Canadian Nurse Practitioner Exam Program
Canadian Nurse Practitioner Examination: Family/All Ages
Each provincial and territorial nursing regulatory authority is responsible for ensuring that registered nurses who apply for registration as nurse practitioners within their jurisdiction meet an acceptable level of competence before they begin to practise.
The level of competence of nurse practitioners working in a family/all ages environment is measured, in part, by the Canadian Nurse Practitioner Examination: Family/All Ages (CNPE:F/AA). The CNPE:F/AA is administered by provincial and territorial nursing regulatory authorities who purchase this exam from the Canadian Nurses Association (CNA). CNA owns the exam, and Assessment Strategies Inc. (ASI), a subsidiary of CNA, develops it by collaborating with and seeking input from the regulatory authorities and nurse practitioners from across Canada. Nurse practitioners are the content experts in developing and validating the exam on behalf of the regulatory authorities.
The purpose of the CNPE:F/AA is to protect the public by ensuring that the entry-level nurse practitioner working in a family/all ages context possesses the competencies required to practise safely and effectively.
PREP GUIDE UPDATE (Please see below.)
When is the exam offered?
CNA offers the CNPE:F/AA twice a year.
The exam administration dates for 2009 are:
- May 13, 2009
- October 21, 2009
The exam administration dates for 2010 are:
- May 12, 2010
- October 20, 2010
Authority to take the CNPE:F/AA and become registered as a nurse practitioner is given by your nursing regulatory authority. Please note that the exam may not be offered in your province or territory on both of the dates indicated. Deadlines for applying to take the exam are usually well in advance of the exam date.
What is the examination length and format?
The CNPE:F/AA consists of approximately 200 to 220 multiple-choice and short-answer questions. The exam is offered over a 7-hour period on one day during two 3.5-hour sessions.
How are the questions presented?
The multiple-choice questions are presented as either case-based or independent questions. The short-answer questions are presented as case-based questions only.
Case-based questions – some of which are multiple choice and others short answer – include a set of approximately two to five questions associated with a brief health-care scenario. Independent questions – all of which are multiple choice – contain all of the information necessary to answer the question.
What is tested on the CNPE:F/AA?
There are 78 competencies that make up the content domain for the exam. Each question on the CNPE:F/AA is linked to one of these competencies (see Appendix D of the CNPE Blueprint).
How is the CNPE scored?
Your results on the multiple-choice questions and the short-answer questions are combined for a total score on the exam. A pass or fail result is determined by comparing your score to the established examination standard (pass mark). If your score is higher than or equal to the standard, you will be assigned a pass result; if your score is lower than the standard, you will be assigned a fail result.
The standard (or pass mark) required to pass the CNPE is set in reference to the content and level of difficulty of the questions that appear in that particular version of the CNPE. The standard-setting procedure used for CNPE involves a panel of subject matter experts (the CNPE Examination Committee) representing every jurisdiction that uses the CNPE. This panel rates the CNPE questions on the basis of the expected performance of entry-level nurse practitioners.
The standard is expressed in percentage points for ease of referencing. In the past, this standard has ranged from about 64 per cent to 70 per cent, depending on the difficulty of the particular version of the CNPE. To ensure fairness, the different versions of the CNPE are statistically equated such that all candidates from year to year are measured against a comparable standard.
What is the competency framework?
A framework or classification system has been developed to identify and organize the 78 competencies that the CNPE:F/AA assesses. The resulting framework reflects a primary health care nurse practitioner model. There are four categories in the framework, and each category is exemplified by its individual competencies.
- Health assessment and diagnosis: 23 competencies
- Health-care management and therapeutic intervention: 29 competencies
- Health promotion and prevention of illness, injury and complications: 10 competencies
- Professional role and responsibility: 16 competencies
See Appendix D below for the full list of competencies.
How do I apply to write the exam?
Authority to take the CNPE:F/AA and become registered as a nurse practitioner is given by your nursing regulatory authority. Deadlines for applying to take the exam are usually well in advance of the exam date.
The provincial and territorial nursing regulatory authorities administer the exam and determine who is eligible to write it. Contact your licensing body for application information.
Is there a prep guide for the CNPE?
CNA offers one official learning tool to assist candidates studying for the exam, the Canadian Nurse Practitioner Exam (CNPE) Prep Guide.
The CNPE Prep Guide is a study guide in print format. Available in either English or French, the guide offers close to 71 multiple-choice questions and 27 short-answer questions.
The guide also provides:
- answers and explanations to help you learn
- a performance profile to identify your strengths and weaknesses
- valuable test-taking strategies and study tips
PREP GUIDE UPDATE:
Here is an update to two questions and references to the CNPE:F/AA Prep Guide, which reflect current best practices.
Sample multiple choice questions:
#31 According to the most current evidence on osteoporosis, Depo-Provera may not be the best option. The intrauterine device (IUD) is the best option in this scenario.
Sample short answer questions:
#27 According to the Prep Guide, the correct answer is a thiazide medication; however, according to the new Hypertension Guidelines 2007 and Therapeutics Choices 2007, in uncomplicated hypertension a thiazide diuretic, a beta blocker (for patients < 60 years), an angiotensin-converting enzyme inhibitor (ACE inhibitor), an angiotensin receptor blocker (ARB) or a long-acting calcium channel blocker (CCB) can be used as a first-line therapeutic agent.
References:
In addition to the references you may have used in your education program, it is recommended that you use the most current guidelines in preparation for the CNPE:F/AA, including the following:
Canadian Hypertension Guidelines
Canadian Diabetes Association Guidelines
Dyslipidemia Guidelines
Canadian Immunization Guidelines
Canadian Sexually Transmitted Infection (STI) Guidelines
Clinical Practice Guidelines of the Society of Gynaecologists of Canada
Chronic Obstructive Pulmonary Disease (COPD) Guidelines
Asthma Guidelines
Purchase the CNPE Prep Guide from CNA at http://bookstore.cna-aiic.ca or by calling 1-800-385-5881. The price is $69.95 plus taxes and shipping and handling.
Also available for purchase is the CNPE Blueprint for $27.95.
How long will it take to get my results?
Your pass or fail result on the exam will be sent to your provincial or territorial regulatory authority within 4 to 8 weeks of the exam administration. The regulatory authority will then mail your result to you; how long it takes for you to receive your result from the regulatory authority varies, depending on the jurisdiction.
The CNPE Core Competencies with CNPE: Family/All Ages Grouping
(from Blueprint for the Canadian Nurse Practitioner Examination: Family/All Ages [April 2005], available from CNA at http://bookstore.cna-aiic.ca)
1. Health Assessment and Diagnosis
The nurse practitioner demonstrates competence in health assessment and diagnosis by performing the following behaviours.
The nurse practitioner:
1.1 performs an advanced, comprehensive and focused health assessment that
includes a health history andcomplete physical evaluation; considers the
psychosocial, emotional, ethnic, cultural and spiritual dimensions of health; and
involves understanding with clients the meaning of their health/illness
experiences and how their daily living is affected.1.2 uses and adapts assessment tools and techniques based on the client’s unique
needs.1.3 synthesizes health assessment information and uses critical thinking and clinical
reasoning skills to:
1.3.1 identify health concerns and risks;
1.3.2 identify normal and abnormal states of health; and
1.3.3 formulate differential diagnoses.
1.4 in the process of making a diagnosis within the nurse practitioner scope of
practice, combines client assessment findings with scientific and clinical
knowledge, considering such factors as:
1.4.1 developmental stages:
1.4.2 behavioural sciences;
1.4.3 health/illness experiences;
1.4.4 pathophysiology and psychopathology;
1.4.5 epidemiology and infectious diseases;
1.4.6 multiple etiologies; and
1.4.7 clinical manifestations of acute illness/injuries, chronic diseases,
emergency health needs and normal health events.
1.5 orders appropriate screening and diagnostic investigations (e.g., laboratory tests,
X-rays, ultrasound) and interprets reports of these investigations based on sound
clinical reasoning, scientific evidence and critical thinking.1.6 diagnoses diseases, disorders and conditions, while taking the client’s
responses to the illness experience into consideration.1.7 communicates with clients about health findings and/or diagnoses and
discusses health outcomes and prognoses.1.8 collaborates with clients to identify and choose treatment or care options.
1.9 supports and counsels clients regarding their personal responses to diseases,
disorders or conditions, while creating an environment in which effective learning
can take place.1.10 synthesizes client information with scientific information to identity broader
implications for health within the family and community.1.11 uses family assessment tools to evaluate family strengths and needs.
1.12 applies theories of family dynamics, interactions and role expectations when
managing family health.1.13 documents health assessments, clinical data, findings, diagnosis,
collaborations, communications and conclusions in a timely, accurate and
relevant manner.1.14 initiates timely, effective consultation, collaboration and/or referral to physicians,
other health-care professionals and social service providers, as appropriate, to
assess and diagnose client health/illness status.1.15 anticipates and recognizes rapidly changing urgent and emergent situations.
2. Health-Care Management and Therapeutic Intervention
The nurse practitioner demonstrates competence in health-care management and therapeutic intervention by performing the following behaviours.
The nurse practitioner:
2.1 collaborates with clients and, where applicable, their families and other members
of the health-care team to share decision-making and set priorities for the
management of diseases, disorders or conditions.2.2 intervenes appropriately by:
2.2.1 using relevant knowledge about the humanities, behaviour sciences and
lived human experiences to help clients adopt health practices that will
achieve their desired state of wellness;2.2.2 negotiating with clients a plan of care that integrates their goals with
scientific rationale and evidence-based guidelines and helping clients
incorporate the plan into their daily lives;2.2.3 determining treatments and prescribing them, in writing, based on theory
and evidence-based practice for the specific client population while
considering active participation of clients, best outcomes and
cost-effectiveness;2.2.4 advocating with or on behalf of clients to ensure their health needs are
met;2.2.5 helping clients throughout the teaching/learning process to plan, follow
and evaluate therapeutic regimes, including negotiating ongoing contact
to assist clients to monitor and evaluate their plan of care and
health/illness status;2.2.6 continually monitoring, with clients, the effect of the chosen treatment
plan – which may include a range of complementary and alternative
interventions – and making adjustments as indicated;2.2.7 using sound clinical reasoning skills and established outcome criteria to
evaluate the initial and ongoing outcomes of the plan of care, including
consultation/referral; and2.2.8 documenting the plan of care, including consultation/referral, the client’s
health status, and the outcomes of the plan of care, in a timely, accurate
and relevant manner.
2.3 applies knowledge of pharmacology in selecting, prescribing, monitoring and
dispensing drugs1 and performs these competencies as appropriate for the
nurse practitioner’s scope of practice, level of competency and clinical practice
setting:
2.3.1 selects drug thereapy based on knowledge of pharmacology – including
pharmacokinetics, pharmacodynamics and evidence-based practice –
as well as drug interactions and client health history, disease, disorder
or condition;2.3.2 uses health teaching principles when prescribing, educating and
supporting clients in recommended drug use;2.3.3 prescribes drug therapies while considering the active participation of
clients, best outcomes and cost-effectiveness;2.3.4 consults, collaborating with and /or referring to physicians and
pharmacists as appropriate;2.3.5 is aware of and considers the power dynamics and marketing strategies
of the pharmaceutical industry when prescribing drugs;2.3.6 writes prescriptions and dispenses drugs2 that meet provincial,
territorial, and federal standards and legislative requirements, including
responsibilities relevant to prescription and management of controlled
substances;2.3.7 monitors and discusses with clients their response and adherence to
drug therapy and makes changes needed to achieve desired effects; and2.3.8 identifies when misuse/abuse of drugs by clients occurs and takes
steps to prevent further misuse.
2.4 uses federal, provincial and territorial information systems for the purpose of
documentation or acquiring information.2.5 manages the treatment of clients diagnosed by the nurse practitioner within the
scope of practice as determined by provincial and territorial regulatory standards.2.6 manages the treatment of clients with diseases, illnesses, health conditions and
injuries previously diagnoses by a physician and makes adjustments as
indicated within the nurse practitioner scope of practice.2.7 evaluates and revised the plan of care, based on established client goals,
preferences, health status and outcomes.2.8 carries out counseling and advanced therapeutic interventions, such as minor
surgical and invasive procedures, essential for the clinical management of
diseases, injuries, disorders and conditions in accordance with federal, provincial
and territorial regulations.2.9 initiates interventions for the propose of stabilizing clients in urgent or emergent
situations.2.10 initiates timely and appropriate consultation, referral and collaboration with other
health-care providers.2.11 coordinates and facilitates client care by liaising with other health-care providers,
agencies and community resources.2.12 develops, uses and evaluates or participates in the evaluation of follow-up
systems to ensure clients receive coordinated health services, to demonstrate
client outcomes, to contribute to nursing knowledge and to achieve effective
service utilization.2.13 applies theoretical principles when promoting behaviour change.
2.14 consults and/or collaborates with members of the health-care team about
variations in health outcomes at the individual and systems level to develop
quality improvement and risk-management strategies.2.15 promotes self-determination for clients by helping them navigate the health-care
system to select and obtain the necessary resources.
3. Health Promotion and Prevention of Illness, Injury and Complication
The nurse practitioner demonstrates competence in health promotion and prevention of illness, injury and complications by performing the following behaviours.
The nurse practitioner:
3.1 appropriately and intentionally includes health promotion, illness prevention and
capacity building in client relationships and responses to health needs.3.2 collaborates with clients to identify and assess trends or patterns that have health
implications for individuals, families, groups or communities.3.3 works with other health-care providers to gather and synthesize qualitative and
quantitative information determinants of health from a variety of sources.3.4 participates with other health-care providers and other sectors to plan and develop
health promotion/illness prevention programs based on client needs, cultural
considerations, evidence-based approaches and available resources (including
such programs as screening for populations at risk and population based
harm-reduction strategies.3.5 participates in the implementation, monitoring and evaluation of health promotion
and illness/injury prevention programs in partnership with other health-care
providers, communities and social and public services sectors.3.6 collaborates with other health-care providers and other sectors to use knowledge
of determinants of health and principles of community development to help
groups or entire communities obtain the services they need to meet their
health-care goals.3.7 creates or advocates for an environment that facilitates clients’ learning and
maximizes their participation and control in meeting their own health needs,
including those clients living with chronic disease or in unhealthy environments.3.8 recognizes determinants of health affecting clients and supports health protection
interventions that promote healthy environments.3.9 recognizes that culture influences health/illness experiences and client use of
health-care services and adapts practice to meet the needs of an ethnically and
culturally diverse population.3.10 selects and modifies teaching strategies based on principles of education to
facilitate client-centred learning.
4. Professional Role and Responsibility
The nurse practitioner demonstrates competence in her or his professional role and responsibility by performing the following behaviours.
The nurse practitioner:
4.1 explains and promotes the role of the nurse practitioner to clients, the public,
legislators, policy-makers and other health-care professionals.4.2 understands the changes in scope of practice from that of a registered nurse and
accepts the increased responsibilities and accountability of the nurse practitioner
role, including practicing in accordance with legislative acts, regulations and
bylaws relevant to the nurse practitioner’s area of practice and client population
served, as demonstrated in the following ways:
4.2.1 by defining the specific areas of practice and the client population and
providing health-care services within the nurse practitioner scope of
practice;4.2.2 by understanding and incorporating into practice the additional
professional and legal standards and ethically decision-making involved
in caring for clients; and4.2.3 by formally requesting consultation and referring clients to physicians or
other members of the health-care team at any point in the care process
when the client’s condition is assessed as beyond the nurse practitioner
scope of practice or the individual nurse practitioner’s competence.
4.3 demonstrates an understanding of resource allocation and cost-effectiveness in
making decisions related to diagnostics, therapeutic interventions and
pharmacotherapy.4.4 understands and incorporates the additional professional legal standards and
ethical decision-making involved in the diagnosis and treatment of acute and
chronic illnesses, including prescribing medication.4.5 identifies and/or develops research questions and contributes to research
relevant to practice.4.6 critically evaluates and applies relevant research to practice.
4.7 integrates theoretical and research-based approaches to design care and
implements changes.4.8 acts as a resource person, educator, role model, advocate and/or mentor for
students, health-care professionals and the community.4.9 provides consultation to other nurse practitioners and health-care professionals.
4.10 demonstrates effective interpersonal communication, negotiation and
conflict-resolution skills in collaborative and inter/intradisciplinary practice.4.11 provides leadership to promote the analysis of key issues and participates in a
broad range of policy-making activities to influence practices, health services and
healthy public policy.4.12 demonstrates leadership to ensure the provision of education that is theoretical
and evidence-based and designed for a specific audience/client using multiple
strategies.4.13 influences the development and implementation of standards, practice,
guidelines, education and research initiatives related to the nurse practitioner’s
clinical specialty and nursing in general.4.14 provides leadership to define and create an organizational culture the supports
professional growth, continuous learning and collaborative practice.
1. At this time, the performance of competencies (or components of competencies) related to
dispensing are not expected for registration purposes by the College of Nurses of Ontario and
the Association of Registered Nurses of Newfoundland and Labrador.
