# Canadian Nursing (NCLEX-RN Canada & REx-PN): Entry-to-Practice Competencies, Pharmacology, Maternal-Newborn & Mental Health

> Essential Canadian nursing entry-to-practice competencies (CNO / BCCNM / CARNA), Next Generation NCLEX clinical judgment, isolation precautions, fluid/electrolytes, maternal-newborn care, and psychiatric nursing.

- **Canonical URL:** https://flashcards.world/flashcards/sets/8da47336-bd0d-436f-add3-48dcf8335b32/
- **Markdown URL:** https://flashcards.world/flashcards/sets/8da47336-bd0d-436f-add3-48dcf8335b32.md
- **Level:** intermediate
- **Languages:** en → en
- **Total Cards:** 32

## Flashcards (32 Cards)

| # | Front (Term / Prompt) | Back (Definition / Answer) | Example | Multiple-Choice Options |
| :--- | :--- | :--- | :--- | :--- |
| 1 | Compare the therapeutic monitoring and antidotes for Unfractionated Heparin vs. Low-Molecular-Weight Heparin (Enoxaparin/Dalteparin) vs. Warfarin. | Unfractionated Heparin: monitor aPTT (target 1.5–2.5× control) and platelets (watch for Heparin-Induced Thrombocytopenia on days 5–10); antidote is Protamine Sulfate. LMWH: no routine coagulation monitoring (check anti-Factor Xa in renal impairment/pregnancy/obesity); partially reversed by Protamine. Warfarin: monitor INR (target 2.0–3.0, or 2.5–3.5 for mechanical mitral valves); antidote is Vitamin K (and PCC for major bleeding). |  |  |
| 2 | What are the classic clinical features and immediate nursing actions for Autonomic Dysreflexia in a client with a Spinal Cord Injury at or above T6? | Triggered by a noxious stimulus below the lesion (most commonly a distended bladder/kinked Foley catheter or fecal impaction), causing sudden life-threatening hypertension, pounding headache, bradycardia, flushing/diaphoresis above the lesion, and pallor/pilomotion below. Action: 1) Sit the client UPRIGHT (high Fowler's) immediately to induce orthostatic BP drop, 2) Check and unkink/catheterize the bladder or disimpact bowel with anaesthetic jelly, 3) Loosen tight clothing, 4) Administer rapid-acting antihypertensive if BP remains critical. |  |  |
| 3 | In Postpartum Nursing assessment ('BUBBLE-HE'), what does a boggy uterine fundus displaced to the right of the umbilicus indicate, and what is the nursing action? | A distended urinary bladder preventing uterine contraction (risking postpartum haemorrhage); assist the client to void immediately (or perform straight catheterization) and then gently massage the uterine fundus while supporting the lower uterine segment. |  |  |
| 4 | What is the immediate emergency nursing intervention for Umbilical Cord Prolapse? | Call for emergency help/stat Caesarean section, insert two sterile gloved fingers into the vagina to manually elevate the fetal presenting part OFF the prolapsed cord (do NOT attempt to push the cord back inside), and place the mother in knee-chest or steep Trendelenburg position. |  |  |
| 5 | In Triage Prioritization on the NCLEX-RN Canada, which client should the nurse assess FIRST using the ABC + Acute vs. Chronic framework? | Always prioritize unstable clients with acute Airway, Breathing, or Circulation threats (e.g., new stridor, restlessness/hypoxia, chest pain, sudden neurological change, post-thyroidectomy neck swelling) over stable clients with expected chronic disease findings (e.g., COPD client with SpO2 90% at baseline). |  |  |
| 6 | Under Canadian Health Information Privacy Laws (e.g., PHIPA in Ontario, HIA in Alberta), what constitutes a privacy breach ('snooping') by a nurse? | Accessing any electronic or paper chart of a patient Who is NOT within the nurse's current circle of care (even a family member, celebrity, colleague, or self) without explicit authorization is an illegal privacy breach that triggers mandatory reporting to the patient, employer, Privacy Commissioner, and regulatory College. |  |  |
| 7 | Why do all newborns in Canada receive an intramuscular Vitamin K1 (Phytonadione) injection and Erythromycin eye ointment shortly after birth? | IM Vitamin K (0.5–1.0 mg in vastus lateralis within 6 hours of birth) prevents Vitamin K Deficiency Bleeding (haemorrhagic disease of the newborn) because the newborn gut is sterile and lacks bacterial Vitamin K synthesis. Erythromycin ointment prevents Ophthalmia Neonatorum (Neisseria gonorrhoeae). |  |  |
| 8 | When mixing Regular (short-acting, clear) and NPH (intermediate-acting, cloudy) insulin in one syringe, what is the exact nursing sequence? | 'Cloudy air, Clear air, Draw Clear, Draw Cloudy' ('RN': Regular before NPH)—inject air into NPH vial, inject air into Regular vial, draw up clear Regular insulin first, then draw up cloudy NPH insulin so the rapid/short vial is never contaminated with NPH. |  |  |
| 9 | In Blood Transfusion administration, what are the mandatory nursing steps and how is an Acute Haemolytic vs. Febrile Non-Haemolytic Transfusion Reaction managed? | Prime Y-tubing ONLY with 0.9% Normal Saline, verify blood with a second nurse at the bedside, start slowly for the first 15 minutes while remaining with the client, and complete each unit within 4 hours. If ANY reaction occurs (fever, chills, low back/flank pain, hypotension, haemoglobinuria): STOP the transfusion immediately, keep the IV line open with fresh 0.9% NaCl tubing from the hub, notify the physician/blood bank, and send the blood bag/tubing and client urine/blood samples to the lab. |  |  |
| 10 | In Maternal-Newborn Nursing, how is the Estimated Date of Birth (EDB / EDD) calculated using Naegele's Rule? | Take the first day of the Last Menstrual Period (LMP), subtract 3 calendar months, add 7 days, and adjust the year (assuming a regular 28-day cycle). |  |  |
| 11 | What should the nurse do immediately if a client's Chest Tube accidentally disconnects from the drainage system vs. gets pulled completely out of the chest wall? | Disconnected from drainage unit: Submerge the distal end of the chest tube in 2 cm of sterile water to create a temporary water seal while a new sterile system is set up (never clamp for prolonged periods due to tension pneumothorax risk). Pulled out of the chest wall: Immediately cover the insertion site with a sterile occlusive petroleum gauze dressing taped on THREE sides ONLY (vented dressing allows air to escape on exhalation while preventing air entry on inhalation). |  |  |
| 12 | In Paediatric Nursing, what is the immediate positioning and management for a child with Tetralogy of Fallot experiencing a Hypercyanotic 'Tet Spell'? | Place the infant/child immediately in the Knee-Chest position (or squatting position), which increases systemic vascular resistance (SVR) and decreases right-to-left shunting across the VSD, then administer 100% oxygen, morphine sulfate, and IV fluid bolus. |  |  |
| 13 | What is the correct sequence for Donning (putting on) and Doffing (removing) Personal Protective Equipment (PPE) per PHAC / IPAC Canada? | Donning (bottom-to-top/clean): 1) Hand hygiene, 2) Gown, 3) Mask/N95 respirator, 4) Eye protection (goggles/face shield), 5) Gloves. Doffing (most contaminated to least contaminated): 1) Gloves, 2) Gown, 3) Hand hygiene, 4) Eye protection, 5) Mask/N95 respirator, 6) Hand hygiene. |  |  |
| 14 | Under Canadian nursing regulatory standards (e.g., CNO / BCCNM), what are the 'Three Factor Framework' elements used to decide whether an activity should be assigned or delegated to an RPN/LPN vs. RN vs. Unregulated Care Provider (UCP)? | 1) Client factors (complexity, predictability, and risk of negative outcomes), 2) Nurse factors (competence, knowledge, skill, and scope of practice), and 3) Environmental factors (practice supports, resources, consultation availability). |  |  |
| 15 | In Orthopaedic Nursing, what are the '6 Ps' of Acute Compartment Syndrome, and how should the limb be positioned? | Pain out of proportion to injury worsened by passive stretch (EARLIEST and most reliable sign), Paresthesia (early), Pallor, Paralysis, Poikilothermia, and Pulselessness (very late sign). Keep the extremity at HEART LEVEL (do NOT elevate above heart level or apply ice, as both further reduce arterial perfusion), loosen/bivalve any constricting cast, and prepare for emergency fasciotomy. |  |  |
| 16 | In Psychiatric Nursing, how should a nurse care for a client in an Acute Manic Episode vs. Severe Major Depression with Suicidal Ideation? | Acute Mania: Provide a low-stimulus environment, set firm consistent limits, offer high-calorie 'finger foods' and fluids that the client can eat while moving, and avoid competitive group games. Suicidal Ideation: Ask directly about suicide plan/means/intent, initiate 1-to-1 constant observation, remove sharps/ligatures, and stay vigilant as energy improves early in antidepressant therapy. |  |  |
| 17 | In Fetal Heart Rate (FHR) monitoring, use the 'VEAL CHOP' mnemonic to match each FHR pattern to its physiological cause and nursing intervention. | Variable decelerations = Cord compression (reposition mother side-to-side or knee-chest, stop oxytocin, amnioinfusion). Early decelerations = Head compression (benign during active labour, continue monitoring). Accelerations = Okay (well-oxygenated fetus). Late decelerations = Placental insufficiency (URGENT: turn mother to left lateral position, STOP oxytocin infusion, give IV fluid bolus, administer high-flow O2 if indicated, notify obstetric provider). |  |  |
| 18 | In Psychiatric Nursing, what is the nurse's priority response when a client with Schizophrenia is experiencing Command Auditory Hallucinations? | Assess the content of the hallucinations directly ('What are the voices telling you to do?') to evaluate immediate safety risk to self or others, acknowledge that the voices are real to the client without validating their objective reality ('I don't hear the voices, but I understand they are frightening to you'), and engage the client in reality-based activities. |  |  |
| 19 | What are the two major complications of Central Venous Catheters (CVCs) / Total Parenteral Nutrition (TPN) lines, and what is the immediate nursing action for suspected Air Embolism? | Air Embolism (sudden dyspnea, chest pain, tachycardia, hypotension, 'mill-wheel' murmur): immediately clamp the catheter, place the client in Durant's position (Left Lateral Trendelenburg—left side down with head lowered to trap air in the right ventricular apex), and administer 100% oxygen. If TPN bag runs out before the next bag arrives, hang 10% Dextrose in water (D10W) at the same rate to prevent rebound hypoglycaemia. |  |  |
| 20 | In IV Fluid Therapy, classify 0.9% NaCl, Ringers Lactate, D5W, 0.45% NaCl, and 3% NaCl by tonicity in the body. | Isotonic: 0.9% Normal Saline and Lactated Ringer's (D5W is isotonic in the bag but physiologically hypotonic once glucose is metabolized). Hypotonic: 0.45% NaCl (Half-Normal Saline—contraindicated in raised ICP). Hypertonic: 3% NaCl, D5NS, D5LR (administer 3% NaCl cautiously via central line/pump to avoid osmotic demyelination and fluid overload). |  |  |
| 21 | On the NCLEX-RN Canada, how do SI units used in Canada compare for Blood Glucose, Therapeutic Lithium, Haemoglobin, and Platelets? | Fasting Blood Glucose: 4.0–6.0 mmol/L (70–110 mg/dL; hypoglycaemia <4.0 mmol/L). Lithium: 0.6–1.2 mmol/L (toxicity >1.5 mmol/L). Haemoglobin: 120–160 g/L (female) / 140–180 g/L (male). Platelets: 150–400 × 10⁹/L. |  |  |
| 22 | In Insulin pharmacology, list the onset, peak, and duration of Rapid-Acting (Lispro/Aspart), Short-Acting (Regular/Humulin R), Intermediate-Acting (NPH), and Long-Acting (Glargine/Detemir) insulins. | Rapid-acting (Lispro/Aspart): onset 10–15 min, peak 1–2h, duration 3–4h (ensure meal is in front of client). Short-acting (Regular—ONLY insulin given IV): onset 30–60 min, peak 2–4h, duration 5–8h. Intermediate (NPH—cloudy): onset 1–2h, peak 4–12h, duration 14–24h. Long-acting (Glargine—peakless): onset 1–2h, no pronounced peak, duration 24h (never mix Glargine/Detemir in the same syringe with any other insulin). |  |  |
| 23 | Which client tasks can NEVER be delegated by an RN to an Unregulated Care Provider (UCP / Health Care Aide)? | The Nursing Process itself: initial and ongoing comprehensive clinical assessment, nursing diagnosis, care plan formulation, unstable patient evaluation, patient teaching of new clinical concepts, and titration of high-alert IV medications ('EAT: Evaluate, Assess, Teach'). |  |  |
| 24 | In Canadian Infection Prevention and Control (IPAC), classify the diseases requiring Airborne vs. Droplet vs. Contact Precautions. | Airborne ('MTV': Measles, Tuberculosis, Varicella/disseminated Herpes Zoster, plus aerosol-generating procedures in COVID-19): N95 respirator + Negative-pressure isolation room. Droplet (Influenza, Meningococcal meningitis, Pertussis, Mumps, Rubella, RSV): surgical mask + eye protection within 2 meters. Contact (MRSA, VRE, C. difficile, Scabies, RSV, Rotavirus): gloves and gown (use soap and water handwashing, NOT alcohol rub, for C. difficile and Norovirus spores). |  |  |
| 25 | What are the clinical stages and assessment tool used for Alcohol Withdrawal Syndrome, and when does Delirium Tremens (DTs) peak? | Assessed using the CIWA-Ar scale (administer symptom-triggered benzodiazepines like lorazepam/chlordiazepoxide/diazepam when CIWA-Ar ≥8–10). Minor tremor/anxiety begins 6–12h after last drink; alcoholic hallucinosis at 12–24h; withdrawal seizures at 24–48h; Delirium Tremens (autonomic instability, tachycardia, hypertension, fever, severe agitation, visual/tactile hallucinations) peaks at 48–72 hours after the last drink. |  |  |
| 26 | What are the classic nursing assessments for Hypocalcaemia (Ca2+ <2.15 mmol/L) and Hypomagnesaemia? | Neuromuscular excitability: positive Trousseau's sign (carpopedal spasm upon BP cuff inflation), positive Chvostek's sign (facial twitching when tapping facial nerve), paresthesias, hyperreflexia, laryngospasm/stridor, and prolonged QT interval. |  |  |
| 27 | What are the 6 steps of the NCSBN Clinical Judgment Measurement Model (CJMM) tested on the Next Generation NCLEX-RN Canada and REx-PN? | 1) Recognize Cues, 2) Analyze Cues, 3) Prioritize Hypotheses, 4) Generate Solutions, 5) Take Action, and 6) Evaluate Outcomes. |  |  |
| 28 | How is the Newborn APGAR score calculated at 1 and 5 minutes of life? | 5 parameters each scored 0, 1, or 2 (max 10): Appearance (0=blue/pale all over, 1=acrocyanosis—pink body/blue extremities, 2=pink all over), Pulse (0=absent, 1=<100 bpm, 2=≥100 bpm), Grimace/reflex irritability (0=none, 1=grimace, 2=cry/cough/sneeze), Activity/muscle tone (0=flaccid, 1=some flexion, 2=active motion), Respiration (0=absent, 1=slow/irregular/weak cry, 2=good strong cry). Score 7–10 is normal. |  |  |
| 29 | What are the normal Arterial Blood Gas (ABG) reference ranges in Canadian SI units, and how do you interpret pH 7.29, PaCO2 58 mmHg, HCO3- 26 mmol/L? | Normal: pH 7.35–7.45, PaCO2 35–45 mmHg, HCO3- 22–26 mmol/L, PaO2 80–100 mmHg. Interpretation: pH <7.35 (acidemia) with elevated PaCO2 >45 mmHg and normal HCO3- = Uncompensated Respiratory Acidosis (e.g., opioid overdose or COPD exacerbation). |  |  |
| 30 | What are the strict nursing safety rules when administering Intravenous Potassium Chloride (KCl)? | NEVER administer IV KCl by direct IV push/bolus (causes fatal cardiac arrest); always dilute in compatible IV fluid, administer via an infusion pump (peripheral line max rate 10 mmol/hr, concentration ≤40 mmol/L), and verify adequate urine output (≥30 mL/hr) before infusing. |  |  |
| 31 | According to the Diabetes Canada 'Rule of 15', how does a nurse treat mild-to-moderate Hypoglycaemia (BG <4.0 mmol/L) in a conscious client vs. severe hypoglycaemia in an unconscious client? | Conscious client: Give 15 g of fast-acting simple carbohydrate (15 g glucose tablets, 150 mL/3/4 cup juice or regular pop, or 3 teaspoons sugar/honey; use pure glucose tablets if taking Acarbose), recheck BG in 15 minutes, repeat if still <4.0 mmol/L, then give a snack with protein/complex carb if next meal is >1 hour away. Unconscious client: Give IV Dextrose (20–50 mL of D50W) or 1 mg IM/SC Glucagon (or 3 mg intranasal Baqsimi). |  |  |
| 32 | In Chest Tube Water-Seal Drainage systems, what does continuous bubbling vs. intermittent bubbling in the Water-Seal Chamber vs. Suction Control Chamber mean? | Water-Seal Chamber: Tidaling (rising and falling with respiration) is NORMAL (stops when lung re-expands or tube is kinked); intermittent bubbling during expiration/coughing is normal in a pneumothorax; CONTINUOUS bubbling in the water-seal chamber indicates an AIR LEAK in the system. Suction Control Chamber: Gentle continuous bubbling is NORMAL in wet suction systems. |  |  |

---
Study this deck interactively with FSRS-6 spaced repetition, audio review, and multiple-choice mode at [Flashcards World](https://flashcards.world/flashcards/sets/8da47336-bd0d-436f-add3-48dcf8335b32/).