Writing the CNCC(C)

Examination

Brenda Morgan RN BScN CNCC(C)

Clinical Educator: CCTC, London, Ontario
 Why Become Certified?
‹ Affirms specialized skill and knowledge
‹ Provides open recognition
‹ Demonstrates commitment to our
specialty
‹ Encourages professional growth and
development
‹ Renews interest in profession
‹ Personal pride and accomplishment
 Why Become Certified?
‹ Nationally recognized standard
‹ Increased marketability
‹ Benefits will increase as more
nurses certify across all specialties
‹ Some provinces have provided pay
differentials
‹ Preferred job hiring
 Greatest benefits
achieved through
process of preparation…
… make the choice for
your own personal
reasons.
 Competency-Based
Multiple Choice Exam
 Exam
‹ Adult patient population only
‹ ONE correct answer from 4 options
‹ No double negatives (e.g. all the
above except)
‹ No multiple options (e.g. a and b; b, c,
and d; or all the above)
‹ Competency based questions
 Competency Based
‹ Focuson appropriate behaviour
‹ Components of a well written question
9 If you know the content, you will select
the correct response
9 If you don’t know the content, you will
select an incorrect response
9 It should not be a test of your “reading
skills”
 Important Concepts
1. Cardiac cycle
2. Determinants of cardiac output
3. Basic rhythm analysis
4. Arterial lines, PA catheters
5. Hemodynamic waveforms
6. 12 lead interpretation
7. Mixed venous oxygen (SVO2), lactate
8. Shocks: hypovolemic,cardiogenic, septic,
neurogenic,anylphylaxis
9. Alpha and beta receptor responses
 Important Concepts
10.ACLS protocols
11.Sympathetic drugs
12.Anti-arrhythmics
13.Temporary pacemakers, VVI
14.Basic Principles of balloon pumping
15.Blood gas interpretation
16.Minute volume
 Important Concepts
17.Standard ventilator parameters
18.Fixing PaO2s and PaCO2s
19.Chest tubes
20.Cardiac tamponade, tension pneumothorax,
myocardial contusion
21.Major areas of neuro function
22.Intracranial hypertension
23.ICP monitoring
 Important Concepts
24.Basic seizure management
25.Inflammation
26.Coagulation and anticoagulants
27.Renal failure
28.Renal replacement therapy
29.Electrolyte imbalance and treatment
(Calcium, magnesium, phosphate,
potassium, sodium, chloride)
 Calculations to Know
1. Cardiac Output/Index
2. Oxygen Delivery
3. Minute Volume
4. SVRI/PVRI
5. Cerebral Perfusion Pressure
Competency

“The critical care nurse recognizes

potential-life threatening alterations in
renal function”
Mr. Abel’s creatinine rises from 72 to 165 in 24
hours. This lab result is consistent with which
one of the following problems?

a) Liver failure
b) Renal failure 9
c) Myocardial infarction
d) Dehydration
 Examination
‹ Approximately 170 items
‹ Independent and case based items
‹ Type of questions:
9 Knowledge and comprehension
9 Application
9 Critical thinking
 Examination Limitations
‹ Snapshot in time
‹ Only tests a portion of possible
questions
‹ Cannot detect discrepancies between
correct response and actual clinical
behaviour
 Independent Item Stem

Identify the following rhythm?

a) Ventricular rhythm with PVCs

b) Junctional rhythm with PJCs Distracters
c) Junctional rhythm with PACs
d) Controlled atrial fibrillation 9 Response
Case-Based

Steven is a 45 year old man who was admitted 24

hours ago with pneumonia. At 0800 hrs, he
develops a sudden onset of crushing chest pain.
At 0845 hrs, despite morphine and nitroglycerine,
the pain is unresolved.
Item One: Steven’s 12-lead ECG reveals 2 mm ST
elevation in V3-V4. These findings are consistent
with which one of the following?
a) Lateral wall ischemia
b) Anterior wall infarction
c) Anterior wall ischemia
d) Lateral wall ischemia
 Knowledge and Comprehension

Interpret the following blood gas

PaO2 75 HCO3 22
PaCO2 32 BE -1
pH 7.49 SaO2 .96

a) Respiratory alkalosis 9
b) Respiratory acidosis
c) Metabolic alkalosis
d) Metabolic acidosis
Application

Mrs Jones develops torsades de pointes. Which

one of the following interventions would the
critical care nurse anticipate?

a) Magnesium sulphate and calcium gluconate 9

b) Defibrillation and amiodarone infusion
c) Lidocaine and fluid
d) Magnesium sulphate and cardiac pacing
Critical Thinking

Joe develops a bradycardia with a radial arterial

pressure of 42/29. Which one of the following
interventions is the priority?

a) Atropine
b) Epinephrine
c) Pacemaker
d) Compressions 9
Developing a Study Plan
 Study Plan
‹ Obtain copy of exam blueprint
(competencies)
‹ Identify areas of strengths and
weaknesses
‹ Identify major versus minor content
‹ Determine where the largest study
time is needed
Make the most of your investment;
use this time to broaden your
knowledge and explore new
research evidence.
 Review the rationales for
interventions and practices.
Focus on the why’s.
The exam tests nationally
established standards.
You are not starting from
scratch!
Make a list of learning needs
and identify possible
resources
 Use multiple resources or
learning strategies for complex
concepts.
 Consider your learning
style?
‹ 30 minutes per day versus 8 hour
“power study”
‹ Group versus independent study
‹ Self-directed versus review class
format
‹ Hands-on opportunities for learning
Develop an organized and
progressive study schedule.
 Make a
commitment…schedule your
study time into your planner
as if you were attending a
class.
The cost of procrastination
is high!
Enlist the help of your family
and friends.
 Set realistic limits for
study times. Consider times
of the day when you could
fit in your review and
factor in lifestyle.
Be careful that you still
have a family to celebrate
with when you are done!
Reward yourself when you
stick to your plan.
Obtain sample questions…
with caution!
Tips for Writing the Exam
 3 Steps Response
1. Read any introductory text, then
read the stem carefully
9 Cover the answers until you are clear
on what is being asked
9 Imagine the correct response
2. Read each option carefully
3. Select the best response
9 Reread the stem before finalizing
Read carefully; don’t jump to
quick conclusions!
Be sure you read the stem
correctly
Read distracters carefully.
 The right answer is
missing!
9 Reread the stem carefully to make sure
read it correctly
9 Work backwards, eliminating incorrect
responses
9 If more than one correct answer is
present look for the MOST correct
response
9 If more than one correct answer is
present, look for what you would do
FIRST
When in doubt, remember to
guess!
 Study Pitfalls
9 Insufficient preparation
9 Memorizing or inactive learning
9 Confusing “experience” with “knowledge”
9 Use of inaccurate resources; be wary
of using other’s notes!
9 Over-reliance on sample questions; they
should complement rather than replace
learning of concepts
 Exam Pitfalls
9 Reading errors
9 Changing answers
9 Losing your “spot”
9 Spending too much time on one question
9 Rushing
9 Lack of preparation
9 Stress, hunger, fatigue
Enter the exam room
relaxed.
The answer that seems
obvious probably is!
What is the passmark?
You need to get at least 50
wrong to fail!
Ignore everyone else in the
room..they are probably
writing a different exam.
It is not a race!
 Summary; Tips for Success

9 Perform a realistic needs

assessment and allow adequate
time for review
9 Rehearse
9 Come prepared (pencils, photo ID,
exam identification card, snack)
9 Know where you are going and
arrive early
 Summary; Tips for Success

9 Don’t talk about the exam before

or after…it just causes
unnecessary stress!
9 Plan a reward
9 Take slow deep breaths and focus
on each question; allow a maximum
of 2 minutes before moving on
 Summary; Tips for Success

9 Ignore other writers

9 Stretch if needed
9 Don’t leave blanks…guess!
9 Move on if you get stuck…but don’t lose
your place when recording your score.
9 Don’t let your mind wonder
9 Stick to the 3 step approach
9 Keep moving!
 Should you write…
…definitely
but do it for yourself!
After the exam, wear your
credential with pride!