Free CNA Medical-Surgical Nursing Certification Exam for RNs Practice Questions
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Sample Practice Questions
Try these 10 sample questions from the CNA Medical-Surgical Nursing Certification Exam for RNs practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.
1An adult suddenly loses all muscle tone for several seconds and falls during a seizure. Which seizure type best matches this event?
- A.Tonic
- B.Clonic
- C.AtonicCorrect answer: C
- D.Myoclonic
Explanation: The source states, "Atonic (akinetic): A sudden loss of muscle tone for a few seconds and followed by postictal (period after seizure) confusion." The abrupt loss of tone is atonic activity. Tonic activity increases tone, clonic activity involves rhythmic contraction and relaxation, and myoclonic activity consists of brief jerks.
Reference: Open RN — Health Alterations: 9.7 Seizures and Epilepsy — 9.7 Seizures and Epilepsy, Generalized Seizures
2An adult reports facial pressure and nasal congestion. The clinician explains that swollen nasal membranes are obstructing mucus drainage from the paranasal cavities. Which condition is the nurse assessing?
- A.Pharyngitis
- B.SinusitisCorrect answer: B
- C.Tonsillitis
- D.Stomatitis
Explanation: The source states, "Sinusitis is the medical diagnosis for inflamed sinuses that can be caused by a viral or bacterial infection." The blocked drainage and facial pressure localize the problem to the sinuses. The other terms identify inflammation of the pharynx, tonsils, or oral mucosa rather than the paranasal sinuses.
Reference: Open RN — Health Alterations, 6.11 Other Disorders of Head and Neck — 6.11 Other Disorders of Head and Neck, Sinusitis
3A client whose angina was previously predictable with exertion now develops prolonged chest pressure at rest that is incompletely relieved by the prescribed nitroglycerin. Which condition should the nurse suspect?
- A.Stable angina
- B.Unstable anginaCorrect answer: B
- C.Acute pericarditis
- D.Costochondritis
Explanation: The source states, "unstable angina is characterized by chest pain that does not resolve completely with rest or nitroglycerin." The new rest pain and changed response indicate an acute coronary pattern requiring urgent evaluation, rather than the client's former stable pattern. The scenario does not identify the positional, inflammatory or reproducible chest-wall features of the other pain syndromes.
Reference: Open RN — Health Alterations, 5.7 Coronary Artery Disease — 5.7 Coronary Artery Disease, Angina
4An adult's imaging shows a segment of intestine twisted around itself, causing a mechanical obstruction. Which term should the nurse use for this finding?
- A.Intussusception
- B.Paralytic ileus
- C.VolvulusCorrect answer: C
- D.Adhesion
Explanation: The source states, "A mechanical bowel obstruction can also be caused by a volvulus (twisting of the intestines) or intussusception (part of the bowel telescopes into itself)." Volvulus describes twisting. Intussusception is telescoping, ileus is failed peristalsis without a physical blockage, and adhesions are bands of scar tissue.
Reference: Open RN — Health Alterations, 11.13 Bowel Obstruction — 11.13 Bowel Obstruction, opening description of mechanical causes
5A 68-year-old man reports gradually increasing difficulty starting urination, a weakening stream, and incomplete emptying over several months. Which condition most closely fits this bladder-outlet symptom pattern?
- A.Acute pyelonephritis
- B.Benign prostatic hyperplasiaCorrect answer: B
- C.Acute glomerulonephritis
- D.Urinary stone disease
Explanation: "During BPH, the enlarged prostate presses against the urethra, causing it to narrow." Progressive urethral compression from BPH fits this older man's gradual outflow difficulty and incomplete emptying. Pyelonephritis is an upper-tract infection, glomerulonephritis is a renal inflammatory process, and stone disease more typically produces an acute obstructive or colicky presentation. Clinical evaluation is needed to confirm the cause.
Reference: Open RN — Health Alterations, 8.12 Benign Prostate Hypertrophy — 8.12 Benign Prostate Hypertrophy, Pathophysiology
6An adult with chronic knee pain has asymmetric joint involvement, crepitus, narrowed joint space, and osteophytes on imaging. Which condition best explains these findings?
- A.Rheumatoid arthritis
- B.Septic arthritis
- C.Acute gout
- D.OsteoarthritisCorrect answer: D
Explanation: The source states, "Osteoarthritis is a degenerative joint disease characterized by the breakdown of joint cartilage and changes in the underlying bone." The degenerative pattern with osteophytes and narrowing supports OA. Rheumatoid arthritis is inflammatory and commonly symmetric; septic arthritis and acute gout have different acute inflammatory patterns.
Reference: Open RN — Health Alterations, 10.7 Osteoarthritis — 10.7 Osteoarthritis, Pathophysiology and Diagnostic Testing
7An adult has cold intolerance, constipation, fatigue, a low free T4, and an elevated TSH. Which endocrine condition best fits this assessment?
- A.Graves' hyperthyroidism
- B.Primary hypothyroidismCorrect answer: B
- C.Cushing's syndrome
- D.Primary adrenal insufficiency
Explanation: The source states, "Therefore, in hypothyroidism, the TSH level is typically elevated." Low thyroid hormone with a compensatory TSH rise and reduced-metabolic symptoms supports primary hypothyroidism. Graves' disease has the opposite thyroid pattern; the adrenal disorders do not explain this thyroid-panel combination.
Reference: Open RN — Health Alterations, 7.6 Thyroid Disorders — 7.6 Thyroid Disorders, Hypothyroidism, Diagnostic Testing
8An adult with diabetic peripheral neuropathy describes burning pain and pins-and-needles sensations in both feet. Which pain mechanism best fits this description?
- A.Superficial somatic pain
- B.Neuropathic painCorrect answer: B
- C.Deep somatic pain
- D.Visceral pain
Explanation: The source states, "Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as pain caused by a lesion or disease of the somatosensory nervous system." The known nerve disease and burning/tingling quality support neuropathic pain. The other categories arise from superficial tissues, deep musculoskeletal tissues, or visceral organs.
Reference: Open RN — Nursing Fundamentals 2e, 11.2 Comfort Basic Concepts — 11.2 Comfort Basic Concepts, Types of Pain
9An older adult with pneumonia was fully oriented yesterday. Today the client alternates between alertness and inattention, cannot follow a conversation, and becomes more confused overnight. Which condition should the nurse suspect?
- A.DeliriumCorrect answer: A
- B.Alzheimer dementia
- C.Major depression
- D.Vascular dementia
Explanation: "The symptoms of delirium usually start suddenly, over a few hours or a few days, and they often come and go." An abrupt, fluctuating change during acute infection supports delirium, rather than a gradual dementia process or depression. The nurse should promptly investigate and report the change.
Reference: Open RN — Nursing Fundamentals, 2e: 6.2 Basic Concepts — 6.2 Basic Concepts — Delirium
10A client consents to a hospital nurse sending wound-care information to the community nurse arranging dressing visits. There is no legal requirement for additional disclosure. How much of the hospital record should the nurse disclose for this purpose?
- A.The complete admission history and all progress notes.
- B.The minimum pertinent information needed for wound care.Correct answer: B
- C.The complete medication history and all consultation notes.
- D.The full discharge record and all previous encounter notes.
Explanation: "disclose the minimum required and pertinent information necessary" Consent to a purpose does not authorize indiscriminate disclosure. The nurse should share information needed for safe community wound care, using applicable privacy requirements, rather than automatically sending entire record categories.
Reference: CNA — Code of Ethics for Nurses: Guiding Principle 7.3 — Context for Practice
Exam Review
About CNA Medical-Surgical Nursing Certification Exam for RNs
CNA Medical-Surgical Nursing Certification Exam for RNs · CA
Key exam facts
- Provider
- Canadian Nurses Association (CNA) owns the certification program and specialty exam. Specialty exam committee sets the pass mark with testing consultants; Meazure Learning provides testing/statistical services and in-person delivery, and ProctorU provides remote proctoring.
- Format
- Computer-based multiple-choice examination for registered nurses/nurse practitioners: independent questions (60-75%) and case-based questions (25-40%). Remote proctoring at home through ProctorU or in-person Meazure Learning test centres in selected Canadian cities. This practice bank uses four-option single-answer questions.
- Exam questions
- Total questions: 160–165.
- Time limit
- Four hours (240 minutes) to answer the examination questions. The delivery tutorial does not affect examination timing; booking/check-in procedures are separate.
- Passing score
- No public numerical pass mark: CNA explicitly states that it is not published. Each specialty committee uses a modified Angoff method, with testing consultants checking fairness and validity. Results are pass or unsuccessful; no percentage or scaled-score cutoff is asserted.
- Exam fee
- CNA Canadian initial-exam fee schedule: $588 for CNA members or $780 for non-members, plus applicable taxes; includes a non-refundable $130 administrative fee. Separate appointment fee: $85 for remote ProctorU or $110 for an in-person Meazure Learning centre. Eligible unsuccessful candidates may rewrite for $378 (member) or $500 (non-member) over the next two calendar years, plus appointment fees and taxes. Amounts are shown in dollars in CNA's Canadian domestic fee table.
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.
Neurological System — Official range: 7–11% (Practice allocation: 9.09%)
- Recognizes clinical presentation and cares for clients with: a) neuromuscular diseases (e.g., Parkinson’s, ALS, MS); b) altered levels of consciousness; c) cerebrovascular incidences (e.g., transient ischemic attacks, cerebrovascular accidents); d) with seizures/status epilepticus; e) spinal cord injuries; f) head injuries (e.g., concussions, hematomas); g) headaches (e.g., cluster, tension, migraines); and h) cancers (e.g., brain, spinal cord, non-malignant).
- Cares for clients undergoing the following neurological procedures: a) lumbar punctures; b) diagnostics (e.g., MRI, CT, angiograms, EEG); and c) neurological surgeries (e.g., craniotomies, discectomies).
- Assesses the neurological system for subtle changes using: a) trending of vital signs and neurological vital signs; b) motor sensory assessments; c) cognitive screenings; d) laboratory results; and e) information obtained from the client and family.
- Determines the appropriate nursing diagnosis for clients with neurological needs.
- Plans appropriate interventions to manage and monitor neurological status by: a) monitoring fluid and electrolyte balance; b) administering and monitoring pharmacological agents; c) implementing non-pharmacological strategies; d) providing safe client environment (e.g., fall risk prevention, seizure precautions, behavioural management); and e) addressing client’s/family’s psychosocial needs (e.g., body image, sexuality).
- Recognizes and manages potential neurological complications (e.g., bleeding/hemorrhage, headaches, seizures, anxiety, depression).
- Evaluates interventions for clients with neurological care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with neurological care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, safety, health promotion, community resources).
Eye, Ear, Nose and Throat (EENT) System — Official range: 3–7% (Practice allocation: 5.05%)
- Recognizes clinical presentation and cares for clients with: a) inflammatory and infectious processes (e.g., stomatitis, pharyngitis, epiglottitis sinusitis); b) hearing impairment (e.g., sensorineural, conductive); c) visual impairment (e.g., macular degeneration, cataracts, glaucoma); d) facial trauma (e.g., fractures, reconstructions); e) epistaxis; and f) cancers (e.g., oral-pharyngeal, thyroid, esophageal).
- Cares for clients undergoing the following EENT procedures: a) incision and drainage; b) nasal packing; c) swallowing assessments; d) eye surgery (e.g., cataracts, glaucoma); and e) neck and throat surgery (e.g., tonsillectomy, thyroidectomy, tracheotomy).
- Assesses the EENT system using: a) trending of vital signs; b) assessment of the respiratory system and airway patency; and c) laboratory results.
- Determines the appropriate nursing diagnosis for clients with EENT needs.
- Plans appropriate interventions to manage and monitor EENT status by: a) maintaining adequate airway; b) optimizing ventilation; c) monitoring fluid and electrolyte balance; d) providing nutritional support and monitoring; e) administering and monitoring pharmacological agents; f) implementing non-pharmacological strategies; g) providing safe client environment (e.g., wire cutters, tracheostomy tray, fall risk prevention); h) addressing impaired communication (e.g., oral, visual, auditory); and i) addressing client’s/family’s psychosocial needs (e.g., body image, sexuality).
- Recognizes and manages EENT complications (e.g., bleeding/hemorrhage, airway patency).
- Evaluates interventions for clients with EENT care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with EENT care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, health promotion, community resources).
Cardiovascular System — Official range: 10–14% (Practice allocation: 12.12%)
- Recognizes clinical presentation and cares for clients with: a) heart failure (e.g., pulmonary edema); b) venous thromboembolism; c) acute coronary syndromes; d) heart conduction disturbances; e) infectious and inflammatory processes (e.g., endocarditis, pericarditis, systemic sepsis); f) hypertension/hypotension; g) shock; h) peripheral vascular disease; and i) cardiac arrest.
- Cares for clients with or undergoing the following cardiovascular procedures: a) vascular access devices; b) diagnostic tests (e.g., exercise tolerance test, non-stress test, electrocardiograms); c) pacemaker; d) angiograms/angioplasty; and e) surgery (e.g., femoral popliteal bypass, stenting, CABG).
- Assesses the cardiovascular system using: a) trending of vital signs; b) cardiac and peripheral vascular assessments; and c) laboratory results.
- Determines the appropriate nursing diagnosis for clients with cardiovascular needs.
- Plans appropriate interventions to manage and monitor cardiovascular status by: a) monitoring fluid and electrolyte balance; b) administering and monitoring pharmacological agents (e.g., high alert medications); c) implementing non-pharmacological strategies; d) providing safe client environment (e.g., fall risk prevention, hypotension); and e) addressing client’s/family’s psychosocial needs.
- Recognizes and manages actual or potential cardiovascular complications (e.g., embolisms, bleeding/hemorrhage, shock).
- Evaluates interventions for clients with cardiovascular care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with cardiovascular care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, safety, health promotion, community resources).
Respiratory System — Official range: 10–14% (Practice allocation: 12.12%)
- Recognizes clinical presentation and cares for clients with: a) partial or complete airway obstruction (e.g., foreign bodies, mucus plugs); b) restrictive lung diseases (e.g., pneumonia); c) obstructive lung diseases (e.g., COPD, emphysema, asthma); d) interstitial lung diseases (e.g., cystic fibrosis); e) pulmonary emboli; f) empyema/pleural effusion; g) sleep apnea; h) hemo/pneumothorax and atelectasis; and i) cancer (e.g., lung, esophageal).
- Cares for clients with or undergoing the following procedures: a) chest tube (e.g., insertion, removal); b) pleurocentesis; c) pleurodesis; d) diagnostic tests (e.g., bronchoscopy, pulmonary function test); and e) surgery (e.g., lobectomy, tracheostomy, pneumonectomy, thoracotomy).
- Assesses the respiratory system using: a) trending of vital signs; b) arterial blood gases; c) respiratory assessments; and d) laboratory results.
- Determines the appropriate nursing diagnosis for clients with respiratory needs.
- Plans appropriate interventions to manage and monitor respiratory status by: a) maintaining adequate airway including non-invasive positive pressure ventilation devices (e.g., CPAP, Bi-PAP); b) optimizing gaseous exchange (e.g., positioning, mobilizing, pain management, oxygen, incentive spirometry); c) administering and monitoring pharmacological agents; d) monitoring fluid and electrolyte balance; e) implementing non-pharmacological strategies; f) providing safe client environment (e.g., fall risk prevention, isolation precautions); and g) addressing client’s/family’s psychosocial needs.
- Recognizes and manages actual or potential respiratory complications (e.g., embolisms, bleeding/hemorrhage, infection).
- Evaluates interventions for clients with respiratory care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with respiratory care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, safety, health promotion, community resources).
Gastrointestinal System — Official range: 6–10% (Practice allocation: 8.08%)
- Recognizes clinical presentation and cares for clients with: a) mechanical gastrointestinal disorders (e.g., bowel obstruction, constipation/diarrhea, hernia, dysphagia); b) gastrointestinal/dietary disorders (e.g., pancreatitis, GERD, appendicitis, pernicious anemia); c) liver diseases (e.g., cirrhosis, hepatic failure); d) inflammatory bowel diseases (e.g., Crohn’s disease, ulcerative colitis, diverticulitis); e) gallbladder diseases (e.g., cholelithiasis, cholecystitis); f) gastrointestinal bleeds (e.g., esophageal varices, peptic ulcers, upper and lower bleeds); and g) cancer (e.g., bowel, pancreatic).
- Cares for clients undergoing the following gastrointestinal procedures: a) diagnostic imaging (e.g., upper and lower GI series); b) scopes (e.g., gastroscope, sigmoidoscope, colonoscope, ERCP); c) insertion of enteral feeding tubes (e.g., PEG); d) paracentesis; and e) surgery (e.g., ostomies, resections, bariatric).
- Assesses the gastrointestinal system using: a) trending of vital signs; b) weight gain/loss; c) abdominal assessments; d) nutritional assessments; and e) laboratory results.
- Determines the appropriate nursing diagnosis for clients with gastrointestinal needs.
- Plans appropriate interventions to manage and monitor gastrointestinal health by: a) optimizing gastrointestinal function; b) managing nasogastric tubes, enteral feeding, drains and ostomies; c) performing abdominal assessment (e.g., rigidity, distention, tenderness); d) administering and monitoring pharmacological agents; e) implementing non-pharmacological strategies; f) providing and monitoring nutritional support (e.g., total parenteral nutrition, therapeutic diets); g) monitoring fluid and electrolyte balance; h) providing safe client environment (e.g., fall risk prevention, safe patient handling); and i) addressing client’s/family’s psychosocial needs.
- Recognizes and manages actual or potential gastrointestinal complications (e.g., obstructions, paralytic ileus, wound dehiscence/evisceration, perforation).
- Evaluates interventions for clients with gastrointestinal care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with gastrointestinal care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, safety, health promotion, community resources).
Genitourinary and Reproductive Systems — Official range: 4–8% (Practice allocation: 6.06%)
- Recognizes clinical presentation and cares for clients with: a) acute/chronic renal failure (e.g., rhabdomyolysis); b) infections (e.g., UTI, glomerulonephritis, pyelonephritis, prostatitis, cystitis); c) incontinence, urinary retention and obstruction; d) benign prostatic hypertrophy; e) prolapse; f) urolithiasis; and g) cancer (e.g., renal, prostate, ovarian, breast).
- Cares for clients undergoing the following procedures: a) diagnostic imaging/procedure (e.g., IVP, cystoscopy); b) urinary diversions (e.g., neobladder, ileal conduit); c) continuous bladder irrigation (CBI); d) tubes and drains (e.g., nephrostomy, suprapubic, urethral); e) dialysis (e.g., peritoneal, hemodialysis); f) nephrectomy; g) male-specific surgical procedures (e.g., TURP, radical prostatectomy, orchiectomy); h) female-specific surgical procedures (e.g., mastectomy, lumpectomy, hysterectomy, transvaginal taping, uterine artery embolization); and i) reconstructions (e.g., breast, urologic).
- Assesses the genitourinary and/or reproductive systems using: a) trending of vital signs; b) intake/output; c) urine/vaginal flow characteristics; d) voiding patterns; and e) laboratory results.
- Determines the appropriate nursing diagnosis for clients with genitourinary and reproductive needs.
- Plans appropriate interventions to manage and monitor genitourinary and/or reproductive status by: a) optimizing genitourinary function (e.g., early catheter removal, bladder training); b) assessing the effects of nephrotoxic agents or delayed clearance (e.g., diuretics, vasopressors, antibiotics, radiographic dyes); c) administering and monitoring pharmacological agents; d) implementing non-pharmacological strategies; e) monitoring fluid and electrolyte balance; f) providing safe client environment (e.g., fall risk prevention, infection control); and g) addressing client’s/family’s psychosocial needs (e.g., body image, sexuality, impotence issues).
- Recognizes and manages actual or potential genitourinary and/or reproductive complications (e.g., bleeding/hemorrhage, shock, infection).
- Evaluates interventions for clients with genitourinary and/or reproductive care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with genitourinary and/or reproductive care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, safety, health promotion, community resources).
Musculoskeletal and Integumentary Systems — Official range: 5–9% (Practice allocation: 7.07%)
- Recognizes clinical presentation and cares for clients with: a) osteoarthritis; b) pathological/traumatic fractures (e.g., osteoporosis, falls); c) muscle, soft tissue and/or ligament injuries; d) infections (e.g., necrotizing fasciitis, cellulitis, osteomyelitis, abscesses); e) skin conditions (e.g., psoriasis, dermatitis, eczema); f) ulcers (e.g., pressure, venous, arterial); and g) cancers (e.g., skin, bone).
- Cares for clients with or undergoing the following: a) joint replacements; b) casts/braces (e.g., backslabs, splints); c) internal/external fixations (e.g., traction, pinning, plating, fusions); d) amputations; e) wounds (e.g., surgical wounds, skin grafts, pressure ulcers, burns); and f) biopsies.
- Assesses the musculoskeletal/integumentary system using: a) rending of vital signs; b) neuro/peripheral vascular assessments; c) skin assessments; d) mobility assessments; and e) laboratory results.
- Determines the appropriate nursing diagnosis for clients with musculoskeletal and integumentary needs.
- Plans appropriate interventions to manage and monitor musculoskeletal or integumentary status by: a) administering and monitoring pharmacological agents; b) implementing non-pharmacological strategies; c) monitoring fluid and electrolytes balance; d) managing changes in neurovascular assessment; e) managing assistive devices (e.g., braces, walkers, prostheses); f) promoting healthy skin (e.g., pressure redistribution strategies); g) managing wounds (e.g., negative pressure therapy, wound care protocol); h) promoting optimal nutrition; i) providing safe client environment (e.g., fall risk prevention, use of Braden Scale, safe patient handling); and j) addressing client’s/family’s psychosocial needs (e.g., body image).
- Manages actual or potential musculoskeletal/integumentary complications (e.g., embolisms, bleeding/hemorrhage, infection, compartment syndrome).
- Evaluates interventions for clients with musculoskeletal/integumentary care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with musculoskeletal/integumentary care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, safety, health promotion, community resources).
Immunological, Hematological and Endocrinological Systems — Official range: 6–10% (Practice allocation: 8.08%)
- Recognizes clinical presentation and cares for clients with: a) diabetes; b) thyroid conditions; c) adrenal gland conditions (e.g., Addison’s disease, Cushing’s syndrome, syndrome of inappropriate antidiuretic hormone (SIADH), diabetes insipidus); d) blood dyscrasia (e.g., multiple myeloma, hemophilia, anemia, sickle cell crisis, polycythemia, thrombocytopenia); e) immunosuppression; f) autoimmune disorder (e.g., rheumatoid arthritis, systemic lupus erythematosus, gout); and g) cancers (e.g., leukemia, lymphoma).
- Cares for clients with or undergoing the following: a) thyroidectomy; b) anti-neoplastic agents; c) bone marrow aspirate; and d) blood and blood product transfusion.
- Assesses the immunological, hematological or endocrinological systems using: a) trending of vital signs; b) skin inspection; c) weight gain/loss; d) nutritional assessments; e) neuro/peripheral vascular assessments; and f) laboratory results.
- Determines the appropriate nursing diagnosis for clients with immunological, hematological or endocrinological needs.
- Plans appropriate interventions to manage and monitor hematological or endocrinological status by: a) managing blood glucose levels; b) administering blood and blood products; c) administering and monitoring pharmacological agents (e.g., cytotoxic agents, insulin pumps); d) implementing non-pharmacological strategies; e) initiating precautions (e.g., isolation); f) promoting optimal nutrition; g) providing and promoting safe client environment (e.g., infection prevention and control, fall risk prevention, personal protective equipment (PPE)); and h) addressing client’s/family’s psychosocial needs.
- Recognizes and manages actual or potential immunological, hematological or endocrinological complications (e.g., allergies, bleeding/hemorrhage, septic shock, infection).
- Evaluates interventions for clients with immunological, hematological or endocrinological care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with immunological, hematological or endocrinological care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, medication regimens, health promotion, community resources).
Infectious Diseases — Official range: 5–9% (Practice allocation: 7.07%)
- Recognizes clinical presentation and cares for clients with: a) drug-resistant organisms (e.g., MRSA, VRE, C. difficile, ESBL); b) non-communicable infections (e.g., necrotizing fasciitis, cellulitis); c) communicable infections (e.g., hepatitis, HIV/AIDS); d) severe respiratory infection (e.g., SARS, TB, influenza); e) systemic inflammatory response syndrome (e.g., sepsis); f) emerging infections (e.g., hemorrhagic fevers, bioterrorism agents); and g) sexually transmitted infections (e.g., chlamydia, gonorrhea, syphilis).
- Cares for clients with or undergoing the following: a) diagnostic tests (e.g., swabs, blood cultures); b) wounds (e.g., grafts, surgical debridements); and c) infection control precautions (e.g., isolation, condoms, hand hygiene).
- Assesses client risk factors related to infectious diseases (e.g., lifestyle, previous hospitalization, laboratory results).
- Determines the appropriate nursing diagnosis for clients with infectious disease care needs.
- Plans appropriate interventions to manage and monitor clients with infectious disease by: a) initiating and maintaining isolation precautions for nurse and/or family; b) notifies appropriate infection prevention and control practitioner and/or public health agency; c) specimen collection; d) administering and monitoring pharmacological agents; e) implementing non-pharmacological strategies; f) providing safe client environment (e.g., personal protective equipment (PPE), fall risk prevention); and g) managing psychosocial implications of living with communicable disease.
- Recognizes and manages actual or potential complications related to infectious diseases (e.g., allergies, systemic complications, shock).
- Evaluates interventions for clients with infectious disease care needs (e.g., recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with infectious disease care needs (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, medication regimens, health promotion, community resources).
Pain — Official range: 9–13% (Practice allocation: 11.11%)
- Recognizes clinical presentation and cares for clients with acute or chronic: a) neuropathic pain (e.g., trigeminal pain, phantom limb); b) visceral pain (e.g., referred pain); c) somatic pain (e.g., sprains, lacerations); and d) psychogenic pain (e.g., emotional distress).
- Cares for clients with or undergoing the following: a) patient-controlled analgesia (PCA); b) nerve blocks; c) epidurals; and d) intrathecals.
- Assesses pain (e.g., functional limitations, physical examinations, psychosocial evaluations, pain scales, vital signs, pain history, pain management, subjective health status).
- Determines the appropriate nursing diagnosis for clients with pain care needs.
- Plans appropriate interventions to manage and monitor clients dealing with pain by: a) implementing and reassessing pain management regimens (e.g., breakthrough, mode of delivery); b) administering adjuvant therapies (e.g., tricyclic antidepressants, anticonvulsants, sedatives); c) implementing non-pharmacological therapies (e.g., relaxation, deep breathing, massage); d) managing and monitoring side effects (e.g., constipation, nausea); and e) addressing client’s/family’s psychosocial needs (e.g., palliative/end-of-life care, cultural care, spiritual care).
- Recognizes and manages actual or potential complications related to pain (e.g., allergies/sensitivities, respiratory distress).
- Evaluates interventions for clients with pain care needs (e.g., age-related medication considerations, recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients experiencing pain (e.g., client’s readiness to learn, evaluating client’s understanding, discharge planning, elimination, medication regimens, end-of-life care, health promotion, community resources).
Mental Health — Official range: 5–9% (Practice allocation: 7.07%)
- Recognizes clinical presentation of and cares for clients with: a) delirium; b) dementia; c) depression; and d) substance dependency (e.g., alcohol, illicit drugs, prescription drugs, cigarettes).
- Assesses the mental health of clients using: a) trending of vital signs; b) screening tools (e.g., neurocognitive, affective, psychosocial); c) medication history; and d) laboratory results.
- Determines the appropriate nursing diagnosis for clients with mental health care needs.
- Plans appropriate interventions to manage and monitor mental health status by: a) utilizing behaviour management techniques; b) promoting the client’s independence and capabilities; c) providing safe client environment (e.g., crisis intervention, environmental modifications, constant care, minimizing risk factors, least restraints); d) administering and monitoring pharmacological agents; and e) implementing non-pharmacological agents to manage underlying cause of behaviours (e.g., therapeutic communication, complementary therapies, family involvement, visualization, relaxation techniques, support groups).
- Recognizes and manages actual or potential complications related to mental health (e.g., safety, withdrawal, seizures, suicide, violence/aggression).
- Evaluates interventions for clients with mental health care needs (e.g., age-related medication considerations, recognizing subtle changes, adapting plan, communicating/documenting plan).
- Develops an individualized teaching plan for clients with mental health care needs (e.g., client’s and/or family’s readiness to learn, evaluating client’s understanding, discharge planning, medication regimens, health promotion, community support).
Professional, Legal and Ethical Issues — Official range: 5–9% (Practice allocation: 7.07%)
- Ensures client confidentiality and privacy (e.g., electronic health records, social media, over-capacity facilities).
- Demonstrates accountability in nursing practice (e.g., client assignment, responsibility for actions, understanding scope, documentation).
- Prioritizes nursing care and adapts to varying or unexpected situations (e.g., staff shortages, skill mix changes, client acuity/intensity, working with unregulated health workers).
- Provides interprofessional care (e.g., collaboration, communication, advocacy).
- Approaches conflict situations in a constructive manner and investigates when appropriate (e.g., horizontal violence, family conflict, abuse, aggression, neglect).
- Recognizes ethical issues and seeks assistance in addressing them (e.g., refusal of blood products, refusal of care, withdrawal of treatment, culturally congruent care, advance health-care directives).
- Participates in professional development (e.g., peer feedback, mentorship/preceptorship, conference attendance, research).
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
What is the exam format?
Computer-based multiple-choice examination for registered nurses/nurse practitioners: independent questions (60-75%) and case-based questions (25-40%). Remote proctoring at home through ProctorU or in-person Meazure Learning test centres in selected Canadian cities. This practice bank uses four-option single-answer questions.
How many questions are on the exam?
Total questions: 160–165.
How long is the exam?
Four hours (240 minutes) to answer the examination questions. The delivery tutorial does not affect examination timing; booking/check-in procedures are separate.
What is the passing score?
No public numerical pass mark: CNA explicitly states that it is not published. Each specialty committee uses a modified Angoff method, with testing consultants checking fairness and validity. Results are pass or unsuccessful; no percentage or scaled-score cutoff is asserted.
How much does the exam cost?
CNA Canadian initial-exam fee schedule: $588 for CNA members or $780 for non-members, plus applicable taxes; includes a non-refundable $130 administrative fee. Separate appointment fee: $85 for remote ProctorU or $110 for an in-person Meazure Learning centre. Eligible unsuccessful candidates may rewrite for $378 (member) or $500 (non-member) over the next two calendar years, plus appointment fees and taxes. Amounts are shown in dollars in CNA's Canadian domestic fee table.
Official sources and references
- CNA Medical-Surgical Nursing Exam Blueprint and Specialty Competencies
p. 1, Introduction
- CNA Exam Competencies & Blueprints
Exam Competencies & Blueprints; Medical-Surgical Nursing for RNs
- CNA Medical-Surgical Nursing Exam Blueprint and Specialty Competencies
p. 5, Table 1: Competency Sampling
- CNA Medical-Surgical Nursing Exam Blueprint and Specialty Competencies
p. 7, Table 2
- CNA Medical-Surgical Nursing Exam Blueprint and Specialty Competencies
p. 6, Question Presentation
- CNA Medical-Surgical Nursing Exam Blueprint and Specialty Competencies
p. 9, Client Age and Gender
- CNA General Competencies
General Competencies
- CNA General Competencies: Medical Assistance in Dying (MAID)
p. 1, title
- CNA General Competencies: Cultural Safety
p. 1, title
- CNA General Competencies: Substance Use
p. 1, title
- CNA Medical-Surgical Nursing Exam Blueprint and Specialty Competencies
p. 6, Structural Variables
- CNA CBT Exam Tips
Budget your time
- CNA Exam Results and Retesting
Exam Results and Retesting
- CNA Initial Exam Fees
Initial Exam Fees, application fee and appointment fee table
Confirm current exam arrangements with the exam provider.