CNA Nephrology Exam Prep Workshop

1. CNA Nephrology Exam Prep Workshop C.Bartol, RN, BScN, CNeph(C) Adapted from: R. Luscombe, RN, BSN, CNeph(C) L. Vachon, RN, BSc, GNC (C)

2. Overview • CNA background • How to study • Multiple choice exams • Certification exam • Practice exam

3. Definition of Certification Certification is the voluntary and periodic process by which an organized professional body (CNA) confirms that a registered nurse has demonstrated competence in a nursing specialty by having met pre-determined standardized criteria of that specialty.

4. CNA Certification Program • Only national certification program for nurses in Canada • CNA is responsible for the overall management • Voluntary, national nursing specialty credential • Opportunity for RNs to demonstrate competence in a nursing specialty at a national level

5. CNA Certification Program • More than 17,696 RNs have valid certification in 20 specialties • Nephrology Nursing Certification exam available since 1993 • Nephrology statistics: • 1201 Nephrology certified nurses across Canada (Source: Canadian Nurses Association, 2013)

6. Province/Territory 2012 • AB - 138 NT -5 • BC - 178 ON -643 • MB - 31 PE -12 • NB - 35 QC -49 • NL - 35 SK -24 • NS – 46 YT/NU -0 • Total - 1196 • (Source: Canadian Nurses Association, 2012)

7. CNA Certification Program • Exam offered annually • Approx 2,300 nurses write exams each administration • Approx 71 writing centers, in all provinces/territories • Current administration method: paper-and-pencil • Offered in French or English

8. Development of the exam • Requires many subject matter experts from across Canada (e.g., nephrology nurses) • Competencies are established and reviewed Q3 years in each specialty • Each exam question is based on a competency • Subject matter experts write items

9. Development cont’d • Psychometric experts ensure reliability and validity of exam items • Final exam is approved by specialty exam committee • Exam is translated (translation experts) • Translation Committee ensures accuracy of translation

10. Eligibility • Current RN license in Canada • Letter of endorsement from supervisor or consultant in the specialty • Meet experience and education requirements • Completion of General Application Form and submission of applicable documents and appropriate fees • Contact Info: Website: getcertified.cna-aiic.ca Email: certification@cna-aiic.ca Toll free: 1-800-361-8404

11. Certification • CNA certified nurses can use designation: Florence Nightingale, RN BScN CNeph(C) Jeanne Mance, Inf., B. Sc. Inf., CNéph(C)

12. Certification Renewal • Renewal every 5 years to maintain CNA credential • 100 Continuous Learning hours required • Two options: • Write the exam • Submit record of Continuous Learning activities during the 5 year term • Renewal Guidelines available online • Continuous Learning Activities Guidelines and Forms

13. Continuing Competence Enhancing continuing competence through life-long learning is essential to professional nursing practice… (CNA Joint Position Statement, 2004) Individual nurses are responsible for demonstrating commitment to continuing competence through life-long learning, reflective practice and integrating learning into nursing practice. (CNA Joint Position Statement, 2004)

14. Continuing Competence Continuous learning requires nurses to reflect on their competencies in relation to the changes occurring in society and the health care environment and, as a result of that reflection, take action to acquire and develop new competencies. (CNA Joint Position Statement, 2004)

15. Studying resources to consider • Online preparation guide – once eligibilityestablishedlink made available to candidates • Exam blueprint • Specialtycompetencies • Bibliography • Online practice test

16. Studyingresources to consider • Reference books • NURSEONE.ca • Mentors list - on website • Study group • List on website if Registeredstudy group with CNA

17. How to study • Do practice exam first before studying (use pencil) • Identify concept competencies are you unfamiliar with (Tx, Peds, PD, HD) • Alone vs Group • Begin and end each session with quick review • Review notes and text- flash cards, create questions • Ask questions (multidisciplinary team) • Develop a timeline

18. How to Study • CNeph(C) Study Group • BC REG organizes and supports an annual CNeph(C) study group for BC nurses who plan to write the exam.  • Presentations are available online for one week following a weekly teleconference • See more at: http://www.bcrenalagency.ca/about/committees#bcreg

20. How to study • Lectures • Texts • Videos • ukidney.com: 5 Modules • linked through CANNT website for CANNT members • http://ukidney.com/presentations/all-nephrology-presentations/essential-concepts-in-chronic-renal-failure-a-practical-continuing-education-series

21. How to Study Focus on: • Common practices (NOT unit-specific practices or procedures; NOT experimental drugs) • Guidelines • KDOQI • Canadian Society of Nephrology (CSN) • Current material within the last 5 years

22. Multiple choice exams1 • Cover broader range of content • Test different levels of thinking • Variety of realistic and practical situations • Easier to score • Approximately 160 – 170 questions • Case studies with related questions • Single multiple choice questions 1.http://www.douglas.bc.ca/__shared/mm/learningcentre/writing-multiple-choice-tests

23. Preparing for multiple choice exams • Start early – long term memory • Understand new vocabulary and key definitions • Brainstorm possible questions • Practice sample questions • Refer to CNA certification specialty competencies on a regular basis

24. Day of the exam • Eat breakfast • Allow enough time to get to the location • Take supplies (snack, water, pencils, erasers) • Bring identification • Go to the bathroom

25. Strategies for taking exams • Positive thinking • Listen to announcements • Read instructions • Complete all forms accurately • Read each question carefully • Choose and record the correct answer • Budget your time 3.5hrs (210min)/165questions = 1.30 min

26. Multiple Choice Exams • Cover up answers before you read the stem • Read Question carefully- put in your own words • Underline Key words • Predict the answer before looking at the options

27. Multiple Choice Exams • Eliminate all obvious wrong responses- place X beside those answers and √ beside possible correct answers • Note the question# -come back if you cannot find the best answer in one minute or less

28. Multiple Choice Exam • Use hints from questions you know to answer questions you don’t know. • If two correct answers are similar- choose best one • If all seem correct, choose best answer relative to all others • The wrong answers will be the worst answers relative to all others

29. Multiple Choice Exams • Wrong answers will not apply to the question • Responses that use absolutes are less likely to be correct • Funny responses are usually wrong • Look for grammatical clues. If the stem ends in “an” the responses probably starts with a vowel.

30. Multiple Choice Exams • The longest response is often the correct response (usually loaded with qualifying adjectives and phrases) • For numerical answers, eliminate the extremes consider the middle ranges • Echo options: if two responses are the opposite to each other, chances are one is correct • “All of the above”/”None of the above”/ABCD combos: NOT on this exam. *CNA has done an excellent job eliminating these cues

31. Multiple Choice Exams • Track your progress at intervals • Transfer all responses to the answer sheet at the same time. (will decrease risk of making silly errors)

32. Guessing • Always guess if there is no penalty. (no penalty on CNA exams) • Eliminate wrong answers before having to guess. • If in doubt pick “C” • Change your answer only when you VERY SURE! (very important)

33. Multiple Choice Exams • Before handing it in: • Take time to check your work • Ensure all questions are answered • Erase all accidental marks on the score card

34. Common test-taking errors • Missed important information in the question • Misreading the question • Did not read the entire responses • Failed to identify key words • Did not relate question to information in the case study

35. Common test-taking errors • Made assumptions (very important) • Focused on insignificant details and missed key issues • Selected more than one answer • Filled in the wrong oval on computer response sheet

36. Types of questions • Knowledge • Application • Critical thinking

37. Knowledge • Tests your cognitive ability to recall learned material and to understand its meaning • Eg.Identify effects of drugs • Select correct facts, concepts, principles or procedures • 15 – 20 % of questions

38. Knowledge Example • In cardiopulmonary resuscitation which of the following actions should the nurse take first? • Assess the carotid pulse • Verify that the patient is unresponsive. • Place the patient on a hard, firm surface • Implement the head-tilt, chin lift maneuver.

39. Knowledge Answer • In cardiopulmonary resuscitation which of the following actions should the nurse take first? • Assess the carotid pulse • Verify that the patient is unresponsive. • Place the patient on a hard, firm surface • Implement the head-tilt, chin lift maneuver.

40. Application • Tests your ability to apply knowledge in providing patient care • Apply rules, methods and theories • Identify consequences • 35 - 45% of questions

41. Application Example • Jamie is a 10 year old boy who received a deep laceration to his scalp when he fell off a play structure. The nurse assesses that Jamie's injury will require suturing by the physician. Which one of the following interventions should be taken by the nurse to promote tissue integrity? • Allow the laceration to remain open to the air until the suturing can be completed. • After cleansing the injury, apply a sterile dressing until the suturing can be completed. • Observe the site for 24 hours to assess the extent of injury before preparation for suturing. • Leave the original pressure dressing in place for at least three hours to prevent hemorrhage.

42. Application Answer • Jamie is a 10 year old boy who received a deep laceration to his scalp when he fell off a play structure. The nurse assesses that Jamie's injury will require suturing by the physician. Which one of the following interventions should be taken by the nurse to promote tissue integrity? • Allow the laceration to remain open to the air until the suturing can be completed. • After cleansing the injury, apply a sterile dressing until the suturing can be completed. • Observe the site for 24 hours to assess the extent of injury before preparation for suturing. • Leave the original pressure dressing in place for at least three hours to prevent hemorrhage.

43. Critical Thinking • Test your ability to interpret data • Deal with abstracts • Evaluate options • Problem solve • 25 –35 % of questions

44. Critical thinking example • Mrs.Carson, 70 years old, is recovering from day surgery. She has been tolerating oral fluids. At 1600 hours, the nurse goes into Mrs. Carson’s room to discontinue her IV and observes her vomiting. Which of the following interventions is the most appropriate initial action for the nurse to take? • Administer an antiemetic and discontinue the IV. • Maintain the IV infusion and prepare for possible admission • Continue with discharge plans and make a home care referral. • Notify Mrs. Carson’s family that there have been complications.

45. Critical thinking answer • Mrs.Carson, 70 years old, is recovering form day surgery. She has been tolerating oral fluids. At 1600 hours, the nurse goes into Mrs. Carson’s room to discontinue her IV and observes her vomiting. Which of the following interventions is the most appropriate initial action for the nurse to take? • Administer an antiemetic and discontinue the IV. • Maintain the IV infusion and prepare for possible admission • Continue with discharge plans and make a home care referral. • Notify Mrs. Carson’s family that there have been complications

46. Categories • Renal anatomy and physiology • Patient assessment relating to renal function • Renal disorders • Renal insufficiency • Renal replacement therapies* • Nursing management of the Palliative Care patient • Nursing management of the pediatric patient • Pharmacology • Alternative therapies

47. Competencies • Review list of competencies for nephrology nursing CNA web site, exam prep guide • Examples I. Renal Anatomy and Physiology 1.1 The nephrology nurse identifies normal renal anatomy including structure and characteristics of the a) kidney, b) urinary tract, c) renal vasculature. V. Nursing management of the transplant client 5.44c The nephrology nurse collects and reviews data on the potential cadaveric renal donor with respect to diagnostic tests

48. Competencies VII. Nursing Management of the Pediatric Client 7.4 The nephrology nurse describes the impact of renal failure in children (e.g., nutrition, anemia, activity, socialization, medication, bone density, etc.) IX. Adjunctive and Complementary Therapies 9.1 The nephrology nurse is aware of the existence of alternative therapies and medications (e.g., acupuncture, homeopathy, herbal therapy, etc.)

49. What do I study? • Do practice questions • Focus of study: • Where are you struggling? • Where are your gaps in knowledge? • What are you unfamiliar with?

50. Practice exam • 25 questions • Review answers • Practice exam questions and answers are from the CNA Nephrology Nursing Certification Exam Prep Guide, 2nd edition, 2002.