Canadian RN Exam
CRNE Case 1

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Canadian RN Exam Case II

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Situation: Analisa, 16 years old, is living with diabetes mellitus Type 1. She has been recently hospitalized for cellulitis of her left lower leg. Analisa has had numerous hospital admissions in the past for uncontrolled diabetes.

1. The physician has ordered intravenous antibiotic therapy to replace oral medication for Analisa's cellulitis. What should the nurse do prior to initiating the therapy?

a) insert a 20 gauge I.V. cannula
b) obtain written consent from Analisa
c) ask if Analisa has any allergies to an antibiotics
d) assess Analisa's understanding of I.V. therapy

2. Analisa is extremely afraid of receiving an I.V and pleads with the nurse to give her oral antibiotics. What is the most appropriate action by the nurse?

a) reassure Analisa that the insertion will not be too painful
b) initiate oral antibiotic therapy as requested by Analisa
c) contact Analisa's parents to discuss this situation
d) discuss the importance of receiving antibiotics via the I.V. route

3. Analisa is frustrated and states, "The doctors and nurses always try to control everything in my life. It is hard to live with so many restrictions." How should the nurse who pass the Canadian RN Exam respond?

a) if you control your blood sugar, you will prevent complications
b) I think you would benefit from the outpatient diabetes program
c) it is difficult being an adolescent with diabetes, but it will become easier
d) it seems that you are upset. Let's discuss what you see as challenges

4. The physician has recommended that Analisa be sent home with an insulin pump, which the family must purchase. What is the most important consideration prior to discharge?

a) Analisa's ability to test blood sugar level
b) the family's ability to operate the pump
c) the financial status of the family
d) Analisa's activity level

Canadian RN Exam
Answers and Rationale

1) D - Correct
- this response assesses Analisa's ability to provide informed consent prior to initiation of I.V. therapy.
A - Incorrect - this action is inappropriate only after consent has been obtained.
B - Incorrect - written consent is not required for this procedure. Verbal consent is sufficient.
C- Incorrect - this would have been done when the p.o. route was ordered. There is no indication in the stem that there was a change in the antibiotic drug.

2) D - Correct
- Analisa may need additional information before providing informed consent.
A - Incorrect - this action does not address Analisa's request for a different mode of medication delivery.
B - Incorrect - to initiate a change in the mode of medication delivery, the nurse must obtain a physician's order.
C - Incorrect - legally, minors are allowed to make decisions regarding their care, on the condition that they are able to understand the consequences of refusing the recommended treatment.

3) D - Correct
- According to Canadian RN Exam, this response promotes open communication in hopes to empower Analisa to take ownership of her health.
A - Incorrect - this response does not empower Analisa to be involved in her own care. Controlling blood sugar will not necessarily prevent complications.
B - Incorrect - this response is controlling in nature and does not address Analisa's concern.
C - Incorrect - this response does not empower Analisa to be involved in her own care and may be providing a false sense of reassurance.

4) C - Correct
- the family's ability to purchase the pump is the critical factor.
A - Incorrect - this is important, but it may be irrelevant if she cannot afford to buy the pump.
B - Incorrect - this is important, but it may be irrelevant if she cannot afford to buy the pump.
D - Incorrect - this is important for insulin regulation, but it does not address the financial status.

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