6 months before:

Develop/find/create a positive
attitude.
Decide you will have fun and
enjoy yourself studying for
the CRNE.
Tell your friends and family
what you are doing (get
their support).
Develop a study plan.
Create a study area (can leave your materials, conducive to
studying, in your own area, use anytime of day or night, etc.).

Prepare yourself to
Study the correct content.
Study in short bursts.
Study actively not just
reading, but write, talk
out loud, have people
quiz you, take notes.
Study with others
(if that is your style).
Know yourself and all your good and bad habits.
Study Groups
Study groups can be
helpful or frustrating.
Its not a support or
social group.
If you study in a group,
be sure that:
it is organized, that
participants are committed, they will participate and share
info.
Invite experts, if necessary.
If necessary, build in time for socialization and support after
having accomplished some task.
Before Exam Day
Find out where the writing centre is and how to get
there.
Have a positive attitude:
- Mantra: I will pass.
Decide what you need on exam day: food, pencils,
layers of clothing, water, HB pencils, etc.
Be with positive people only.
On Exam Day
Get to the writing centre early.
Listen to all announcements.
Read all exam book instructions.
Complete all forms accurately.
Budget your time.

After the Exam
Do not discuss the exam in the exam room
or outside the door.
If you need to talk about it, do it discreetly
away from the exam area.
Celebrate that it is over !!!


Cheating
Cheating
Cheating is unethical test-
taking behaviour, such as
Taking, giving or
receiving info from others
Using prohibited
materials or information
Circumventing or taking
advantage of the
assessment process


Cheating
Using any unauthorized books, papers, memos,
calculators, electronic equipment
Speaking or communicating
with other candidates
Purposely exposing written
papers to the view of other
candidates

Cheating
Removing or attempting to remove any exam
materials from the exam site
Looking at other candidates responses


Cheating
Divulging exam information is considered cheating.
You will be asked to sign a confidentiality form!

Cheating
Cheating in any form will NOT be tolerated!
Statistics can detect cheating.
Cheating Hotline:
1-888-900-0005
cheating@asinc.ca

Scheduling
Your Exam

In order to write the CRNE
Make sure you are eligible.
Contact your provincial/territorial regulatory authority:
http://www.cna-aiic.ca/en/becoming-an-rn/regulation-of-
rns/regulatory-bodies/



Quiz

CASE 1
Ms. Rankin, 25 years old, and Mr. McKay,
26 years old, are expecting their first
baby. They are interested to learn more
about the pregnancy and infant care.

Question 1
1. Ms. Rankin and Mr. McKay enroll in group prenatal
education sessions. When facilitating the classes,
how can the public health nurse best convey
information?
1. Deliver a PowerPoint presentation.
2. Use familiar objects as teaching aids.
3. Explain pain control methods in labour and delivery.
4. Write a list of fears about labour and delivery.

1. correct answer: 2
1. A PowerPoint presentation is not necessarily the best
method to convey information.
2. Hands-on activities can be an effective learning
tool.
3. Listening does not use all of the methods for learning
(e.g., visual kinesthetics).
4. This is an assessment method for learning and is not a
method for conveying information.
Question 2
2. Mr. McKay visits the public health nurse stating that
he wants to support his partner but does not feel
confident assisting her in labour and delivery. What
would be the most appropriate nursing response?
1. Have Mr. McKay practise comfort measures for labour and
delivery.
2. Ask the labour and delivery nurses to make Mr. McKay feel
welcome upon arrival.
3. Inform Mr. McKay that it is his right to choose to be present
during labour and delivery.
4. Give Mr. McKay an infant care video so he can help with
the baby after delivery.

2. correct answer: 1
1. Helping Mr. McKay practise comfort measures will
increase his confidence to help his partner.
2. His concern is to provide assistance to help his
partner.
3. This does not deal with the issue of Mr. McKay
wanting to support his partner.
4. The nurse should support Mr. McKay in the area of
family support that he has requested.
Question 3
3. Ms. Rankin sees the public health nurse at 1 week
postpartum for a routine visit. What information
provided by Ms. Rankin would cause the nurse to be
concerned?
1. Seven wet diapers per 24 hours
2. Breastfeeding every 6 hours
3. Mustard-coloured bowel movement
4. Nursing from one breast per feeding

3. correct answer: 2
1. This is normal output for an infant of this age.
2. The infant should breastfeed 8-12 times per 24 hours
at this age. Infrequent breastfeeding can cause
dehydration, which can lead to an infant waking less
often.
3. Mustard-coloured bowel movements are normal for an
infant of this age.
4. Draining one breast per feed is encouraged to allow the
higher fat hindmilk to be consumed.

Question 4
4. The couple have decided to wean 6-week-old J acey
to commercial formula. Which action would support
their decision?
1. Inform the couple that formula is not the best nutrition
for their baby.
2. Advise Ms. Rankin to discuss this issue with her
physician.
3. Offer a breastfeeding information video for the couple
to take home.
4. Discuss proper preparation and technique for formula
feeding.

4. correct answer: 4
1. This does not support the clients' decision. This infers
that the clients need more information to make a
decision.
2. This is not supportive of the clients decision and could
be perceived as coercion.
3. This solution does not address the issue because the
clients already have the knowledge.
4. The nurse must accept their decision in a non-
judgmental way. Formula knowledge is required to
ensure proper infant nutrition.
Question 5
5. Ms. Rankin and Mr. McKay express stress regarding
the transition to being new parents. What should the
public health nurse suggest to assist the couple
during this transitional period?
1. Support group for new parents
2. Equal sharing of infant care
3. Ms. Rankin's mother to visit
4. Adjustments to parenthood take time

5. correct answer: 1

1. Social connections through a support group can
help develop new coping mechanisms.
2. Both parents need support; care may be equal at this
time.
3. This may not be practical or the best long-term
solution.
4. While normalizing a situation can be useful, it does
not address development of new coping skills.
Canadian Nurses Association, 2013
Questions?
Thank you
Merci