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CPNRE: Newborns and Infants

Maybe you have hopes of working in long term care. Or maybe you see yourself working in home care or palliative care.  Maybe you don’t really like kids. Unfortunately the CPNRE doesn’t care.  Whether you like it or not, the CPNRE tests your understanding of the basic principles of caring for people of all ages….

Maybe you have hopes of working in long term care. Or maybe you see yourself working in home care or palliative care.  Maybe you don’t really like kids.

Unfortunately the CPNRE doesn’t care. 

Whether you like it or not, the CPNRE tests your understanding of the basic principles of caring for people of all ages. At least 15% of the questions involve people under 18.

It’s better to see the CPNRE the way it is rather than seeing it the way you want it to be. Especially if newborns and infants aren’t your thing.

If you give yourself enough time and attention to know the important things about different ages, and you’re willing to stick with studying when it gets hard (and it will), you’ll have a better chance of passing.

Here are the most common newborn and infant scenarios you should prepare for:

  • Newborn jaundice
    • You should understand how jaundice may be prevented, the signs and symptoms of jaundice and initial nursing management once jaundice is identified (usually this means notifying a physician or nurse practitioner).
  • APGAR scores
    • Be able to determine an APGAR score based on newborn assessment findings and know what APGAR stands for.
  • Breastfeeding 
    • You should be able to identify the signs that breastfeeding is going well – or not and the basics of helping mothers who want to breastfeed.
  • Vital signs 
    • Know the normal vital sign parameters in newborns and infants under 12 months.
    • Be able to identify abnormal vital signs and initial nursing management. For example, you should know what to do when a newborn’s temperature is higher or lower than normal.
  • Major developmental milestones 
    • You should be able to recognize the age at which significant milestones usually occur and identify when to report developmental concerns for infants from birth to 1 year of age.
  • Nutrition and hydration 
    • Identify signs and symptoms of fluid volume deficit or overload in newborns and infants.
    • Know the basics of introducing solid foods to infants. For example, what age to introduce solids and what signs suggest an infant is ready to start eating solids.
  • Assessment considerations  
    • Many infants develop a fear of strangers in the first year of life. Many will resist physical exams and interventions. So you should be able to identify how to assess and care for infants in ways that are the least upsetting. For example, when it’s appropriate, infants should be assessed while sitting on their caregivers lap as opposed to laying on an exam table by themselves.

More to come

We’re working on some more CPNRE question scenarios and strategies for answering questions … so stay tuned.

If you want to get free CPNRE resources, studying tips and strategies sent straight to your inbox, you can subscribe to the NursEd blog here:

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Studying Tips for the CPNRE

You may or may not realize it, but the CPNRE actually tests very little. It’s only 160 to 170 questions long. How can it test much of anything?  The truth is, it doesn’t. Other nursing registration exams are the same. The challenge is figuring out what you need to know – and what you don’t need…

You may or may not realize it, but the CPNRE actually tests very little. It’s only 160 to 170 questions long.

How can it test much of anything? 

The truth is, it doesn’t. Other nursing registration exams are the same. The challenge is figuring out what you need to know – and what you don’t need to know.

When getting ready for my own registration exams in the past, I reviewed everything.
Course notes, PowerPoint slides, articles, textbooks, exam prep guides. You name it, I read it.

But the more I read, the less I seemed to know. I put so much time and effort into trying to learn everything, that I really didn’t learn much.

There was just so little guidance to help me figure out what I needed to be successful.

Even though I passed both registration exams the first time I wrote them, I’ll never forget the stress of getting ready for exams that were so difficult to prepare for.

I’m bringing this up today because I want to pay it forward. To share tips to help you more easily prepare for the CPNRE and do the best you can.

Start with a plan

1. Attention is priceless

There’s only so much information we can absorb at once.  The more information there is to learn, the more time we need.

Reading too much information – especially new information, is like reading nothing at all.

It’s far easier to learn information over time, drip by drip, than it is to cram it all into a day or two or even a couple of weeks.

Get clear on the amount of time you need to get ready for the CPNRE. For most people, this is usually 4-6 weeks.

This doesn’t mean you need to study every day for weeks on end, but giving yourself this much time will allow you to properly understand the information you need to know.

 

2. Create a flexible schedule

It’s an exciting time: you’re on your way to calling yourself a practical nurse and starting a wicked job. It’s fun to think about what’s ahead, but it’s also a busy time. Life doesn’t stop just because you’re preparing for an exam.

One of the most important things to do before writing the CPNRE is to keep focused on what you need to do in the short term so you can reach your goals of becoming a practical nurse.

You don’t have to forget about life during exam prep. You just have to prioritize and manage your time properly.

Figure out what’s important to you and decide on the parts of life that you’re not willing to sacrifice as you get ready for the CPNRE. This might mean writing out a daily or weekly schedule of the things you have to do or want to do.

You could spend 75% of your free time prepping for the CPNRE and 25% of your free time doing other things in life.

 

3. Start with the worst part 

We all put things off for a day and the next thing we know they don’t get done. So why not start preparing by reviewing what tends to be put off the most?

The most ignored topics tend to be the toughest questions on the CPNRE.

Topics like:

  • Documentation
  • Communication
  • Therapeutic relationships
  • Boundaries
  • Consent
  • Privacy and confidentiality
  • Culture
  • Restraints
  • Ethics
  • Conflict management
  • Medication administration

Learning how to answer questions about these topics won’t get any easier by avoiding them. If you start with them, you’ll be ahead of the game and well on your way to passing.

 

4. Knowledge before practice 

To pass the CPNRE you need to do two things:

  1. Know the relevant nursing principles
  2. Be able to apply this knowledge when answering multiple-choice questions

A lot of people skip the first part and jump to practicing multiple choice questions. But these people usually end up guessing their way through practice tests.

To these people, more than one answer option often looks right. Simply because they don’t know the nursing principles behind the questions.

I know this, because that’s how I studied for my own registration exams.

Few if any practice questions end up on the actual CPNRE. The underlying nursing principles will be the same. But the questions will be different.

Better be able to know the nursing principles first if you want to have a shot at getting questions right without guessing.

 

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Knowledge vs. Skills

Who else preparing for the CPNRE is wondering what’s the difference between knowledge and skills? No doubt you’ve heard that practical nurses must have knowledge, skill and judgment to provide safe and effective care. You believe this is true. But what does this even mean?   What you know vs. what you can do Knowledge…

Who else preparing for the CPNRE is wondering what’s the difference between knowledge and skills?

No doubt you’ve heard that practical nurses must have knowledge, skill and judgment to provide safe and effective care. You believe this is true.

But what does this even mean?

 

What you know vs. what you can do

Knowledge is simply knowing facts or information. Like knowing the normal adult heart rate or side effects of narcotics. Or how much fluid can be safely injected into the deltoid muscle.

Whereas skills are the ability to do something. Like being able to correctly administer eye drops or calm a delirious person. Or make someone feel important.

Sometimes it’s hard for us to understand when something is knowledge and when something is a skill. A way to figure this out is to ask yourself: can someone be good at this without practice? 

If the answer is no, then it’s a skill.

Professional athletes and Hollywood actors are skilled at what they do because of practice. No one gets a hole in one just because they know the rules of golf. No one gets a Grammy Award because they know song lyrics.

To be good at any skill, we need practice.

Take a look at the chart below. Can you tell which ones are skills? For each one, ask yourself: can I be good at this without practice?

Skill

Yes No
Obtaining consent   ✓
Communicating with an agitated person  ✓
Establishing boundaries
 Helping someone quit smoking
Advocating for others
Understanding people’s reactions and needs

Working with people who are different from you

Identifying and responding to inappropriate behaviours
Preventing and resolving conflict
Seeing problems that other people don’t
Managing your time
Prioritizing multiple problems
Teaching other people how to do things

They’re all skills. Every single one. It can take months and years to be good at them.

The thing is, these are the skills that actually improve and maintain people’s health. Regardless of where you practice nursing, these are the skills you need to develop. That’s why they’re tested on the CPNRE.

Being able to irrigate nasogastric tubes or change dressings are important no doubt. But it’s these other skills that will determine how well you can truly help people.

 

You won’t find them in a textbook

You may not have the necessary skills just yet, and that’s ok. You can’t be expected to have these skills if you haven’t had the chance to practice them.

Your job is to understand what these skills look like, and be able to recognize what these skills look like in a multiple-choice test question on the CPNRE.

Understanding what questions are really testing can mean the difference between passing and failing this exam.

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Best Learning Experience

What was the best learning experience you had in nursing school? Can you think of one? Usually, most people think of awesome instructor they had. Or the time they worked with a partner or small group of people. Few people, if any say ‘there was an amazing textbook or PowerPoint’. It just doesn’t happen. How we…

What was the best learning experience you had in nursing school? Can you think of one?

Usually, most people think of awesome instructor they had. Or the time they worked with a partner or small group of people.

Few people, if any say ‘there was an amazing textbook or PowerPoint’. It just doesn’t happen.

How we learn information is just as important as the information itself.

 

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The Problem with Nursing Education

Most of the work you do in nursing school is done on your own. Things like reading and writing papers, assignments, quizzes and tests. And most of the time this work involves learning and testing your understanding of basic nursing knowledge and skills. Things that can be easily taught, measured and graded. Things like knowing…

Most of the work you do in nursing school is done on your own. Things like reading and writing papers, assignments, quizzes and tests.

And most of the time this work involves learning and testing your understanding of basic nursing knowledge and skills. Things that can be easily taught, measured and graded. Things like knowing medication side effects or symptoms of disease. Or skills like how to give needles, how to measure blood pressure, or how to calculate IV flow rates.

The main reason we do the majority of school work on our own is because it’s simpler to grade us this way.

Which is a problem because almost nothing in nursing is done by ourselves.

 Nursing is the business of relationships and interactions

We’re taught to believe that nursing is mostly about assessments and physical exams, pharmacology and diseases.

We get really good at giving needles and calculating doses, measuring pulses and changing IV bags because that’s what we’re taught. These skills are easier to learn and master than skills like:

  • Empathizing with others
  • Problem solving
  • Prioritizing
  • Critical thinking
  • Advocating and leading
  • Collaborating with others
  • Communicating effectively

These kind of skills are tough to measure, hard to learn and are usually poorly taught. We get these skills with practice and experience.

They’re called soft skills, but they’re anything but soft.

What you need to know

Pharmacology, IV therapy, physical assessments and procedures account for less than 30% of the competencies tested on the CPNRE.

 And more than 70% of the competencies tested on CPNRE are based on your understanding of soft skills

The people who create the CPNRE obviously realize the importance of soft skills in nursing.

Once you understand that the CPNRE is mostly about the soft skills, it should be obvious what you need to know for this exam: nursing practice standards.

To be successful on the CPNRE you need to know the hard-to-learn attitudes of nursing. They aren’t common sense. We aren’t born with them. Just like we aren’t born knowing how to hear murmurs or flush nasogastric tubes. Soft skills are at the heart of what we do as nurses.

Having basic nursing skills most certainly isn’t enough to pass.

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