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REX-PN: Frequently asked questions

Background and purpose

What is the REx-PN™?

The Regulatory Exam – Practical Nurse (REx-PN™) is an entry-to-practice exam for those applying to become a Registered Practical Nurse (RPN) in Ontario or Licensed Practical Nurse (LPN) in British Columbia. Implemented on January 4, 2022, it tests for the knowledge, skill and judgment Practical Nurses need at the beginning of their careers to practice safely.

Why do we have a registration exam?

Registration exams such as the REx-PN contribute to patient safety. As provincial regulators of the nursing profession, CNO and the British Columbia  College of Nurses and Midwives are accountable for ensuring that only those who demonstrate the ability to apply nursing knowledge and provide safe care at the beginning of their careers are able to practice nursing. The registration exam helps to do this.

When was the REx-PN implemented?

The new exam was implemented on January 4, 2022. We established this timing with nursing education programs in Ontario and British Columbia to give educators time to include the revised entry-to-practice competencies in their curriculum, and support students in preparing for the REx-PN.

Why is Ontario changing to the REx-PN?

As Ontario’s nursing regulator, CNO is accountable for ensuring that it grants registration only to those who demonstrate the nursing knowledge needed to provide safe care. We regularly review processes for assessing this knowledge to determine the most accessible, fair and efficient approaches.

The REx-PN will meet our requirements for being a valid, reliable and secure exam. It will also meet the needs of exam writers by giving them year-round access to the exam and faster results.

How do the Canadian entry-to-practice competencies relate to the items that will be on the exam?

The REx-PN is based on data collected from an analysis of RPN/LPN practice conducted in early 2019, a process that will be repeated every five years. In addition, revised national entry-to-practice competencies were mapped to the Practice Analysis to ensure the competencies essential for safe nursing practice are included on the exam.

Before writing the REx-PN, PN students will have completed an educational program designed to teach them the knowledge, skills and judgment to prepare them to enter the nursing profession. Nursing candidates’ academic preparation provides a starting point for them to practice in a variety of settings. In complement, the REx-PN will assess whether PN candidates possess the minimal entry-level competence to provide safe and effective care.

Is the content of the REx-PN reviewed by Canadian nurses?

Yes. Nurses in Ontario and British Columbia review the content of the REx-PN. They continue to review and develop the exam to ensure it meets our needs as regulators, and the needs of the public for safe nursing care. 

How are the exam questions translated into French?

To meet the needs of French-speaking Canadian REx-PN candidates, the exam is offered in French. A third party will translate questions following best practice and recommended standards. A panel of French PN academics  familiar with nurse practice settings developed a lexicon that is informing third-party translation. You can see the Lexicon terms here. The third party translates questions following the lexicon, best practice and recommended standards.

Once the questions are translated, a Canadian Translation Panel made up of French-speaking Canadian nurses reviews each translated question for accuracy and contextual equivalency.

This method (referred to as a mixed-method, process-oriented approach) is supported in the literature as a preferred method for ensuring construct equivalence in health care measurement instruments.

Was the exam tested before being implemented?

PN programs in Ontario and British Columbia pre-tested the exam items with student volunteers who were preparing to graduate in 2020 and 2021. The results are being used to determine the difficulty level for each question, which is a critical feature of computerized adaptive testing (CAT). Questions are flagged if they need to be revised, re-tested or possibly removed from the bank of questions. After implementing the exam in 2022, all new questions that are developed are pre-tested on the REx-PN.

Applicants have unlimited writes on this exam. How is this safe for the public?

Regardless of the number of writes, the only way a writer will be successful on the REx-PN is if they are able to show they have the knowledge, skill and judgment to practice safely as an entry-level PN. Each person who writes the exam will have a different set of questions. There is no risk of memorizing content because the software system behind the REx-PN knows when someone is rewriting the exam and generates a new set of questions for them each time.

The REx-PN exam is a Computerized Adaptive Test (CAT) instead of a traditional multiple-choice exam. During a CAT exam, the exam writer must sustain a pre-determined level of difficulty to show their ability. Whether they pass the exam on their first try or any subsequent try, they won’t be passing by chance or because they memorized test content. They will pass because they have the ability, which helps to keep the public safe.

Registration

I'm applying for registration in Ontario. Will I be able to write the CPNRE and the REx-PN?

The Canadian Practical Nurse Registration Exam (CPNRE) was available until the end of 2021. On January 4, 2022, the REx-PN became the registration exam for Ontario Practical Nurses. The CPNRE is no longer be an option for Ontario applicants.

If you passed the CPNRE by the end of 2021 as part of your CNO application, you meet CNO’s registration exam requirement, even if you have not completed the other requirements of your registration by that time.

Visit National Council of State Boards of Nursing’s website for more FAQs.

If I apply for registration in Ontario, do I have to write the REx-PN exam in Ontario?

No. You can write the REx-PN at any Pearson VUE test centre that offers the exam. However, there will be an additional fee if you write the exam outside of Canada or the U.S.

What does it cost to write the REx-PN?

The fee to write the REx-PN is $350 (plus applicable taxes) per attempt. This is non-refundable. Check the Application & Membership Fees page for the latest information on additional fees applying to your RPN application and registration in the General class.

Please note that if you pay to write the CPNRE and decide to withdraw, we cannot transfer the CPNRE exam fees to the REx-PN. However, you can use the amount as a credit to pay another CNO fee (such as a membership fee).

Preparation

Will my Ontario nursing education prepare me for the content in the REx-PN?

Yes, the REx-PN tests competencies that nurses need at the beginning of their nursing careers to practice safely in Ontario, as covered by your nursing program’s curriculum. 

Are there REx-PN study resources to help me prepare?

Yes, resources have been or are being developed. These include:

Should I take an REx-PN prep course?

You may find preparatory courses helpful in preparing to write the exam, but choosing what will help you prepare is your decision. Your nursing education and the resources on this page should be enough to prepare you for writing the REx-PN. Third-party vendors may develop and offer REx-PN preparation courses, but it is important to know that they do not have access to the REx-PN question bank. CNO is aware of some preparation courses being developed in English, but we cannot vouch for their success in helping someone write the REx-PN. To date, we are not aware of any preparation courses produced in French, although we continue to make inquiries.

What is the REx-PN Test Plan, and how can I use it to prepare?

The REx-PN Test Plan (ENFR) is an excellent guide to preparing for the exam. It’s a concise summary of the content areas and scope of what is tested on the exam. It also includes: definitions for each Client Needs category; nursing activity statements; sample REx-PN questions; and information about the format of the exam and how it will be scored. 

Will I have to memorize normal lab values?

The lab values an exam writer is expected to know are on page 36 of the REx-PN Test Plan (ENFR). They include the lab values for ABGs (pH, PO2, PCO2, SaO2, HCO3), BUN, cholesterol (total), creatinine, glucose, glycosylated hemoglobin (HgbA1C), hematocrit, hemoglobin, INR, platelets, potassium, PT, PTT & APTT, sodium, and WBC. All other values will be provided

Writing and results

How many times can I write the REx-PN?

There is no limit on the number of times applicants can write the exam before they pass. Because the REx-PN will be a computerized adaptive test (CAT), the system knows if a writer is retaking the exam. The system supplies different questions than those the writer had in previous attempts. Regardless of the number of attempts, the only way a person will successfully pass the REx-PN is if they are able to show they have the knowledge, skill and judgment to practice safely as an entry-level RPN.

How often is the REx-PN be available to write?

The REx-PN is available to write at any time in permanent and temporary centres of the exam provider, Pearson VUE. REx-PN writers will have to wait at least 60 days between attempts, which is maximum of six attempts per year.

How much time does an exam writer have to answer each question?

There is no time limit for each question, however there is a limit of four hours to complete the overall exam. On similar exams, candidates generally take 60 – 90 seconds per question. Writers should not feel the need to rush. For more information on the time limit, please see the “Examination Length” section in the REx-PN Test Plan.

Where are Ontario's REx-PN test centres located?

Use Pearson VUE’s Test Site Locator to find the test centre nearest you

Rewriting

How many times can I re-write the exam?

There is no limit to the number of times you can write the REx-PN until you pass. You can take the REx-PN once in any 60-day period (up to a maximum of six times per year). However, once you pass you will still need to meet all other requirements to become registered to practice as a nurse in Ontario.

What happens if I don't pass the REx-PN the first time?

If you do not pass, CNO will send you a Candidate’s Performance Report (CPR). This document provides information about how you did in each section of the exam, indicating whether you performed above, near or below the passing standard. Find more information about CPRs on NCSBN’s website. 

How can I improve my chances of passing if I have to retake the REx-PN exam?

If you fail, you will receive a Candidate’s Performance Report (CPR). This is a breakdown of your results including content areas that had deficiencies on the exam. You can then use this information to determine additional learning you may need to complete to increase your ability and overall competence. For example, this could mean studying more in one area, getting additional academic help, or taking a continuing education course on a specific topic to improve your knowledge.

Before the REx-PN was implemented, I failed the CPRNE three times. Will I be able to write the REx-PN?

If your application remains open with CNO and you meet the exam eligibility requirements, you will be able to write the REx-PN. There is no limit to the number of times you can write the REx-PN.

I applied to CNO in the past and never got registered. Now, I would like to take the REx-PN exam. How do I apply?

If you graduated from a nursing program in Canada, you can apply directly to CNO. We will assess your credentials to ensure you’re eligible to write the REx-PN.

If you received your nursing education in another country, visit the National Nursing Assessment Service (NNAS) website for the steps you need to take. Once NNAS has given you your RPN Advisory Report for CNO, you can begin your application with us. We will assess your credentials for exam eligibility for the REx-PN.

Content and format

What does the REx-PN test?

The REx-PN does not test everything that is taught in a PN program. Rather, it tests entry-level skills, knowledge and judgment — what nurses need to know to provide safe care at the beginning of their careers. The REx-PN Test Plan describes what is tested. 

Does the REx-PN include questions specifically about Canadian health care systems or legislation?

No. The REx-PN does not test knowledge of health care systems, history, cultural issues, or government policy and laws. Such items vary by province and territory in Canada. While nurses must know about the health care system they work in, including its legislation, testing for that knowledge is not the purpose of the REx-PN.

Applicants to CNO write a Jurisprudence Exam that tests for this knowledge.

What format does the REx-PN take? What is Computerized Adaptive Testing?

The exam format is Computerized Adaptive Testing (CAT). Using CAT, the system determines the level of difficulty of the question it presents to the writer based on how well they responded to the preceding question. For example, if a writer responded correctly to a question of medium difficulty, the next question presented will be slightly more difficult. A candidate must achieve a certain ability level on the exam to pass.

This video provides you with more information about the CAT format of the REx-PN.

How many questions does the REx-PN have?

The number of questions exam writers receive ranges from a minimum of 90 to a maximum of 150. The actual number of questions the writer must answer depends on how long it takes the exam’s algorithm to determine whether the writer is consistently performing above or below passing level. Of all the questions the writer receives, 60 to 120 questions count in the exam writer’s score. The remaining 30 are being pre-tested for possible inclusion on future exams and do not count in the score.

Pre-testing is required to ensure CAT exams function properly. By administering pre-test items to a large sample of REx-PN writers, the degree of difficulty of each question can be determined. The writer will not be able to distinguish between an unscored pre-test question and a scored question on the REx-PN, so exam writers should give each question their best effort. 

Do the exam questions use generic and trade names of medications? Is there a list of drugs I need to know?

At this time, the REx-PN uses generic medication names only, in most cases. This is because generic names are more consistent, while brand/trade names may vary. Some items may refer to general classifications of medications. A list of medications that are on the exam is not provided.

Is there be a default practice setting for the questions?

No. The exam states relevant practice settings if they are relevant to any questions. 

How many questions do I need to answer correctly to pass?

Since the exam is a computerized adaptive test (CAT), this answer requires some explanation. A CAT is designed to measure the writer’s ability: their entry-level nursing knowledge, skill and judgment. Each question is rated at a different level of difficulty. Some questions are easier to answer than others.

Every time a writer answers a question, the computer re-estimates their ability level based on all previous answers and the difficulty of those questions. This gives the computer as much information as possible about the writer’s ability to provide safe care. With each question answered, the computer’s estimate of the writer’s ability becomes more precise.

Therefore, there is no set number of questions to answer. Rather, a writer passes the exam when the computer determines they are above the passing standard: a cut point that marks the minimum ability level required to practice nursing safely and effectively as an entry-level RPN in today’s health care environment. To learn more about the passing standard, including how it is determined, visit REx-PN Passing Standard | NCSBN.

What types of questions are on the exam and how often is each type asked?

As described in the REx-PN test plan, there are many different types of questions on the REx-PN. Most of the questions are multiple-choice, while others are multiple response; fill-in-the-blank calculation; exhibit; and graphic. You can access the Candidate Tutorial to familiarize yourself with each type.

Are exam questions numbered so I will know how many questions I’ve responded to?

Yes. On the computer, exam questions are numbered so you will know how many questions you’ve responded to.

Can I go back to a previous question and change my response?

No. Given the computerized adaptive test (CAT) format of the exam, you cannot go back to previous questions or skip questions. With a CAT, every time you answer a question on the exam, the computer re-estimates your ability based on all previous answers and the difficulty level of those questions. Using this process, the computer gets as much information as possible about the writer’s ability to provide safe care. With each question answered, the computer’s estimate of the writer’s ability becomes more precise.

Page last reviewed January 11, 2022