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Quality Assurance: Practice Assessment Guide 2013
Pub. No. 44046Copyright College of Nurses of Ontario, 2013.
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College of Nurses of Ontario
Toronto ON M5R 3P1www.cno.org
2 Quality Assurance: Practice Assessment Guide 2013
Read this guide for information about participating in Practice Assessment.
The information in this guide applies to all nurses (Registered Nurses [RNs], Registered
Practical Nurses [RPNs] and Nurse Practitioners [NPs]) who have been selected for Practice
how your participation is assessed and communicated to you
preparing for the multiple-choice objective tests. (Example test questions are included in
You can find other helpful resources at www.cno.org/qa
What is Practice Assessment?
It is the component of the College’s Quality Assurance (QA) Program where members are
selected to participate in Practice Assessment. All nurses selected will have their Learning
Plan assessed by a College-assigned Peer Assessor and will complete multiple-choice
objective tests based on the practice documents the College selects. Nurses are required to
complete their Learning Plan and objective tests using the online myQA site at www.cno.
What should I include in my Learning Plan?
Your Learning Plan for 2013 must include two learning goals. You choose the College
practice documents that relate to your goals, based on the results of your practice
If you are a Nurse Practitioner, then you must also develop a third learning goal based on
the Nurse Practitioner
Your Learning Plan must be completed online using myQA, and submitted by 11:59 p.m.
on April 27, 2013. You do not have to submit a paper copy of your Learning Plan to the
What do the objective tests assess?
The objective tests assess a nurse’s knowledge and application of the principles and
indicators identified in the practice documents. The Nurse Practitioner
test also assesses an
NP’s knowledge of the Canadian Nurse Practitioner Core Competency Framework
scenarios are used in the test to give context to the questions and to evaluate an NP’s
Each test is based on a selected practice document. There are 50 to 55 multiple-choice
questions on each test, and you have 75 minutes
to complete each test. You can complete
each test anytime before the Practice Assessment deadline. But once you start the test, you
have to finish it within the 75 minutes; you can’t stop or pause the test.
You can prepare for the objective tests by reviewing the relevant practice standards and the
example test questions at the back of this guide. Nurse Practitioners should also review the
Canadian Nurse Practitioner Core Competency Framework
and the NP Practice Resources
To maintain confidentiality, you will be required to acknowledge the confidential nature of
the test content. You are not allowed to copy the test materials or take notes. Participants
who engage in misconduct or who disclose information about the test questions may be
reviewed by the College and subject to penalties.
What happens after I have completed Practice Assessment?
The College will assess your participation. A Peer Assessor will review your Learning
Plan and your test results, and write a report for the Quality Assurance Committee. The
Quality Assurance: Practice Assessment Guide 2013 3
committee will review this report and decide if you have successfully completed Practice
Assessment, or if you have to participate in follow-up activities.
For example, if you are unsuccessful in an objective test, then you still have the
opportunity to demonstrate that you can meet the competencies related to the practice
document by completing a follow-up activity, such as submitting a case example from your
practice related to that practice document.
How will I be informed of my results?
You will receive a copy of the Peer Assessor’s report and a letter informing you of the
committee’s decision. The letter will identify whether you are successful or unsuccessful
in Practice Assessment, and whether any further activities are required. You will have an
opportunity to provide a response to the committee’s decision within 14 days from the date
Is Practice Assessment a confidential process?
Yes, your participation in Practice Assessment is confidential and between you and the
committee. The College will not notify your employer of your selection or your results.
Only the committee is aware of your participation and your results, and it cannot use
the information for a non QA Program-related College activity, such as a complaints
Who should I contact if I have questions?
Contact the Quality Assurance Administrator at QAAssessment@cnomail.org, or 416 928-
0900, ext. 7570 (toll-free in Ontario at 1 800 387-5526).
4 Quality Assurance: Practice Assessment Guide 2013
Appendix A: Therapeutic Nurse-Client
Relationship Sample Questions
The following are examples of multiple-choice questions you will find in the Therapeutic
A nurse is completing an initial health history with a client. The client raises a life issue that does not immediately seem relevant to the nurse. What should the nurse do?
Ask the client to discuss the issue with a family member.
Refocus the client on the purpose of the assessment.
Provide immediate advice about resolving the issue and continue with the history.
Listen to the client’s issue and explore its relevance to the assessment.
A nurse witnesses her colleague speaking to a client in a manner that she perceives as sexually suggestive. What is the first action the nurse must take?
Inform the colleague of how the interaction was perceived.
Report the colleague’s behaviour to the nurse’s supervisor.
Speak to the client in private to assess the situation further.
Intervene immediately to protect the client.
A nurse has provided care for a client who has since been discharged from care. The nurse later joins a book club that meets monthly and finds that the client is a member. What should the nurse do in this ongoing social situation?
Withdraw from the book club until an acceptable period of time has passed since the prior client’s discharge.
Clarify with the prior client that the relationship is no longer therapeutic.
Consult with the nurse’s supervisor about the appropriateness of socializing with the prior client.
Avoid speaking with the prior client during the book club meetings.
Quality Assurance: Practice Assessment Guide 2013 5
An adolescent client has just been diagnosed with diabetes. What should the nurse take into consideration before teaching the client about his condition?
The client’s age and current level of knowledge about his diagnosis.
The client’s parents interest in attending the education session, and their work schedules.
The nurse’s teaching-style preference and years of experience.
The availability of another adolescent with diabetes to attend and offer support to the client.
A nurse is experiencing difficulty establishing a therapeutic relationship with a client despite being caring, competent and having used a range of interventions. How should the nurse proceed?
Continue to try to establish a therapeutic relationship.
Involve the client’s family members in the provision of care.
Discuss her or his concerns with the client.
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Appendix B: Documentation Sample
The following are examples of multiple-choice questions you will find in the
What must nurses include in all client care documentation?
The date and time that care was provided.
The time of documentation and the client’s location.
The nurse’s name and the client’s nursing diagnosis.
The nurse’s professional designation and registration number.
Which one of the following circumstances allows a nurse to document care that was performed by another health care provider?
The other health care provider is unregulated.
The client informed the nurse about the care received.
The nurse is the designated recorder during an emergency situation.
The other health care provider has delegated the documentation.
An outpost nurse routinely completes client health records. Which one of the following statements should guide the nurse when determining the retention of these health records?
The policies of the nurse’s employing organization determine retention.
The College of Nurses of Ontario determines the standards for record retention.
Clients’ health records are sent for destruction when clients are discharged from nursing services.
Outpost nurses receive temporary assignments, so record retention is the responsibility of the physician.
A nurse using an electronic health record system is called away to assist with a client transfer. What should the nurse do?
Ask a colleague to complete the documentation.
Leave the session open, but return as quickly as possible.
Quality Assurance: Practice Assessment Guide 2013 7
What must a nurse do when another member of the health care team has recorded incorrect client information in a paper-based documentation system?
Use correction fluid to delete it and initial the change.
Indicate that an error was made and document the correct information.
Cross out the incorrect information and provide an updated entry.
Document that the health care team member made an error and inform her or him.
8 Quality Assurance: Practice Assessment Guide 2013
Appendix C: Nurse Practitioner Sample
The following are examples of multiple-choice questions you will find in the Nurse
objective test. They are applicable only to Nurse Practitioners (NPs)
A homeless client reluctantly presents for assessment. The NP diagnoses chlamydia. The client denies having any allergies. Which one of the following medication regimens would be most appropriate?
Ten-day course of doxycycline (Vibra-Tabs)
Fourteen-day course of amoxicillin (Amoxil)
A client presents to the NP to discuss HIV testing. What information about HIV testing should the NP communicate to the client during pre-test counselling?
It is voluntary and should only be offered when requested.
It should be performed at least annually for high-risk individuals.
It should be performed every two years for all sexually active individuals.
It should be performed annually regardless of individual risk.
After receiving an immunization, the client experiences flushing, dyspnea, wheezing and tachycardia. Emergency response has been activated. What action should the NP take immediately?
Administer diphenhydramine (Benadryl).
A teenage client presents with symptoms of sore throat, fever and lethargy. The NP’s assessment reveals an erythematous pharynx, posterior cervical lymphadenopathy and splenomegaly. What is the most likely diagnosis?
Quality Assurance: Practice Assessment Guide 2013 9
In assessing a client with acute abdominal pain, the NP finds periumbilical tenderness, guarding, tachycardia and low-grade fever. The pain lessens with flexion of the right thigh. What is the most likely diagnosis among the following differentials?
10 Quality Assurance: Practice Assessment Guide 2013
Quality Assurance: Practice Assessment Guide 2013 11
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