CNA Critical Care (Adult) Nursing Certification Exam — Information & Free Practice

About CNA Critical Care (Adult) Nursing Certification Exam

CNA Critical Care (Adult) Nursing Certification Exam · CA

Key exam facts

Provider

Canadian Nurses Association (CNA) owns the certification program. CNA, Meazure Learning and Canadian critical care nurses collaboratively developed the blueprint; Meazure Learning provides testing/statistical services. Remote exams are proctored by ProctorU; selected Canadian test centres are administered by Meazure Learning.

Format

Computer-based multiple-choice examination for adult critical care nursing. Official presentation: 55–65% independent questions and 35–45% case-based questions. Available by remote online proctoring or at selected in-person Canadian test centres. This practice bank uses independent four-option questions.

Exam questions

Total questions: 160–165.

Time limit

Four hours (240 minutes) to answer the examination questions; booking, identification and preparation time are separate.

Passing score

Criterion-referenced pass mark set for each specialty using a modified Angoff method and statistical review. The numeric pass mark is not published; results are reported as pass or unsuccessful.

Exam fee

Canadian domestic fee schedule ($): initial application $588 for CNA members or $780 for non-members, plus an appointment fee of $85 for remote ProctorU testing or $110 at a Meazure Learning test centre. Applicable taxes are extra. Application fees include a non-refundable $130 administration fee. An unsuccessful candidate may rewrite at $378 (member) or $500 (non-member) during the next two calendar years; appointment fees are additional.

Topics covered

The authority publishes percentage ranges for each content area. The practice percentages below use the midpoint of each range, normalized to 100%; they are not exact percentages published by the authority. Practice question counts may differ slightly because of rounding.

• Neurologic System — Official range: 15–20% (Practice allocation: 17.5%)

  • interprets data (initial and ongoing assessment or response to interventions) related to the neurologic system, including:
  • understands the rationale for and clinical implications of diagnostic results (e.g., computed tomography [CT or CT angiography], magnetic resonance imaging [MRI], electroencephalogram [EEG], transcranial Doppler [TCD]).
  • recognizes actual or potential life-threatening alterations in neurologic function, including:
  • selects the appropriate evidence-informed nursing interventions to minimize or prevent motor or sensory deficits, such as:
  • selects the appropriate evidence-informed nursing interventions to optimize cerebral tissue perfusion and autoregulation, such as:
  • selects appropriate evidence-informed nursing interventions to prevent and manage pain, agitation, delirium, immobility and sleep (PADIS), such as:
  • selects appropriate evidence-informed nursing interventions to manage substance withdrawal (e.g., minimal use of restraints, alleviation of seizures and delirium tremens, referral to mental health services for harm reduction and substance use withdrawal).
  • selects appropriate evidence-informed nursing interventions to promote recovery and rehabilitation for the person with alterations in mental health and/or cognition (e.g., addictions, dementia, suicidal ideation, post-traumatic stress disorder [PTSD], harm reduction strategies).
  • physical assessment (e.g., vital signs; level of consciousness; Glasgow Coma Scale; cranial nerve assessment; motor, reflex and sensory assessment; pupils; peripheral nerve stimulation; train-of- four [TOF]);
  • pain, agitation, delirium, immobility and sleep assessment (PADIS) (e.g., pain scale, agitation/sedation scale, delirium score, opioid tolerance, sleep/wake pattern, activity tolerance);
  • laboratory results (e.g., osmolality, cerebral spinal fluid [CSF], sodium, arterial blood gases [ABGs], glucose);
  • intracranial waveforms and pressures (e.g., troubleshooting inaccurate results, interpreting abnormal findings); and
  • cerebral perfusion pressure (e.g., calculation).
  • ineffective thermoregulation (e.g., hyperthermia, hypothermia);
  • motor and sensory dysfunction related to neuromuscular impulse transmission, (e.g., Guillain- Barré syndrome‚ spinal cord injury, myasthenia gravis, amyotrophic lateral sclerosis [ALS]);
  • motor, reflex and sensory dysfunction related to brain injury (e.g., stroke, traumatic brain injury);
  • inadequate cerebral tissue perfusion (e.g., seizures, stroke, altered cerebral metabolism, hypoxic brain injury);
  • intracranial hypertension (e.g., traumatic brain injury, hepatic failure, stroke, herniation); and
  • overdose (e.g., accidental or intentional).
  • maintaining spinal cord integrity (e.g., positioning, immobilization devices); and
  • intervening in spinal cord crises: spinal shock, neurogenic shock, autonomic dysreflexia (e.g., alleviating cause, pharmacological agents, positioning, fluids).
  • using techniques to prevent obstruction and promote venous and cerebral spinal fluid (CSF) drainage (e.g., positioning, neck alignment, head-of-bed elevation, proper application of collars, tracheostomy ties);
  • optimizing PaCO 2 ;
  • administering pharmacological agents (e.g., diuretics, analgesics, sedatives, neuromuscular blocking agents, vasopressors);
  • managing invasive intracranial pressure monitoring or ventricular drainage devices (e.g., set-up, drainage, troubleshooting, positioning of device);
  • using techniques that control intrathoracic pressures (e.g., minimizing airway stimulation, pharmacological agents, minimizing positive end-expiratory pressure [PEEP], gastric decompression);
  • managing vasospasm (e.g., calcium channel blockers, positioning);
  • managing metabolic rate (e.g., cooling devices or fluids, pharmacological agents, reduced stimulation);
  • managing seizure activity (e.g., pharmacological agents, correcting hypoglycemia, correcting electrolytes);
  • preventing secondary injury (e.g., maintaining adequate oxygenation, preventing hypercarbia, fluid management, blood pressure management); and
  • managing stroke (e.g., stroke protocol, thrombolytics, blood pressure control, thermoregulation, blood glucose).
  • pain (e.g., intermittent or continuous analgesia, procedural sedation, client-controlled analgesia [PCA], multimodal approach, alternative therapies, spiritual care, adjustment for opioid tolerance);
  • agitation (e.g., communication, distraction, selection and titration of sedatives);
  • delirium (e.g., activity, comfort and environment interventions, consideration of causes, pharmacological agents, family presence, visual and communication aids);
  • immobility (e.g., early and progressive mobilization strategies); and
  • sleep (e.g., sleep promoting strategies, minimizing sleep disruptions, normalizing circadian rhythm, pharmacological interventions, manipulation of the environment).

• Cardiovascular System — Official range: 18–23% (Practice allocation: 20.5%)

  • interprets data (initial and ongoing assessment or response to interventions) related to the cardiovascular system, including:
  • understands the rationale for and the implications of advanced diagnostics (e.g., 15-lead ECG, transesophageal echocardiogram [TEE], transthoracic [2-D] echocardiogram, coronary angiography, pulmonary artery catheter pressures and wave forms).
  • intervenes based on observation of manifestations of the following actual or potential life-threatening alterations in cardiac output and perfusion:
  • intervenes based on observation of manifestations of the following actual or potential life-threatening alterations of the vascular structure and function:
  • manages and titrates appropriate evidence-informed medications to correct alterations in cardiovascular perfusion (e.g., vasopressors, vasodilators, inotropes, thrombolytic agents, anticoagulants, antiplatelet therapy).
  • selects appropriate evidence-informed nursing interventions to correct alterations in cardiac output, such as:
  • selects appropriate evidence-informed nursing interventions to manage intravascular access devices, such as:
  • selects appropriate evidence-informed nursing interventions with hemodynamic monitoring systems, such as:
  • physical assessment (e.g., vital signs, pulses, skin temperature and colour, heart sounds, lung sounds, work of breathing, edema);
  • laboratory results (e.g., B-type natriuretic peptide [BNP], cardiac enzymes and troponin, complete blood count [CBC], coagulation, arterial blood gases [ABGs], electrolytes, digoxin levels, lactate);
  • ECG rhythm (e.g., cardiac rhythm, ectopy, continuous ST segment monitoring, QT interval);
  • 12-lead ECG (e.g., ischemia, infarction, heart blocks);
  • right atrial venous oxygen saturation measurements (e.g., oxygen delivery and consumption);
  • information from technological supports (e.g., pacemakers [sensing and capture], implantable cardioverter defibrillator [ICD]);
  • arterial pressures and waveforms (e.g., radial, femoral); and
  • hemodynamic parameters (e.g., fluid responsiveness).
  • cardiogenic shock (e.g., myocardial infarction, cardiomyopathy);
  • hypovolemic shock (e.g., hemorrhage, third space loss);
  • distributive shock (e.g., sepsis, neurogenic shock, anaphylactic shock);
  • acute coronary syndrome: myocardial ischemia (e.g., angina, infarction, dissection);
  • cardiac tamponade (e.g., cardiac surgery, trauma, pericardial effusion);
  • pulmonary edema;
  • dysrhythmias;
  • valvular disease (e.g., stenosis, regurgitation, papillary muscle rupture, mechanical or tissue valves);
  • heart failure (e.g., preserved and reduced ejection fraction, preload and afterload abnormalities); and
  • inflammatory cardiac processes (e.g., pericarditis, endocarditis).
  • aneurysm and/or dissection (e.g., aortic, thoracic, abdominal);
  • limb or organ ischemia (e.g., mesenteric infarct, compartment syndrome); and
  • hypertension (e.g., post cardiovascular surgery, pheochromocytoma, pregnancy-induced).
  • optimizing preload (e.g., fluid administration, pharmacological agents);
  • optimizing afterload (e.g., pharmacological agents);
  • optimizing contractility (e.g., fluid administration, pharmacological agents);
  • optimizing heart rate or rhythm (e.g., fluid management, pharmacological agents, electrolytes, pacing and cardioversion); and
  • managing a cardiac arrest (e.g., advanced cardiac life support [ACLS] protocols, post cardiac arrest care).
  • assisting with invasive procedures (e.g., maximal barrier precautions, site selection, site preparation, central line associated blood stream infections [CLABSI]);
  • preventing or managing complications (e.g., air embolism, thrombosis, infection, occlusion, hemorrhage, malposition, extravasation); and
  • removing intravascular access devices: central venous catheters, arterial lines (e.g., adequate hemostasis, positioning, infection prevention, timely removal).
  • managing hemodynamic devices (e.g., set-up, levelling, patency, positioning); and
  • troubleshooting hemodynamic devices (e.g., inaccurate results, interpreting abnormal findings, waveform interpretation).

• Respiratory System — Official range: 15–20% (Practice allocation: 17.5%)

  • interprets data (initial and ongoing assessment or response to interventions) related to the respiratory system, including:
  • understands the rationale for and clinical implications of diagnostic results (e.g., chest X-rays, CT scans, bronchoscopies, pulmonary function tests, metabolic assessment, sputum cultures).
  • recognizes actual or potential life-threatening alterations of the respiratory system, including:
  • selects appropriate evidence-informed nursing interventions to correct alterations in respiratory function, such as:
  • selects appropriate evidence-informed nursing interventions to promote return to spontaneous ventilation (e.g., nutrition; spontaneous awakening trial; spontaneous breathing trial; pain, agitation, delirium, immobility and sleep assessment [PADIS] recommendations).
  • selects appropriate interventions to prevent and manage ventilator-associated pneumonia (VAP).
  • physical assessment (e.g., respiratory pattern, rate, auscultation, palpation, inspection);
  • laboratory results (e.g., arterial blood gases [ABGs], methemoglobins, carboxyhemoglobins);
  • monitoring and troubleshooting technological devices (e.g., pulse oximetry and its limitation on different skin tones, capnography);
  • oxygen information (e.g., PaO 2 , SaO 2 , SpO 2 , oxygen content, PaO 2 /FiO 2 ratio);
  • modes of mechanical ventilation;
  • need for ventilatory support (e.g., non-invasive, indications for intubation and ventilation, readiness for weaning and liberation); and
  • ventilation information (e.g., tidal volume, minute volume, respiratory rate, airway pressures, positive end-expiratory pressure [PEEP]).
  • ineffective airway (e.g., asthma, epiglottitis, laryngeal spasm/edema, head/neck trauma, mucous plug);
  • ineffective breathing (e.g., Guillain-Barré syndrome, chest trauma, impaired respiratory drive, spinal cord injury);
  • pleural abnormalities (e.g., tension pneumothorax, pleural effusion, hemothorax);
  • non-cardiac pulmonary edema (e.g., acute respiratory distress syndrome [ARDS], acute respiratory failure);
  • ventilation/perfusion mismatch (e.g., embolism [thrombotic, fat, air, amniotic], atelectasis);
  • pulmonary hypertension;
  • inhalation injuries (e.g., thermal, carbon monoxide, aspiration, toxins);
  • chronic pulmonary disease (e.g., restrictive, obstructive); and
  • pulmonary infections (e.g., community-acquired pneumonia [CAP], health-care associated pneumonia [HCAP], ventilator-associated pneumonia [VAP], tuberculosis, influenza-like illness [ILI]).
  • positioning (e.g., prone, head-of-bed elevation);
  • basic airway management (e.g., jaw thrust or chin lift, oral or nasopharyngeal airways);
  • administering and titrating oxygen;
  • advanced airway management (e.g., endotracheal tube, tracheostomy);
  • managing secretions (e.g., chest percussion, vibration, postural drainage, assisted cough, rotational therapy, subglottic suction, lung recruitment manoeuvre [breath stacking]);
  • administering pharmacological agents to facilitate ventilation (e.g., analgesics, reversal agents, sedatives, paralytics, meter dose inhalers/aerosol therapy);
  • administering pharmacological agents to prevent or treat pulmonary embolism (e.g., thrombolytic agents, anticoagulants);
  • administering pharmacological agents to treat pulmonary hypertension and/or hypoxemia (e.g., epoprostenol sodium, phosphodiesterase inhibitors);
  • administering pharmacological agents to optimize airway resistance (e.g., steroids, meter dose inhalers/aerosol therapy);
  • troubleshooting mechanical supports (e.g., invasive and non-invasive);
  • recognizing the need for changes to ventilatory support mode (e.g., oxygenation, ventilation, tidal volume, positive end-expiratory pressure [PEEP];
  • assisting with medical interventions (e.g., tracheostomy, intubation, chest tube insertion, bronchoscopy); and
  • managing devices to resolve pneumothorax, hemothorax and/or pleural effusion (e.g., chest tube, Heimlich valve, percutaneous drain).

• Gastrointestinal System — Official range: 5–10% (Practice allocation: 7.5%)

  • interprets data (initial and ongoing assessment or response to interventions) related to the gastrointestinal function, including:
  • understands the rationale for and clinical implications of diagnostic results (e.g., abdominal X-rays, CT scans, ultrasounds, endoscopy).
  • recognizes actual or potential life-threatening alterations to the gastrointestinal system, including:
  • selects appropriate evidence-informed nursing interventions to manage the person who has ingested a toxic substance (e.g., acetylsalicylic acid, antidepressants, acetaminophen, toxic alcohols, narcotics, calcium channel blockers).
  • selects appropriate evidence-informed nursing interventions to correct alterations in gastrointestinal function, such as:
  • physical assessment (e.g., inspection, auscultation, percussion, palpation, weight, caloric intake);
  • laboratory results (e.g., liver profile, glucose, amylase, lipase, proteins, electrolytes, albumin, lactate); and
  • monitoring devices (e.g., intra-abdominal pressure, drains, fecal management systems).
  • ischemic disorders (e.g., infarcted bowel, hepatic failure, cirrhosis, abdominal compartment syndrome);
  • inflammatory and infective disorders (e.g., peritonitis, pancreatitis, hepatitis, C. difficile, Crohn’s disease, ulcerative colitis);
  • mechanical disorders (e.g., esophageal rupture, perforated bowel, ileus);
  • hemorrhagic disorders (e.g., upper and lower gastrointestinal bleeding, splenic injuries, hepatic injuries, esophageal varices);
  • complications of enteral or parenteral feeding (e.g., sinusitis, gastritis, aspiration, constipation, hyperglycemia, refeeding syndrome); and
  • malnutrition.
  • promoting early and safe oral or enteral feeding (e.g., indications, positioning to prevent aspiration, tube placement, post pyloric feeding tube);
  • optimizing parenteral nutrition (e.g., indications, caloric needs, lipid therapy, glucose concentration, selection of access site);
  • administering pharmacological agents (e.g., motility enhancers, gastrointestinal prophylaxis);
  • managing ischemic disorders;
  • managing inflammatory and infective disorders;
  • managing mechanical disorders;
  • managing hemorrhagic disorders; and
  • optimizing bowel functions (e.g., diarrhea, constipation, stoma, fecal management system).

• Renal System — Official range: 5–10% (Practice allocation: 7.5%)

  • interprets data (initial and ongoing assessment or response to interventions) related to the renal system, including:
  • understands the rationale for and clinical implications of diagnostic results (e.g., CT scans, ultrasounds, kidney, ureter and bladder X-ray [KUB], cystoscope, point of care bladder scan).
  • understands the rationale for and clinical implications of intermittent and continuous renal replacement therapy.
  • recognizes the effects of nephrotoxic agents or delayed clearance (e.g., diuretics, vasopressors, antibiotics, toxins).
  • recognizes potential life-threatening alterations in renal function (e.g., acute kidney injury criteria, pre/intra/post renal failure).
  • selects appropriate evidence-informed nursing interventions to correct electrolyte, acid–base imbalances (e.g., potassium, magnesium, calcium, sodium, phosphate, metabolic acidosis, alkalosis).
  • selects appropriate evidence-informed nursing interventions to optimize renal function, such as:
  • physical assessment (e.g., edema, urine, fluid balance, weight); and
  • laboratory results (e.g., electrolytes, urine electrolytes, urea, creatinine, urinalysis, serum and urine osmolality, anion gap, drug levels, glomerular filtration rate [GFR]).
  • optimizing cardiac output (e.g., fluid management, inotropic agents);
  • administering pharmacological agents;
  • assessing and managing renal and urinary drainage devices (e.g., preventing, assessing and managing catheter associated urinary tract infections [CAUTIs], advocating for early catheter removal, routine care and maintenance, managing ileal conduit, managing hematuria).

• Endocrine System — Official range: 2–6% (Practice allocation: 4%)

  • interprets data (initial and ongoing assessment or response to interventions) related to the endocrine system, including laboratory tests (e.g., blood glucose, arterial blood gases [ABGs], thyroid-stimulating hormone [TSH], T4, T3, cortisol, osmolality, electrolytes, urine ketones).
  • recognizes actual or potential life-threatening alterations in endocrine function, such as:
  • selects appropriate evidence-informed nursing interventions to correct alterations in endocrine function, such as:
  • antidiuretic hormone (e.g., diabetes insipidus [DI], syndrome of inappropriate antidiuretic hormone [SIADH]);
  • hyperglycemia (e.g., diabetic ketoacidosis [DKA], hyperglycemic hyperosmolar syndrome [HHS]);
  • hypoglycemia;
  • adrenal insufficiency (e.g., primary, secondary, critical illness–induced corticosteroid insufficiencies); and
  • thyroid function (e.g., thyrotoxicosis, myxedema).
  • managing antidiuretic hormone;
  • managing hyperglycemia;
  • managing hypoglycemia;
  • managing adrenal insufficiency; and
  • managing thyroid function.

• Immunology and Hematology Systems — Official range: 5–10% (Practice allocation: 7.5%)

  • interprets data (initial and ongoing assessment or response to interventions) related to the immunologic and hematologic systems, including:
  • understands the rationale for and clinical implications of diagnostic results (e.g., Doppler ultrasound, CT scan).
  • Recognizes actual or potential life-threatening alterations of the immunologic and hematologic systems, such as:
  • selects appropriate evidence-informed nursing interventions to prevent or correct alterations in the hematologic system including:
  • identifies infection control risks to person families and interprofessional team and takes necessary preventive measures to protect against exposure and break the chain of infection (e.g., point of care risk assessment [PCRA], hand hygiene, personal protective equipment [PPE], negative pressure room).
  • laboratory results related to hematology (e.g., complete blood count [CBC]: erythrocytes, hemoglobin, hematocrit; coagulation profile: INR, aPTT, platelet count, fibrinogen, disseminated intravascular coagulation [DIC] screen, heparin antibody, lactate level); and
  • laboratory results related to immunology and inflammation (e.g., complete blood count [CBC]; neutrophils; leukocytes; lymphocytes; bands; immunoglobulins; bacterial, viral and fungal cultures).
  • inflammatory process;
  • infections (e.g., immunosuppression, invasive vascular devices, indwelling drainage devices, malnutrition, intubation, hyperglycemia, surgical site infection [SSI], skin breakdown, health- care associated infections [HAI]);
  • sepsis;
  • thrombocytopenia (e.g., drug-induced, sepsis, idiopathic thrombocytopenia purpura [ITP], mechanical devices);
  • venous thrombotic disorders (e.g., venous thromboembolism, vascular access–associated thrombosis);
  • arterial thrombotic disorders (e.g., cerebral thromboembolism, peripheral arterial thrombosis);
  • consumptive coagulopathies (e.g., disseminated intravascular coagulation [DIC], heparin-induced thrombocytopenia [HIT]); and
  • hemorrhagic disorders (e.g., hemophilia).
  • infections (e.g., aseptic technique, adequate nutrition, pharmacological treatment, maximizing infection control practices including source control);
  • sepsis (e.g., early recognition, fluid and pharmacological treatment);
  • thrombocytopenia;
  • venous thrombotic disorders (e.g., venous thromboembolism [VTE] prophylaxis, pharmacological treatment);
  • arterial thrombotic disorders (e.g., pharmacological treatment, devices, interventional radiology, surgical intervention);
  • consumptive coagulopathies; and
  • hemorrhagic disorders.

• Musculoskeletal and Integumentary Systems — Official range: 2–8% (Practice allocation: 5%)

  • interprets data (initial and ongoing assessment or response to interventions) related to the musculoskeletal and integumentary systems, including:
  • understands the rationale for and clinical implications of diagnostic results (e.g., X-rays, compartment pressure, CT scan, magnetic resonance imaging [MRI], ultrasound).
  • recognizes actual or potential life-threatening alterations of the musculoskeletal and integumentary systems, such as:
  • selects the appropriate evidence-informed nursing interventions to correct alterations of the musculoskeletal and integumentary systems, such as:
  • selects appropriate evidence-informed nursing interventions to prevent complications related to immobility and pressure injuries (e.g., range of motion, positioning, therapeutic surfaces, coughing, deep breathing, wound care, splinting, early mobilization, minimal restraints, fall prevention, nutrition, medical device associated pressure injuries).
  • selects appropriate evidence-informed nursing interventions to manage complex wounds (e.g., vacuum- assisted wound drainage, packing, burn dressing, pharmacological agents, skin graft, extravasation, referrals).
  • physical assessment (e.g., skin integrity and perfusion on a variety of skin tones, risk measurement scale [Braden Scale], range of motion, peripheral pulse presence [palpable or Doppler]); and
  • laboratory results (e.g., creatine kinase [CK], arterial blood gases [ABGs], electrolytes, complete blood count [CBC], myoglobin).
  • compartment syndrome (e.g., abdominal, limb);
  • burns (e.g., thermal, chemical, radiation, electrical);
  • wounds (e.g., postoperative wounds, post trauma wounds, decubitus ulcers, necrotizing fasciitis, pressure injuries); and
  • fractures (e.g., long bone, skull, pelvis, ribs, crush injuries, blood loss).
  • administering pharmacological agents (e.g., antibiotics, analgesics, antiseptics); and
  • managing rhabdomyolysis (e.g., fluid, pharmacological agents, monitoring creatine kinase [CK] or myoglobin).

• Person Centred Care (PCC) — Official range: 2–8% (Practice allocation: 5%)

  • provides care that upholds cultural safety and humility by:
  • interprets data (initial and ongoing assessment or response to interventions) related to each persons/family’s needs, including:
  • selects appropriate evidence-informed nursing interventions to facilitate information sharing by:
  • selects appropriate evidence-informed nursing interventions to promote person- and family-centred participation in care by:
  • understanding how the distal determinants of health (colonialism, racism, self-determination and social exclusion) account for the oppressive historical and contemporary context in Canada and have resulted in direct impacts on the health of Indigenous peoples;
  • ensuring that the cultural beliefs, values and preferences of the person and family are respected in the health-care process;
  • understand the impact of personal and systemic bias, approaching every interaction with the understanding that each individual’s cultural experience is unique and remaining open to learning from those experiences;
  • promoting a discrimination-free environment where racism, discrimination, and bias are actively addressed, fostering a sense of safety and inclusion for all; and
  • understanding how institutional and public policies cause harm to people (i.e., criminalization of substance use, colonization).
  • experience of the health crisis (e.g., coping skills, goals of care, hopelessness, powerlessness, grief, loss, culture, spirituality, post-traumatic stress disorder [PTSD]); and
  • response to the health-care system (e.g., current and past experiences, trauma-informed care, experience of systemic racism, discrimination and prejudice).
  • facilitating communication among person family, interprofessional team and external resources (e.g., family presence during meetings, bedside rounds, sensitivity to cultural variation); and
  • providing alternative methods of communication (e.g., use of Passy-Muir valve, communication board, cuff deflation, written communication, interpretive services, augmentative and alternative communication strategies, communication technologies).
  • advocating for the person (e.g., advance directives, organ donation, informed consent, privacy, allowing natural death);
  • supporting the person and family during decision making and plan of care (e.g., end-of-life decisions, advance directives, transition, organ donation);
  • facilitating family presence and/or participation in care (e.g., interprofessional rounds, crisis management, invasive procedures, resuscitation, assisting with basic care); and
  • consulting appropriate internal and/or external resources (e.g., social work, ethics, community support).

• Transitions in Care — Official range: 2–6% (Practice allocation: 4%)

  • understands the indications for transition in care (e.g., personal data, advance directives, medical assistance in dying [MAiD], palliative care, person and family wishes, potentially inappropriate treatments, legal considerations, goal of care, early warning signs).
  • enables transition in care (e.g., communication, advocating for person and family wishes, conflict resolution, participating in a rapid response team).
  • understands referral for organ and/or tissue donation after death, such as:
  • selects appropriate evidence-informed nursing interventions to provide care in preparation of organ donation (e.g., maintaining hemodynamic stability, comfort care, symptom relief, diagnostic testing).
  • selects appropriate evidence-informed nursing interventions to provide transitions in care, including:
  • engages in values-based discussions with person and family about changes in goals of care (e.g., level of intervention).
  • determination by neurological criteria (DNC); and
  • determination by circulatory criteria (DCC).
  • supporting person and family (e.g., family presence, grieving, spiritual and cultural practices, education, assessment for transition readiness);
  • coordinating with internal and/or external support resources (e.g., spiritual care, ethics, grief support, social work, legal consult);
  • collaborating with interprofessional team members;
  • providing palliative care strategies (e.g., pain and symptom management); and
  • following up with discharge team (e.g., communicate plan of care, post intensive care follow-up).

• Safety, Quality, Legal and Ethical — Official range: 2–6% (Practice allocation: 4%)

  • contributes to a culture of safety by:
  • contributes to quality improvement initiatives (e.g., identify areas for improvement, participate in quality improvement projects, integrate persons’ and families’ feedback, collaborate with interprofessional team members).
  • accesses appropriate resources to guide ethically complex situations and foster effective coping strategies and possible resolutions (e.g., code of ethics, ethical consults, social worker, debriefing).
  • follows legislation, standards of practice, policies and procedures as related to the practice of critical care nursing.
  • integrating safety practices into daily nursing activities (e.g., hand hygiene, independent double check, safety bundles, medication reconciliation);
  • recognizing adverse or near miss events (e.g., medication errors, name alerts, person deterioration);
  • responding to adverse or near miss events (e.g., intervene, communicate, prioritize care);
  • disclosing and reporting adverse or near miss events (e.g., person safety reporting system);
  • preventing the occurrence of adverse or near miss events (e.g., effective communication, team work, participation in simulation, education, safety alerts, product updates, just culture); and
  • employing the principles of harm reduction: dignity and compassion, pragmatism, human rights, social justice, focus on harms, participation and inclusion.

How to prepare

Work through the topics, read the explanation after each answer, and revisit the areas where you miss questions. Use the official outline and reference materials below to guide your study.

These independent practice questions are not actual exam items and do not guarantee a passing result.

Frequently asked questions

Official sources and references

• CNA Exam Competencies & Blueprints

  Main content, introduction

• CNA Critical Care (Adult) Nursing Exam Blueprint

  p. 1, Introduction

• CNA Critical Care (Adult) Nursing Exam Blueprint

  p. 4, Table 1

• CNA Critical Care (Adult) Nursing Exam Blueprint

  p. 6, Table 2

• CNA Critical Care (Adult) Nursing Exam Blueprint

  p. 5, Question Presentation

• CNA General Competencies

  General Competencies

• CNA Medical Assistance in Dying (MAID)

  Competencies

• CNA Nurses’ Professional Responsibilities in Partnering with Indigenous Peoples

  p. 1, Assumptions, Cultural competence and cultural safety

• CNA SUBSTANCE USE

  Competencies

• CNA Critical Care (Adult) Nursing Exam Blueprint

  p. 5, Structural Variables

• CNA Critical Care (Adult) Nursing Exam Blueprint

  p. 6, Conclusions

• CNA CBT Exam Tips

  CBT exam tips, Budget your time

• CNA Exam Results and Retesting

  Exam Results and Retesting

• CNA Initial Exam Fees

  Initial Exam Fees, application and appointment table, footnotes

• CNA Initial Exam Fees

  Footnotes 1–4

• CNA Initial Exam Fees

  Appointment fees

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