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Free CNA Medical-Surgical Nursing for LPNs/RPNs Certification Exam Practice Questions

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Sample Practice Questions

Try these 10 sample questions from the CNA Medical-Surgical Nursing for LPNs/RPNs Certification Exam practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

  1. 1A practical nurse is assessing mobility in an adult with Parkinson's disease. Which gait finding is most consistent with bradykinesia?

    1. A.Wide-based steps with marked side-to-side swaying.
    2. B.Slow, shuffling steps with a very short stride.Correct answer: B
    3. C.High-stepping strides with exaggerated knee lifting.
    4. D.Stiff scissoring steps with the knees crossing over.

    Explanation: The NHS describes "a distinctive slow, shuffling walk with very small steps". This matches the short, slow steps associated with bradykinesia; the other patterns suggest different motor abnormalities.

    Reference: NHS — Parkinson’s disease symptoms — Main symptoms, slowness of movement

  2. 2An adult develops a rapidly worsening sore throat, painful swallowing, drooling and a high-pitched sound while breathing in. Which EENT condition should the nurse suspect as an airway emergency?

    1. A.Sinusitis
    2. B.Stomatitis
    3. C.EpiglottitisCorrect answer: C
    4. D.Otitis externa

    Explanation: The NHS describes a "high-pitched, rasping sound" during inspiration in epiglottitis. Rapid throat pain, painful swallowing and drooling with this airway sound warrant urgent airway assessment. Sinusitis, stomatitis and otitis externa do not explain this threatened upper-airway pattern.

    Reference: NHS — Epiglottitis — Symptoms of epiglottitis

  3. 3An adult reports increasing shortness of breath when lying flat and now sleeps propped upright. Which cardiovascular condition is particularly associated with this presentation?

    1. A.Chronic venous insufficiency
    2. B.Peripheral arterial disease
    3. C.Isolated right-sided heart failure
    4. D.Left-sided heart failureCorrect answer: D

    Explanation: NHLBI lists "Inability to sleep lying flat" among left-sided heart-failure symptoms. This new positional breathlessness is consistent with left-sided congestion and requires further assessment, rather than being attributed solely to peripheral vascular disease.

    Reference: NHLBI — Heart Failure Symptoms — Left-sided heart failure symptoms

  4. 4An adult with a history of abdominal surgery develops abdominal pain, distension, vomiting and inability to pass stool or gas. Which complication should the nurse suspect and escalate promptly?

    1. A.Adhesive intestinal obstructionCorrect answer: A
    2. B.Uncomplicated gastro-oesophageal reflux
    3. C.Isolated lactose intolerance
    4. D.Uncomplicated haemorrhoidal disease

    Explanation: NIDDK identifies "not passing gas" among obstruction symptoms and explains that postoperative adhesions can block the intestine. The combined obstructive pattern warrants urgent assessment; the other conditions do not explain cessation of intestinal transit with vomiting and distension.

    Reference: NIDDK — Abdominal Adhesions — Symptoms of intestinal obstruction

  5. 5An adult with previously normal kidney function has a sudden rise in serum creatinine and is passing much less urine over two days. Which concern should the nurse raise for prompt assessment?

    1. A.Chronic stress incontinence
    2. B.Acute kidney injuryCorrect answer: B
    3. C.Uncomplicated cystitis
    4. D.Long-standing chronic kidney disease

    Explanation: The NHS explains that higher creatinine means the kidneys are "not working as well as they should". The sudden change from a normal baseline with reduced urine output supports concern for acute kidney injury, rather than an isolated lower-urinary symptom or established chronic disease.

    Reference: NHS — Acute kidney injury — Tests for acute kidney injury, creatinine

  6. 6An older adult has slowly developing knee pain that worsens with use and improves with rest. Morning stiffness usually lasts about 15 minutes. Which condition most closely fits this pattern?

    1. A.Septic arthritis
    2. B.Acute gout
    3. C.OsteoarthritisCorrect answer: C
    4. D.Rheumatoid arthritis

    Explanation: NIAMS describes osteoarthritis pain that "may improve with rest" and usually brief stiffness. Activity-related pain with short morning stiffness fits this pattern better than an acute hot-joint process or the typical prolonged inflammatory stiffness of rheumatoid arthritis.

    Reference: NIAMS — Osteoarthritis — Symptoms of Osteoarthritis

  7. 7An adult with type 1 diabetes has vomiting, markedly elevated blood glucose, positive urine ketones and fruity-smelling breath. Which acute condition does this pattern most strongly suggest?

    1. A.Hyperosmolar hyperglycemic state
    2. B.Diabetic ketoacidosisCorrect answer: B
    3. C.Insulin-induced hypoglycemia
    4. D.Lactic acidosis

    Explanation: The CDC identifies "Fruity-smelling breath." as a DKA symptom. Insulin deficiency permits ketone production; hyperglycemia, ketonuria and this breath odour support DKA and require emergency assessment. Hypoglycemia has low glucose; the other metabolic emergencies do not explain this characteristic ketone-associated pattern as well.

    Reference: CDC — Diabetic Ketoacidosis — Symptoms; What it is

  8. 8An adult with documented postherpetic nerve injury describes persistent burning and electric-shock-like pain along the affected area. Which pain mechanism best describes this presentation?

    1. A.Nociceptive inflammatory pain
    2. B.Nociceptive ischemic pain
    3. C.Neuropathic painCorrect answer: C
    4. D.Nociplastic pain

    Explanation: NIH describes neuropathic pain as caused by nerve damage and often "burning, tingling, shooting". The documented nerve injury and electric quality support this mechanism. Inflammatory and ischemic nociception involve tissue injury signals; nociplastic pain is not accounted for by a demonstrated somatosensory lesion in this way.

    Reference: National Institutes of Health — Pain — Pain Described By its Cause

  9. 9An adult with established bipolar disorder is admitted for a medical condition. Over several days, the adult has slept very little without fatigue, speaks rapidly and has unusually high energy and confidence. Which mood state should the nurse suspect and communicate to the team?

    1. A.Depression
    2. B.Mania or hypomaniaCorrect answer: B
    3. C.Euthymia
    4. D.Mixed affective episode

    Explanation: The NHS lists high-mood features including "not needing much sleep", alongside racing thoughts and fast speech. The activated pattern warrants assessment for mania or hypomania, with duration, severity and impairment informing diagnosis. No depressive cluster is described to support depression or a mixed episode, and the change is not euthymic stability.

    Reference: NHS — Bipolar Disorder — High mood (mania and hypomania) symptoms

  10. 10An Ontario RPN wants to post a distinctive client story from the hospital in a private social-media group. The client has not consented, and details could identify the client even without a name. Which action protects confidentiality?

    1. A.Post the story after removing the client's name
    2. B.Post the story after making the group invitation-only
    3. C.Withhold the identifiable client story from the groupCorrect answer: C
    4. D.Post the story after deleting the hospital's name

    Explanation: CNO cautions against sharing client information "even if they remove names". Removing direct identifiers or restricting group membership does not ensure a distinctive story is unidentifiable. The nurse must protect the client's information rather than rely on these changes.

    Reference: College of Nurses of Ontario — Social Media: Reflect before You Post — Confidentiality and Privacy — Personal Health Information

Exam Review

About CNA Medical-Surgical Nursing for LPNs/RPNs Certification Exam

CNA Medical-Surgical Nursing for LPNs/RPNs Certification Exam · CA

Key exam facts

Provider
Canadian Nurses Association (CNA) owns the Certification Program; the specialty exam committee approves competencies and sets the pass mark. The blueprint was developed collaboratively with YAS and Canadian specialty nurses. Current testing consultants are Meazure Learning; remote appointments use ProctorU and in-person appointments use Meazure Learning.
Format
Computer-based multiple-choice knowledge examination for licensed/registered practical nurses caring for adults. Offered with remote online proctoring or in-person at select Canadian test centres. The blueprint specifies 60–75% independent and 25–40% case-based questions; this four-option practice bank does not claim to reproduce the official case-linked distribution.
Exam questions
Total questions: 160–165.
Time limit
Four hours (240 minutes) to answer the examination questions. This is answering time, separate from preparation and appointment check-in.
Passing score
The numerical pass mark is not published. Each specialty committee sets a criterion-referenced standard using a modified Angoff method, supported by statistical analysis; results are reported as pass or unsuccessful.
Exam fee
CNA lists application fees of $588 for CNA members and $780 for non-members; the application fee includes a non-refundable $130 administrative fee. A separate writing appointment costs $85 online or $110 in person. Reduced rewrite application fees are $378/$500 (member/non-member) for an unsuccessful candidate's next two calendar years. Applicable taxes are additional. Dollar amounts are reproduced as listed on the Canadian CNA fee schedule; that page does not explicitly label an ISO currency code.

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: 8–12% (Practice allocation: 10.1%)

    • Recognizes clinical presentation of and cares for clients with:
    • neuromuscular diseases (e.g., Parkinson’s, ALS, MS);
    • altered levels of consciousness (e.g., postoperative delirium, sepsis);
    • cerebrovascular incidences (e.g., transient ischemic attacks, cerebrovascular accidents);
    • seizures/status epilepticus;
    • spinal cord injuries;
    • head injuries (e.g., concussions, hematomas);
    • headaches (e.g., cluster, tension, migraines); and
    • cancers (e.g., brain, spinal cord, non-malignant).
    • Cares for clients with or undergoing:
    • lumbar punctures;
    • diagnostics (e.g., MRI, CT, angiograms, EEG); and
    • neurological surgeries (e.g., craniotomies, discectomies, shunts).
    • Assesses the neurological system for subtle changes using:
    • trending of vital signs;
    • motor sensory assessments;
    • cognitive screenings;
    • laboratory results; and
    • 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:
    • monitoring fluid and electrolyte balances;
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological strategies;
    • providing a safe client environment (e.g., fall risk prevention, seizure precautions, behavioural management); and
    • addressing the client’s/family’s psychosocial needs (e.g., body image, sexuality).
    • Recognizes and manages actual and potential neurological complications (e.g., bleeding/hemorrhage, headaches, seizures, anxiety, depression, withdrawal).
    • Evaluates interventions for clients with neurological care needs (e.g., adapting the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with neurological care needs (e.g., the client’s readiness to learn, evaluating the 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 of and cares for clients with:
    • inflammatory and infectious processes (e.g., stomatitis, pharyngitis, epiglottitis, sinusitis);
    • hearing impairment (e.g., sensorineural, conductive);
    • visual impairment (e.g., macular degeneration, cataracts, glaucoma);
    • facial trauma (e.g., fractures, reconstructions);
    • epistaxis; and
    • cancers (e.g., oral-pharyngeal, thyroid, esophageal).
    • Cares for clients with or undergoing:
    • incision and drainage;
    • nasal packing;
    • swallowing assessments;
    • eye surgery (e.g., cataracts, glaucoma); and
    • neck and throat surgery (e.g., tonsillectomy, thyroidectomy, tracheotomy).
    • Assesses the EENT system using:
    • trending of vital signs;
    • physical assessments; and
    • laboratory results.
    • Determines the appropriate nursing diagnosis for clients with EENT needs.
    • Plans appropriate interventions to manage and monitor EENT status by:
    • maintaining adequate airway;
    • optimizing oxygenation;
    • monitoring fluid and electrolyte balances;
    • providing nutritional support and monitoring;
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological strategies;
    • providing a safe client environment (e.g., wire cutters, tracheostomy tray, fall risk prevention);
    • addressing impaired communication (e.g., oral, visual, auditory); and
    • addressing the client’s/family’s psychosocial needs (e.g., body image).
    • 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 the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with EENT care needs (e.g., the client’s readiness to learn, evaluating the client’s understanding, discharge planning, health promotion, community resources).
  • Cardiovascular System — Official range: 8–12% (Practice allocation: 10.1%)

    • Recognizes clinical presentation of and cares for clients with:
    • heart failure (e.g., pulmonary edema);
    • venous thromboembolism;
    • acute coronary syndromes;
    • heart conduction disturbances;
    • infectious and inflammatory processes (e.g., endocarditis, pericarditis, systemic sepsis);
    • hypertension/hypotension;
    • shock;
    • vascular diseases; and
    • cardiac arrest.
    • Cares for clients with or undergoing:
    • vascular access devices;
    • diagnostic tests (e.g., exercise tolerance test, non-stress test, electrocardiograms);
    • pacemaker;
    • angiograms, angioplasty and cardioversion; and
    • vascular surgery (e.g., femoral popliteal bypass, stenting, CABG).
    • Assesses the cardiovascular system using:
    • trending of vital signs;
    • weight gain/loss;
    • cardiac and vascular assessments;
    • laboratory results; and
    • cardiac equipment (e.g., resuscitation, telemetry, ECGs).
    • Determines the appropriate nursing diagnosis for clients with cardiovascular needs.
    • Plans appropriate interventions to manage and monitor cardiovascular status by:
    • monitoring fluid and electrolyte balances;
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological strategies;
    • providing a safe client environment (e.g., fall risk prevention); and
    • addressing the client’s/family’s psychosocial needs (e.g., sexuality).
    • 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 the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with cardiovascular care needs (e.g., the client’s readiness to learn, evaluating the client’s understanding, discharge planning, safety, health promotion, community resources).
  • Respiratory System — Official range: 8–12% (Practice allocation: 10.1%)

    • Recognizes clinical presentation of and cares for clients with:
    • partial and complete airway obstruction (e.g., foreign bodies, mucus plugs);
    • restrictive lung diseases (e.g., pneumonia);
    • obstructive lung diseases (e.g., COPD, emphysema, asthma);
    • interstitial lung diseases (e.g., cystic fibrosis);
    • pulmonary emboli;
    • atelectasis and pleural effusion;
    • hemo/pneumothorax and empyema;
    • dyspnea and tachypnea;
    • sleep apnea; and
    • cancers (e.g., lung, esophageal).
    • Cares for clients with or undergoing:
    • chest tube (e.g., insertion, removal, maintenance);
    • pleurocentesis;
    • pleurodesis;
    • diagnostic tests (e.g., bronchoscopy, pulmonary function test); and
    • surgery (e.g., lobectomy, tracheostomy, pneumonectomy, thoracotomy).
    • Assesses the respiratory system using:
    • trending of vital signs;
    • fluid balance;
    • physical assessments; and
    • laboratory results.
    • Determines the appropriate nursing diagnosis for clients with respiratory needs.
    • Plans appropriate interventions to manage and monitor respiratory status by:
    • maintaining adequate airways;
    • managing non-invasive positive pressure ventilation devices (e.g., CPAP, Bi-PAP);
    • optimizing gaseous exchange (e.g., positioning, mobilizing, pain management, oxygen delivery and titration, suctioning);
    • administering and monitoring pharmacological agents;
    • monitoring fluid and electrolyte balances;
    • implementing non-pharmacological strategies;
    • providing a safe client environment (e.g., fall risk prevention); and
    • addressing the 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 the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with respiratory care needs (e.g., the client’s readiness to learn, evaluating the client’s understanding, discharge planning, safety, health promotion, community resources).
  • Gastrointestinal System — Official range: 6–10% (Practice allocation: 8.08%)

    • Recognizes clinical presentation of and cares for clients with:
    • mechanical gastrointestinal disorders (e.g., bowel obstruction, constipation, diarrhea, hernia, dysphagia, ischemia);
    • gastrointestinal and dietary disorders (e.g., pancreatitis, GERD, appendicitis, pernicious anemia);
    • liver diseases (e.g., cirrhosis, hepatic failure);
    • inflammatory bowel diseases (e.g., Crohn’s disease, ulcerative colitis, diverticulitis);
    • irritable bowel syndrome;
    • gallbladder diseases (e.g., cholelithiasis, cholecystitis);
    • gastrointestinal bleeds (e.g., esophageal varices, peptic ulcers, upper and lower bleeds); and
    • cancers (e.g., bowel, pancreatic).
    • Cares for clients with or undergoing:
    • diagnostic imaging (e.g., upper and lower GI series);
    • scopes;
    • insertion of enteral feeding tubes (e.g., PEG);
    • paracentesis; and
    • surgery (e.g., ostomies, resections, bariatric).
    • Assesses the gastrointestinal system using:
    • trending of vital signs;
    • fluid balance;
    • weight gain/loss;
    • abdominal assessments;
    • nutritional assessments; and
    • laboratory results.
    • Determines the appropriate nursing diagnosis for clients with gastrointestinal needs.
    • Plans appropriate interventions to manage and monitor gastrointestinal health and function by:
    • managing nasogastric tubes, rectal tubes, drains and ostomies;
    • performing physical assessments;
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological strategies;
    • providing and monitoring nutritional support (e.g., total parenteral nutrition, enteral feeding, therapeutic diets);
    • monitoring fluid and electrolyte balances;
    • providing a safe client environment (e.g., fall risk prevention, safe patient handling); and
    • addressing the client’s/family’s psychosocial needs (e.g., body image, sexuality).
    • 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 the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with gastrointestinal care needs (e.g., the client’s readiness to learn, evaluating the client’s understanding, dietary teaching, discharge planning, safety, health promotion, community resources).
  • Genitourinary and Reproductive Systems — Official range: 6–10% (Practice allocation: 8.08%)

    • Recognizes clinical presentation of and cares for clients with:
    • acute/chronic renal failure (e.g., rhabdomyolysis);
    • infections (e.g., UTI, glomerulonephritis, pyelonephritis, prostatitis, cystitis);
    • incontinence, urinary retention and obstruction;
    • benign prostatic hypertrophy;
    • prolapse;
    • urolithiasis; and
    • cancers (e.g., renal, prostate, ovarian, breast).
    • Cares for clients with or undergoing:
    • diagnostic imaging/procedure;
    • urinary diversions (e.g., drainage systems);
    • dialysis (e.g., peritoneal, hemodialysis);
    • nephrectomy and kidney transplant/donation;
    • male-specific surgical procedures (e.g., TURP);
    • female-specific surgical procedures (e.g., hysterectomy);
    • gender reassignment surgery; and
    • reconstructions (e.g., breast, urologic).
    • Assesses the genitourinary and/or reproductive systems using:
    • trending of vital signs;
    • fluid balance;
    • urine/vaginal flow characteristics;
    • tube and drain assessments;
    • voiding patterns; and
    • 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:
    • optimizing genitourinary function (e.g., early catheter removal, bladder training);
    • assessing the effects of nephrotoxic agents or delayed clearance (e.g., diuretics, vasopressors, antibiotics, radiographic dyes);
    • maintaining continuous bladder irrigation;
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological strategies;
    • monitoring fluid and electrolyte balances;
    • providing a safe client environment (e.g., fall risk prevention, infection control); and
    • addressing the client’s/family’s psychosocial needs (e.g., body image, sexuality, incontinence).
    • 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 the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with genitourinary and/or reproductive care needs (e.g., the client’s readiness to learn, evaluating the 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 of and cares for clients with:
    • osteoarthritis;
    • pathological, traumatic and surgical fractures;
    • muscle, soft tissue and ligament injuries;
    • infections (e.g., necrotizing fasciitis, cellulitis, osteomyelitis, abscesses, sepsis);
    • skin conditions (e.g., psoriasis, dermatitis, eczema);
    • ulcers (e.g., pressure, venous, arterial, diabetic); and
    • cancers (e.g., skin, bone).
    • Cares for clients with or undergoing:
    • joint replacements and revisions;
    • casts/braces (e.g., backslabs, splints);
    • internal/external fixations (e.g., traction, pinning, plating, fusions);
    • amputations;
    • wounds (e.g., surgical wounds, skin grafts, pressure ulcers, burns); and
    • biopsies.
    • Assesses the musculoskeletal and integumentary system using:
    • trending of vital signs;
    • neurological/vascular assessments;
    • physical assessments;
    • mobility assessments;
    • risk factor assessments (e.g., wound assessment tools); and
    • laboratory results.
    • Determines the appropriate nursing diagnosis for clients with musculoskeletal and integumentary needs.
    • Plans appropriate interventions to manage and monitor musculoskeletal and integumentary status by:
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological strategies;
    • monitoring fluid and electrolyte balances;
    • managing changes in neurovascular assessment;
    • managing assistive devices (e.g., braces, walkers, prostheses);
    • promoting healthy skin (e.g., pressure redistribution strategies);
    • managing wounds (e.g., negative pressure therapy, wound care principles);
    • promoting optimal nutrition;
    • providing a safe client environment (e.g., fall risk prevention, safe patient handling); and
    • addressing the client’s/family’s psychosocial needs (e.g., body image, sexuality).
    • Manages actual or potential musculoskeletal and integumentary complications (e.g., embolisms, bleeding/hemorrhage, infection, compartment syndrome, wound dehiscence).
    • Evaluates interventions for clients with musculoskeletal and integumentary care needs (e.g., recognizing subtle changes, adapting the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with musculoskeletal and integumentary care needs (e.g., the client’s readiness to learn, evaluating the 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 of and cares for clients with:
    • diabetes;
    • thyroid conditions;
    • adrenal gland conditions;
    • blood dyscrasia;
    • immunosuppression;
    • autoimmune disorders; and
    • cancers (e.g., leukemia, lymphoma).
    • Cares for clients with or undergoing:
    • thyroidectomy;
    • pancreatectomy;
    • anti-neoplastic agents;
    • bone marrow aspirate;
    • blood and blood product transfusion;
    • hormone therapy; and
    • immunosuppressant therapy.
    • Assesses the immunological, hematological and endocrinological systems using:
    • trending of vital signs;
    • physical assessments;
    • fluid balance;
    • weight gain/loss;
    • nutritional assessments;
    • neurological/vascular assessments; and
    • laboratory results.
    • Determines the appropriate nursing diagnosis for clients with immunological, hematological and endocrinological needs.
    • Plans appropriate interventions to manage and monitor hematological and endocrinological status by:
    • managing blood glucose levels;
    • administering blood and blood products;
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological strategies;
    • promoting optimal nutrition;
    • initiating precautions (e.g., isolation);
    • providing and promoting a safe client environment (e.g., fall risk prevention); and
    • addressing the client’s/family’s psychosocial needs (e.g., body image, sexuality).
    • Recognizes and manages actual or potential immunological, hematological and endocrinological complications (e.g., allergies, bleeding/hemorrhage, septic shock, infection).
    • Evaluates interventions for clients with immunological, hematological and endocrinological care needs (e.g., recognizing subtle changes, adapting the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with immunological, hematological and endocrinological care needs (e.g., the client’s readiness to learn, evaluating the client’s understanding, discharge planning, medication regimens, health promotion, community resources).
  • Infectious Diseases — Official range: 5–9% (Practice allocation: 7.07%)

    • Recognizes clinical presentation of and cares for clients with:
    • drug-resistant organisms;
    • non-communicable infections;
    • communicable infections;
    • severe respiratory infection;
    • systemic inflammatory response syndrome;
    • emerging infections; and
    • sexually transmitted infections.
    • Cares for clients with or undergoing:
    • diagnostic tests;
    • wounds; and
    • infection control precautions.
    • Assesses client risk factors related to infectious diseases (e.g., social determinants of health).
    • Determines the appropriate nursing diagnosis for clients with infectious disease care needs.
    • Plans appropriate interventions to manage and monitor clients with infectious disease by:
    • initiating and maintaining isolation precautions for the nurse and/or family;
    • notifying an Infection Prevention and Control Practitioner and/or a public health agency;
    • collecting specimens;
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological strategies;
    • providing a safe client environment (e.g., personal protective equipment (PPE), fall risk prevention);
    • managing the psychosocial implications of living with communicable disease; and
    • addressing the client’s/family’s psychosocial needs (e.g., precautionary measures).
    • 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 the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with infectious disease care needs (e.g., the client’s readiness to learn, evaluating the client’s understanding, discharge planning, medication regimens, health promotion, community resources).
  • Pain — Official range: 9–13% (Practice allocation: 11.11%)

    • Recognizes clinical presentation of and cares for clients with acute or chronic:
    • neuropathic pain (e.g., trigeminal pain, phantom limb);
    • visceral pain (e.g., referred pain);
    • somatic pain (e.g., sprains, lacerations); and
    • psychogenic pain (e.g., emotional distress).
    • Cares for clients with or undergoing:
    • patient-controlled analgesia (PCA);
    • nerve blocks;
    • epidurals; and
    • 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 by:
    • considering interactions between prescribed medications and substances; and
    • safely administering, monitoring and counselling regarding pharmacological therapies (e.g., opioid agonist therapies, anti-craving medication, relapse prevention medication, abstinence support).
    • Plans appropriate interventions to manage and monitor clients dealing with pain by:
    • implementing and reassessing pain management regimens (e.g., breakthrough, mode of delivery);
    • administering adjuvant therapies (e.g., tricyclic antidepressants, anticonvulsants, sedatives);
    • implementing non-pharmacological therapies (e.g., relaxation, deep breathing, massage);
    • managing and monitoring side effects (e.g., constipation, nausea);
    • delivering appropriate pain control interventions for clients who use substances; and
    • addressing the 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 the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients experiencing pain (e.g., the client’s readiness to learn, evaluating the client’s understanding, discharge planning, elimination, medication regimens, end- of-life care, health promotion, community resources).
  • Mental Health — Official range: 6–10% (Practice allocation: 8.08%)

    • Recognizes clinical presentation of and cares for clients with:
    • pre-existing mental health conditions;
    • delirium;
    • dementia;
    • depression; and
    • substance dependency (e.g., alcohol, nicotine, cannabis, illicit drugs, prescription drugs).
    • Assesses the mental health of clients using:
    • trending of vital signs;
    • screening tools;
    • medication history; and
    • 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:
    • utilizing behaviour management techniques;
    • promoting the client’s independence and capabilities;
    • providing a safe client environment (e.g., crisis intervention, environmental modifications, constant care, minimizing risk factors, least restraints);
    • administering and monitoring pharmacological agents;
    • implementing non-pharmacological agents to manage underlying cause of behaviours (e.g., therapeutic communication, complementary therapies, family involvement, visualization, relaxation techniques, support groups); and
    • addressing the client’s/family’s psychosocial needs.
    • Recognizes and manages actual or potential complications related to mental health (e.g., safety, withdrawal, seizures, suicide, violence/aggression).
    • Routinely screens all clients for substance use to identify problematic use and opportunities to provide intervention (e.g., harm reduction, education, treatment).
    • Evaluates interventions for clients with mental health care needs (e.g., age-related medication considerations, recognizing subtle changes, adapting the plan, communicating/documenting the plan).
    • Develops an individualized teaching plan for clients with mental health care needs (e.g., the client’s and/or family’s readiness to learn, evaluating the client’s understanding, discharge planning, medication regimens, health promotion, community support).
  • Professional, Legal and Ethical Competencies — 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.
    • 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 and collaborative manner and reports appropriately (e.g., violence, family conflict, abuse, aggression, neglect).
    • Recognizes ethical issues and seeks assistance in addressing them (e.g., refusal of blood products, patient’s right to refuse, withdrawal of treatment, culturally congruent care, advance health-care directives).
    • Respects the person’s values, beliefs and decisions related to MAiD even if they are different than the nurse’s own.
    • Understands that MAiD may have a personal impact affecting their practice and takes steps to seek support as needed.
    • Understands that symptoms have culture-specific meanings and that clients from diverse backgrounds will describe their symptoms differently, have different ideas of what might have caused them, have different acceptance, and have different ideas about what kind of treatment to seek.
    • Recognizes the value of Indigenous healing practices and uses them in treating Indigenous clients in collaboration with Indigenous healers and Elders when requested by Indigenous clients.
    • Participates in professional development.

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 knowledge examination for licensed/registered practical nurses caring for adults. Offered with remote online proctoring or in-person at select Canadian test centres. The blueprint specifies 60–75% independent and 25–40% case-based questions; this four-option practice bank does not claim to reproduce the official case-linked distribution.

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. This is answering time, separate from preparation and appointment check-in.

What is the passing score?

The numerical pass mark is not published. Each specialty committee sets a criterion-referenced standard using a modified Angoff method, supported by statistical analysis; results are reported as pass or unsuccessful.

How much does the exam cost?

CNA lists application fees of $588 for CNA members and $780 for non-members; the application fee includes a non-refundable $130 administrative fee. A separate writing appointment costs $85 online or $110 in person. Reduced rewrite application fees are $378/$500 (member/non-member) for an unsuccessful candidate's next two calendar years. Applicable taxes are additional. Dollar amounts are reproduced as listed on the Canadian CNA fee schedule; that page does not explicitly label an ISO currency code.

Official sources and references

Confirm current exam arrangements with the exam provider.