Helpful Advise: retaking my RN exam in Oct

Pediatric Critical Care Columnist · Jul 15, 2014

First you need to spend some time looking at the performance profile you received with your results. What areas are you weakest in? Focus on the competencies you had the most difficulty with. If you can, work through as many practice questions as possible, but break them down into manageable bites, say 50 questions. Then go over them, making a list of concepts for the ones you got wrong. Do a review of those then go on and do another 50 questions. That's what I did when I took the critical care certification exam last year. I studied for about 3 weeks before the exam, only reviewing those areas where I obviously had knowledge gaps. The certification exam is much harder than the CRNE and I knew that if I failed, I'd never take it again. That isn't an option for you, because without passing the CRNE, you can't work as a nurse. So it's up to you to find a strategy that works for you. I think you might be surprised to know what you know inside out, and what you can't remember to save your life. (For me it was diabetic ketoacidosis. I just could NOT wrap my head around it. But I know enough about it now to understand why the protocols are constructed the way they are.)

123_ · Jul 24, 2014

I'm so sorry to hear, however you're fortunate that you have another two tries. Now that you've been through the experience of writing the exam and seeing first hand the types of questions i'm sure you will go into the October one more knowledgeable than you did June.

I wrote the exam in June also and I was successful. I will inform you of what I did and perhaps this will be of help to you.

1) I purchased the CNA Prep book. At the back of the book are all of the competencies categorized by each section they will be testing you on, and what I did from about mid April to about three weeks into May was create notes on each and every competency. This is essentially what you will be tested on. Most of my notes were written from my medsurg, fundamentals of nursing, pharmacology book for medications (there was a competency of various categories of medications i.e. cardiac meds, laxatives etc), maternity, and community health textbooks. Something you can do to know what resources to use to study from is look at the back of the CNA prep book and look at what textbooks appear in their bibliography (the bolded ones are the best- this means they are referenced often) because this way you can see what types of texts the test writers are using.

2) I took a prep class with UofT. It was fairly cheap compared to the other prep classes (around 300-400 bucks) and it did not cover content just how to answer questions. The thing is you do not need a prep class. There are the prep classes that are very extensive and costly and they provide you with content.. something you do not necessarily need if you were a strong student, are able to self direct yourself and buckle down and study. If you go through the competencies and make notes, i'd say you don't need the extensive classes. The UofT class was an OK class in that it was two days and provided a short mock exam and some guidelines on the types of questions asked on the CRNE. If you are able to do what I am going to mention in suggestion 3) then you probably don't need this type of class either.

3) I sat down with a friend of mine who was not in the nursing program, and we analyzed the CNA Prep book questions. I had written the test given in the CNA book about halfway into my studying and did horribly (around 50%) and I was crushed. When going through the questions with my friend something we quickly realized is there really is an art to answering the questions provided by the College. If you can really sit down and analyze the questions, you will know how to answer questions you may not have even studied. I found that of course there are questions on the exam that require sound knowledge of patho and anatomy, however many questions are questions that are testing your ability to recognize what the college views as essential (the emotional touchy feeling stuff etc.). It is for this reason why I did not find studying from other prep guides all that helpful. The other prep guides, although the questions may be thought provoking, are not entirely reflective of the structure of the college's questions. You want to get your hands on as many questions written by the CNA themselves.

4) I spent a few days reading the best practice guidelines and con standards documents etc. You should skim over them (especially breastfeeding and other commonly occurring topics from the CRNE)

5) About a week and a half before the exam I purchased and took the two mock tests provided on the CNA website and using my knowledge from studying the competencies, reviewing standards and guidelines, and from understanding the way the college asks and expects answers I managed to score around 80% on both tests. My friend who was not in the nursing program who analyzed the questions with me earlier sat beside me while I took the tests (We didn't speak) and wrote down their own answers also. We found that my friend was about to score around 60% on both tests. I think that because of this there really is a great portion of the exam that requires a certain understanding of knowing how to answer questions, not just nursing knowledge.

6) I allowed myself to zen out the day before the exam. I woke up super early, and went to a national park for a hike. I allowed myself to review the cue cards I had made (I used cue cards to write the stuff I found most important when taking my notes on the competencies) from around 9am-11:30 at the park by a beach, and then I let myself go for a hike, have a picnic, lounge at the beach and relax until the evening. I drove home, went for tea with a friend and was at home in bed by 9. Basically, if you want to review the day before the exam i'd say get 'er done in the morning and spend the rest of your day relaxing knowing you studied the best you can and one day of studying won't make a difference. Also, I didn't talk to anyone when I showed up to the exam centre. I just kept my headphones in and listened to music until the very last minute I could. I think talking to others before an exam = stress.

Anyways, I hope that was helpful. Just thought many people helped me during my time in writing the exam, thought i'd pay it foreword. Take my advice with a grain of salt and do what works best for you as everyone is different. Best of luck and take care.

CaffeinePOstat · Jul 24, 2014

123_ made an excellent post.

Using their tips of analyzing and understanding the competencies that CNA is testing on will assist in understanding what a question is asking, and what is the "best" answer for it. There will be questions that all options will look correct, but being able to recognize what the question is asking and which answer best matches really makes a difference. When reading the stem of a question, also look for key words like priority, what should the nurse do next...etc, keep in mind areas such as your ABCs (airway, breathing, circulation), or does the nurse have to assess the client/situation first? Carefully read all options because there will be words placed in a sentence that can alert you to picking it or definitely not choosing it. For example, on average, it has been said to avoid picking options that say "always", "at all times", or "never", although there are few exceptions where you would pick an option with those terms used. A similar rule applies to when a nurse would require to contact a physician, there are situations when that is the best intervention, and other times, where the nurse is able to carry out an independent intervention first before calling the physician. Keep in the back of your mind that CNA is testing us as a entry-level nurse, so look for options that reflect what is the safest and sometimes the most simple intervention. Avoid picking something that appears fancy.

I was successful in the June 2014 CRNE and I did not take a prep course when I was studying for it. I decided to save the money and study independently. I did not study in groups as well. I believe this was the best way to study for me, while some of my friends only studied as a group which worked for them. I had a plan and I stuck with it. Honestly, there were times that I was nervous that I should have taken a prep course since I only had 6 weeks to study for the exam, I thought "more knowledge couldn't hurt right?" but at the same time, I was not sure what kind of a difference it would make. I decided to use my time wisely and efficiently. I did not cram but focused on my area of weaknesses and practiced many questions, even repeating the same practice exam until I improved.

Stress over this exam is normal, but I hope people do not stress to the point of being overwhelmed and doubting themselves. I know it's easier said than done. I found that I was my biggest barrier, I spent so much time being anxious and second guessing myself but kept saying that if I keep preparing to my best ability, my confidence can only increase from here. You have plenty of studying time and organize your study plan, but also make time to relax and enjoy your summer. Another key pointer is keeping a balance in your life. Study hard, but do not study all the time. Taking a day off without studying can actually do more good than harm :)

Long story short:

1)Believe in yourself; you know more than you think...it's about finding your best way of revealing it when it comes to an exam

2)Get to know what the exam is testing on, and since you received first hand experience of the exam, you're more of an expert on it now

3)Focus on areas that can be improved on (refer back to the Performance profile)

4) Practice many questions and read rationales (look up the references that the prep guide books if you need further explanation)

The psychosocial questions can be tricky so it can't hurt to keep practicing questions where those appear in. I found a site that offers free practice questions with answers and includes many psychosocial type questions (how should the nurse respond..)

Site with 100 questions: http://www.freshnurse.ca/practice-questions

All the best to you!

CanadianGirl79 · Jul 26, 2014

I also took the UofT prep course, and found it very helpful in terms of where to focus my reviewing.

Mosby's Comprehensive review isn't a bad resource, but for how the questions will be formatted, look to the CNA Prep Guide.

Best of luck!

jd83 · Aug 1, 2014

Great advice 123_. I have to re-write in October as well and just feel like there is no way I can pass this test. I feel super discouraged right now. I was wondering if you could elaborate on the realizations you made by analyzing the CNA question in which you were able to answer them even if you did not study that particular area?

Thank you!

123_ · Aug 1, 2014

Great advice 123_. I have to re-write in October as well and just feel like there is no way I can pass this test. I feel super discouraged right now. I was wondering if you could elaborate on the realizations you made by analyzing the CNA question in which you were able to answer them even if you did not study that particular area?
Thank you!

Sure, luckily I had made a list and I kept it. I sometimes used examples from the LeaRN CRNE Prep Guide book (5th ed.) so if you have that you can refer back to it.

Read the whole question and all of the answers (seems obvious, but I thought I was a test taking whiz sometimes and would jump to certain answers before reading the rest)
Do not make assumptions (you only know the information the question provides you) For example, in the prep book there was a question about a special needs male who you had to keep an eye on (question 44) and it asks what to do for his safety. I picked number #3 initially (move him closer to the nurses station) but I now know that to be the wrong answer because just because he’s there you are not 100% ensuring his safety. That’s why #2 (supervise him while he performs activities), although it seems intrusive for a moderately mentally disabled adult male, is the correct answer because it’s the only one where you can ensure this action will 100% ensure his safety and we’re not making assumptions (like other nurses will watch him if he’s near the station).
Decide if the question is knowledge based or wishy-washy. You look at all the answers they provide and if they’re all medical terminology then it’s most likely knowledge based. If you’re communicating to a patient then it’s most likely wishy washy. In the wishy washy questions, don’t focus on facts. In my notes i’ve referenced some question where it said “your ectopic pregnancy is caused by infection ..” from the CNA book so i’m guessing it will illustrate my point better if you can find it out of the 200 questions.
If you can gather more information before providing advice, do it. You usually want to ask the patient for more information, probe into their illness/circumstances/preferences etc. (Note that this isn’t always beneficial for medical/knowledge type questions, usually wishy washy ones)
Your colleagues are very nice and helpful, you can trust their opinion and confide in them. I often selected questions that didn’t rely on colleagues in the practice book and got these wrong. A lot of the time it was the right answer to listen to the colleagues advice, or ask them for help, or discuss things with them. You need to know when this is acceptable though (For example, you don’t just bum your work off onto your colleagues when they are your responsibility).
For people with mental health issues never play into their false beliefs, but also don’t tell them they’re wrong in their beliefs. You usually collaborate/interact with them. For these questions I found that you could usually use process of elimination and cross off questions that played into their delusions, or ones where you challenged their delusions and you’d be left with a lovely collaborative answer.
Never dispute with demented patients, they don’t have the capacity to understand their craziness sometimes. You can’t reason with them, they won’t get it.
Medical emergencies always require immediate medical action, so in these instances the wishy washy answers can wait (even though they may be correct). I.e. lets say someone comes into the emergency room and they’ve severed their hand off. Obviously you will stop the bleeding and stabilize the patient and meet their physical needs before you go on to ask them about how they’re feeling emotionally (even though their emotional needs are important, they aren’t the most important at this time). Think of Maslow’s hierarchy of needs for this kind of stuff.
I found that hospital policy was rarely the answer for anything.
You need to know the order of command. There were a few practice questions that had you snitching about things to the MD, don’t do it. Snitch to the nurse in charge if needed, not the MD.
If you’ve eliminated your possible answers to 2 options and cannot decide, look at the wording of the answers and select the one that says to “explore with patient” over “tell patient” for example.

Take my advice with a grain of salt because these aren’t absolute rules, they’re great general rules but then you need to use your own reasoning and common sense to determine if they’re applicable to your question because they may not always be. Anyways, hope that was of help. Don’t be discouraged, it’s certainly a hard test and like I mentioned earlier.. having seen it once now you will be going into your next write a more prepared and educated test taker. It is absolutely possible for you to pass! Best of luck and take care.

jd83 · Aug 1, 2014

Wow! Thank you so much ! That is really great, I appreciate you posting that. If you are willing to share any other notes that would be amazing. Thanks again!!

jd83 · Aug 1, 2014

sorry I forgot to put my email [email protected]. Just wondering if you could email me there in case I had any questions further as well. Thank you!

123_ · Aug 1, 2014

Wow! Thank you so much ! That is really great, I appreciate you posting that. If you are willing to share any other notes that would be amazing. Thanks again!!

No problem! I don't really have much else in terms of notes because I hand wrote everything onto paper as that's how I retain information best. I typed out my note in that previous post for you, but I think if I did that for all of my competency notes i'd be sitting at my computer for days unfortunately. The rest is simply going through competencies and making notes on them as needed. Also, like I said before- please take my advice with a grain of salt as I am no expert in the CRNE.. I simply know what I taught myself and learned from a prep class. Best of luck!

jd83 · Aug 1, 2014

Oh I definitely do not expect you to type those all out! Thank you so much for typing out the note that you did. I really appreciate you taking the time to help out those, like me, who are feeling discouraged and overwhelmed.

nursecejay · Aug 15, 2014

I think you really need to break up your studying based on the number of days you have left until the exam. Break them down according to system and stick with your schedule. Incorporate 50 questions a day that you intend on answering and study the rationales and where you went wrong. The most important thing though is to not place all the emphasis on your patho and clinical knowledge and address the psycho social aspect of nursing in Canada. You will be successful if you cover your bases. The comments in this section are great and I have heard great things about the Primed course that is offered at U of T