Updated for 2026
REx-PN safety: infection control, fall prevention, and medication safety for Canadian RPNs
Safety is a core competency across the entire REx-PN. Questions integrate safe practices into every clinical scenario — from medication administration to patient positioning to interprofessional communication. Recognising and preventing harm is tested continuously, not in isolated questions.
Educational purpose: This content is for exam preparation and professional development only. It is not intended for clinical decision-making. Always follow current guidelines, institutional policies, and scope of practice.
Infection prevention and control (IPAC) in Canadian settings
Canadian IPAC standards align with Public Health Agency of Canada (PHAC) guidelines. Key frameworks tested on REx-PN include Routine Practices (equivalent to Standard Precautions) and Additional Precautions (equivalent to Transmission-Based Precautions).
Routine Practices: Applied to all patients in all healthcare settings. Hand hygiene (WHO Five Moments: before patient contact, before aseptic procedure, after body fluid exposure, after patient contact, after contact with patient surroundings). PPE based on risk assessment. Respiratory hygiene and cough etiquette. Safe handling of sharps and waste.
Additional Precautions: Contact (MRSA, VRE, C. difficile — soap and water hand hygiene required for C. diff), Droplet (influenza, RSV, pertussis, meningococcal disease), Airborne (TB, measles, varicella). Negative-pressure rooms for airborne pathogens. N95 respirator for airborne precautions.
Hand hygiene compliance: Alcohol-based hand rub is the preferred method for most pathogens. Soap and water for C. difficile, Norovirus, and visibly soiled hands. The REx-PN tests correct moment selection and method selection — not just that hand hygiene should be performed.
Medication safety in Canadian PN practice
Medication safety is one of the most frequently tested REx-PN topics. The RPN/PN applies the rights of medication administration and has a professional obligation to question and clarify unclear or potentially unsafe orders.
High-alert medications in Canada: The same ISMP high-alert drug list applies: insulin, anticoagulants (heparin, warfarin, LMWHs such as enoxaparin), opioids, concentrated electrolytes, neuromuscular blocking agents, concentrated dextrose solutions, and chemotherapy. These require independent double-checks per institutional policy.
Questioning unsafe orders: The RPN/PN has a professional and legal obligation to question an order that appears potentially unsafe before administering. Approach: verify the order with the prescriber, consult pharmacy, or escalate to the RN. Document the query and the response. Never administer a medication you are not confident is safe and appropriate.
Frequently asked questions
- What are Routine Practices and how do they differ from Additional Precautions in Canada?
- Routine Practices (the Canadian equivalent of Standard Precautions) are the baseline IPAC measures applied to every patient encounter regardless of diagnosis. They include: hand hygiene at all Five Moments, risk-assessed PPE selection, respiratory hygiene, and safe handling of sharps. Additional Precautions are added ON TOP of Routine Practices when a patient has a known or suspected pathogen transmitted by contact, droplet, or airborne route. The key concept: Additional Precautions do not replace Routine Practices — both are applied simultaneously. This is a common REx-PN conceptual trap.
Clinically reviewed by NurseNest Clinical Review Team · Last updated 2026-06-10 · For educational purposes only · Review policy