CRNE Prep Tips

Just to share, some notes from my previous CRNE preparation, especially for those heading to the 5-June-2013 CRNE. [Note: I gave my original notes away already.]

The following tips are mostly based on my handwritten notes taken during the FREE CRNE Prep Review held at St Paul's Hospital, Vancouver, B.C. The review is usually held 3 weeks to 1 month before the CRNE. Google for it to register online.

I also heard through the grapevine that BCNU provides IEN CRNE tutoring at the BCNU office. Please check directly with BCNU for details. [Note: I did not use this service myself.]

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Source of notes:

CRNE - RN Exam Preparation for IENs 

15-Jan-2013 6pm-9pm at St Paul's Hospital

by Kathy Fukuyama (higgs at telnus dot net)

VCC Nursing Instructor and Professional Tutor

Recommended text:

1. Mosby's RN Orange-white-blue (topic-by-topic)

2. Mosby's yellow-green white blue

3. CNA Online Prep test (2 hours / 100Qn from exam bank)

MEMORIZE these lab values:

• pH Body Fluids 7.35 to 7.45
• PaCO2 35-45
• HCO3 26-22
• Lippoprotein: Cholesterol < 5, HDL > 1.55, LDL 2.5-4.5, Trigly 0.45 to 1.69
• Electrolytes range: Na, K, Ca, Mg, Cl, Phosphate
• Blood glucose: Random 4-6, Fast 3.3-5.8. Note: Hypoglycemia intervention taken depends on the blood glucose level.
• Hema: RBC, Hemoglobin, HCT (hematocrit), WBC, Platlets
• PTT: 25-35 sec
• PT: 11-13 sec
• INR: 0.9 to 1.2

Important topics to note:

• Shock: Neuro, hypo, anaphylactic, cardio, septic, hemodynamic 
• General Principles: Asepsis, Post-op pt teaching, Changes with age, Blood Transfusion (e.g. stop if lower back pain), IV therapy
• Cancer: Common types and Tx (breast, ovarian, lung, colorectal, prostatic). Risk factors, Colostomy and stoma care, change in body image, Teaching (e.g. increase fibre, stoma care, support group).
• Fractures: Types, alignment, external fixation care, cast care
• Hip replacement: teaching, fall prevention, home adjustment
• Bladder re-training: decrease incontinence, teach catherization, toilet by schedule, etc
• Bowel meds: bulk (methycellulose), stimulants (biscody), hyperosomtic (glycerin), softeners (docuosate), lubricants (mineral oil)

Other topics to note:

1. Analyze the CRNE blueprint :

• Competency Categories: Professional Practice 14-24%, Nurse-Client Relationship 9-19%, Health and Wellness 21-31%, Changes in Health 40-50%
• Taxonomy of Cognitive Ability: Knowledge/Comprehension 10+%, Application 40+%, Critical Thinking 40+%
• Contextual Variables: Client (individuals 40-50%, families 25-30%, groups/populations/communities 20-30%), Lifespan (pre-conception to birth, newborn and infant (birth to 12mth), young child (1-6yr), older child (7-12yr), adolescent (13-18yr), young adult (19-35yr), middle adult (36-64), older adult (65-79), advanced age (80+) -- Age 0-18yo 20-30%, 19-64yo 54-70%, 65-80+ 13-28%, Diversity (do not stereotype), Health Situation (continuum of health and illness), Practice Environment (any setting or circumstances within which entry-level RN practices)

2. Analysze the CRNE competencies: Found in the appendix of the CNA CRNE Prep Guide as a guide to contents/knowledge that will be tested

Pre-examination suggestions:

1. When doing practice Q’s, do not just aim to choose the right answer. Be able to explain the rationale for your choice to assure that you know the underlying *principles* well.
2. Practice MCQ exams using only pencil and eraser, they are the only stationery allowed in the exam hall.
3. Study in groups. [Note: Personally I did not do that, but my clinical preceptor and some of my classmates found group-study helps a lot.]
4. Check route to exam site in advance and preferably during the day of week and time of day when you're expected to travel to the site on the exam date, to gauge traffic conditions and have a realistic estimate of the required travel time. Have Plan A and Plan B if taking public transport, in case of trains/buses stalled due to weather or other issues.
5. Fulfill your physiological needs. Get enough sleep (whatever is your norm) the night before the exams. Eat breakfast on the morning of the exam. Empty bladder and bowel before entering the exam hall.

During the exam:

1. CRNE is composed of 180 Q for actual scoring, 20 Q for experimental purposes. Therefore do not panic if question seems weird. [Note: Indeed, I remember one of the questions being distinctively weird.]

2. Time management. 200Q/240min, roughly 1Q/min or 1min/Q, no breaks. [Note: I heard of those who did not finish answering all the 200 exam questions. It took a lot of time to read the long question stems, especially for those multi-part case-stems. And my English is decent, IELTS overall 8.0, reading 9.0!]

3. Underline keywords/values in exam Q. Especially for the multi-part case Q.

4. There will be around 60% Case Q. Case Q’s are independent of each other.

5. There will be around 40% Independent Q. Jump to independent Q at end of section if Case Q is taking too much time. [Note: Personally I did not jump to the independent Q’s despite the case Q’s taking too much of my time, but I did cut down on the time I spent changing my answers.]

6. Do not change answer on the 1st round. 2nd round is for answering any questions that you have skipped. If need to change answer, do it only in round 3 where one is guessing the answer. [Note: Personally I did not skip any question. Even if I had to make a wild guess, I still made the wild guess on the 1st round, just in case I don't have time to come back to the Q later.]

7. Rule of thumb when guessing: Avoid answer options with words "always", "never", "all", "every", "tell pt/NOK/etc". Choose "explore" choices/options with pt.

8. When communicating with pt's (family) doc, written form is better than verbal discussion. If verbal, always follow-up with written form.

9. Read the question root very carefully -- some ask for "FIRST thing the nurse should do" whereas others ask for "what MUST/SHOULD (*most important thing*) the nurse do?" Different answers depending on the question.

10. Remember to answer as if you're a new graduate nurse. Some things may be done differently in the reality of nursing units. But when answering the questions, assume you're working in the "la-la land" of CRNE where time and other resources are never constrained. [Note: And may I add, in "la-la land" all colleagues/managers will go all out to help each other.]

11. When answering questions, remember to base it on Canadian-wide policies, not provincial ones because CRNE is for all provinces except Quebec. A good place to find Canadian-wide policies is the Health Canada website.

http://www.hc-sc.gc.ca/index-eng.php

http://www.phac-aspc.gc.ca

http://cna-aiic.ca

12. Good luck! [Note: IMHO, luck plays a part.]

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Passing mark: See CNA CRNE Bulletin 5 and Bulletin 6.

[Note: I found the exam hard and was expecting the possibility of failing, similarly for some of my classmates. But it turned out that I passed and so did many of my GNIE classmates. So don't fret too much if one's guts don't feel good after the exam.]

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For more helpful ideas, check out the CRNBC document "Information for Candidates who fail the Canadian Registered Nurse Examination" with contents:

• "Why do people fail the CRNE?"
• "How will I know that I am ready to retake the CRNE?"
• "Resources"

One knows oneself best. If necessary, consider paying for CRNE Preparation Tutorials. It costs around CAD1,000. 

[Note: Personally I did not use their services. IMHO, from my observation, it made a huge difference in a classmate's performance (pre-tutorial vs post-tutorial). All my classmates (I think there were 7 of them who took the CRNE in Feb-2013) who attended classes by someone who specializes *only in "CRNE Preparation"* (*hint hint*) passed the exam. That said, I have heard that there exist IEN(s) who attended the same classes but did not pass. I declare that I do not know the tutors nor do I have any vested interests in their tutorial services. So caveat emptor!]

Worst case scenario: If you're more comfortable with NCLEX-RN exam, wait until 2015 when CRNE will be replaced by NCLEX-RN.