Radiology Nurse Certification Practice Test Questions and Answers

Preparing for the Certified Radiology Nurse (CRN) exam requires far more than reviewing basic nursing concepts or skimming generic test questions. The CRN exam is designed to measure how well you think in real clinical situations — how you prioritize care, recognize subtle deterioration, manage complications, and make safe decisions under pressure. This Radiology Nurse Practice Test was created specifically to match that reality.

Unlike surface-level review guides, this CRN Practice Test focuses on how radiology nurses are actually tested. Every question reflects real decision-making in radiology, interventional, and imaging environments. From sedation complications to contrast reactions, vascular emergencies to neurological changes, this practice test prepares you for the way the CRN exam truly evaluates competence.

If your goal is not just to “study,” but to walk into the exam room feeling prepared, focused, and confident, this resource was built for you.

Why Most Radiology Nurses Fail the CRN Exam on Their First Attempt

Many experienced radiology nurses are surprised when they don’t pass the CRN exam on the first try. The reason is rarely lack of experience. Instead, it’s a mismatch between how nurses prepare and how the exam is written.

Most candidates rely on generic nursing review books or short question banks that focus on recall. The CRN exam, however, emphasizes judgment. It asks what to do first, what to avoid, when to escalate care, and how to respond when patient conditions evolve. Questions often include normal vital signs alongside subtle red flags, forcing candidates to recognize problems before they become obvious.

Another common issue is underestimating the depth of scenario-based questions. The CRN exam frequently presents unfolding clinical situations rather than isolated facts. Without exposure to realistic, high-difficulty CRN Exam Practice Questions, even skilled nurses can struggle. This radiology nurse practice exam was developed specifically to address those gaps.

What You’ll Get Inside This Radiology Nurse Practice Test

This certified radiology nurse practice test is not a random collection of questions. It is a structured, exam-aligned preparation tool designed to strengthen clinical reasoning and exam readiness.

Inside, you’ll find hundreds of carefully written questions that mirror the tone, structure, and complexity of the real CRN exam. The questions include best-next-step scenarios, select-all-that-apply items, priority reversals, and evolving case-based situations that require you to think like an experienced radiology nurse.

Each question includes a detailed explanation written in clear, clinical language. The explanations don’t just tell you which answer is correct — they explain why it is correct and why the other options are unsafe, premature, or incorrect. This approach helps you identify patterns in CRN exam logic so you don’t fall into common traps on test day.

Rather than memorizing isolated facts, you learn how to apply knowledge in realistic clinical contexts.

Comprehensive Coverage of All CRN Exam Domains

• This CRN Practice Exam provides complete coverage of all major CRN exam domains, aligned with the real question styles and clinical scenarios radiology nurses encounter on the exam.

Sedation & Airway Management

• Moderate and procedural sedation safety
• Airway assessment and obstruction recognition
• Early detection of hypoventilation
• Capnography interpretation and trend analysis
• Oversedation vs. expected sedation effects
• Recovery monitoring and discharge readiness
• Early recognition of respiratory compromise before oxygen saturation declines — a concept tested repeatedly on the CRN exam

Contrast Media & Adverse Reactions

• Mild, moderate, and severe contrast reactions
• Delayed contrast reactions occurring 24–72 hours post-exposure
• Differentiating allergic reactions from vasovagal responses
• Identification and management of bronchospasm
• Recognition of contrast-induced hypotension
• Appropriate escalation of care when airway involvement develops

Interventional & Vascular Complications

• Femoral and arterial access monitoring
• Hematoma identification and management
• Retroperitoneal hemorrhage and hidden bleeding
• Ischemia and compromised perfusion
• Compartment syndrome recognition
• Post-procedure bleeding and vascular assessment
• Scenarios that train recognition of complications even when access sites appear normal

Neurological Assessment & Emergencies

• Stroke recognition and rapid response
• Sudden changes in mental status
• Identification of focal neurological deficits
• Time-sensitive escalation and emergency activation
• Post-procedure neurological monitoring priorities

Renal Protection & Contrast Nephropathy

• Identification of high-risk patients
• Dehydration vs. misleading “normal” lab values
• Diabetes-related renal risk
• Hydration advocacy and prevention strategies
• Patient education for kidney protection

Radiation Safety, Ethics & Professional Practice

• Radiation safety principles and ALARA compliance
• Fluoroscopy exposure awareness
• Recognition of radiation-related skin injury
• Ethical informed consent
• Patient advocacy and professional accountability
• Quality improvement and safety culture in radiology nursing

Discharge Safety & Patient Education

• Safe discharge criteria after sedation
• Activity and driving restrictions
• Teach-back methods to confirm understanding
• Recognition of delayed complications
• Legal and ethical discharge responsibilities
• Together, these domains reflect the full scope of the nurse radiology certification exam and prepare candidates for the depth and complexity of the CRN test.

Who This CRN Practice Test Is Perfect For

This resource is ideal for radiology nurses preparing to take the CRN exam, whether you work in CT, interventional radiology, cath lab, nuclear medicine, or procedural imaging. It is equally valuable for interventional RNs and imaging nurses who want preparation that reflects their daily clinical environment.

It is especially well suited for busy working nurses who are preparing around shifts. Because the practice questions are self-contained and explanation-driven, you can study in focused sessions without committing to long lectures or rigid schedules. Even short study periods provide meaningful progress because each question teaches exam logic, not just content.

If you are looking for realistic radiology practice tests that challenge your thinking the same way the CRN exam does, this practice test is designed for you.

Benefits of Using This CRN Practice Test

One of the biggest benefits of this CRN Test Prep resource is confidence. When you repeatedly practice exam-level scenarios, the real test feels familiar rather than intimidating. You learn how to spot early warning signs, avoid overreaction, and choose the safest intervention at the right time.

Another major benefit is strengthened critical thinking for interventional and imaging nursing. The skills reinforced here — airway awareness, escalation timing, vascular assessment, and neurological vigilance — translate directly to improved patient safety on the job.

Most importantly, this practice test is designed to help you pass on the first attempt. It targets the exact reasoning errors that cause experienced nurses to fail, helping you correct them before exam day.

How This CRN Practice Test Is Different From Other Prep Materials

Many prep resources rely on abstract theory or broad nursing concepts that don’t reflect the CRN exam. This radiology nurse practice test is written in clear, clinical language that mirrors how nurses actually think and speak in practice. There is no unnecessary theory, no academic padding, and no confusing terminology.

Unlike generic nursing review products, this resource is built specifically for the CRN exam. The questions are not recycled from NCLEX-style banks or general nursing exams. They are designed around CRN exam patterns, including trap answers, priority reversals, and evolving patient scenarios.

This focus on exam-specific reasoning is what sets this CRN Practice Test apart. It doesn’t just test what you know — it trains how you think.

A Smarter Way to Prepare for the CRN Exam

Preparing for certification should feel purposeful, not overwhelming. With this radiology nurse practice exam, every question moves you closer to exam readiness by sharpening judgment, reinforcing safe decision-making, and building familiarity with CRN-style thinking.

If you’re serious about earning your CRN credential and want preparation that reflects the real exam, this certified radiology nurse practice test provides the structure, depth, and realism you need.

Start your CRN Exam Practice Questions with confidence, strengthen your clinical reasoning, and prepare to take the CRN exam knowing you’ve trained the right way.

Radiology Nurse Sample Questions and Answers

Question 1

Which responsibility is primary for the radiology nurse during administration of IV contrast media?

A. Selecting the imaging protocol
B. Monitoring the patient for adverse reactions
C. Adjusting imaging equipment settings
D. Interpreting diagnostic images

Correct Answer: B

Explanation:
A primary role of the radiology nurse during IV contrast administration is patient safety monitoring. Contrast agents can cause reactions ranging from mild nausea and itching to severe anaphylaxis. The nurse must assess allergies, renal function history, and previous contrast reactions before administration and continuously observe the patient during and after injection. Responsibilities include monitoring vital signs, recognizing early signs of contrast reaction, and initiating emergency protocols if needed. Image interpretation and protocol selection fall under the radiologist’s scope, while equipment adjustments are performed by technologists. Continuous patient observation is the nurse’s most critical responsibility in this scenario.

Question 2

Which assessment finding would most strongly indicate a high risk for contrast-induced nephropathy (CIN)?

A. History of asthma
B. Diabetes mellitus with elevated creatinine
C. Shellfish allergy
D. Controlled hypertension

Correct Answer: B

Explanation:
Contrast-induced nephropathy is a serious complication associated with iodinated contrast use. Patients with diabetes mellitus combined with impaired renal function are at significantly increased risk. Elevated serum creatinine reflects reduced kidney filtration, making it harder to clear contrast material from the body. While asthma and shellfish allergies may suggest allergic risk, they do not directly predict CIN. Controlled hypertension alone is not a primary risk factor. Radiology nurses must identify at-risk patients, ensure adequate hydration, verify lab values, and collaborate with providers to reduce kidney injury risk.

Question 3

Before an MRI procedure, which item must always be removed from the patient?

A. IV catheter
B. Insulin pump
C. Plastic dentures
D. Cotton gown

Correct Answer: B

Explanation:
MRI environments involve powerful magnetic fields that can attract ferromagnetic objects and disrupt electronic devices. Insulin pumps contain metal and electronic components that may malfunction or become projectiles in the MRI scanner. This presents serious safety hazards. While IV catheters and cotton gowns are MRI-safe, and most plastic dentures are non-metallic, insulin pumps must always be removed prior to entering the MRI suite. Radiology nurses are responsible for performing thorough MRI safety screening to prevent injuries, device malfunctions, and life-threatening events.

Question 4

What is the most appropriate nursing action when a patient reports itching and hives after contrast injection?

A. Continue monitoring only
B. Immediately call a code blue
C. Stop contrast infusion and notify the provider
D. Place the patient in Trendelenburg position

Correct Answer: C

Explanation:
Itching and hives are signs of a mild to moderate contrast reaction, indicating hypersensitivity. The appropriate response is to stop the contrast infusion immediately, maintain IV access, and notify the radiologist or provider. Additional interventions may include administering antihistamines per protocol. Calling a code blue is reserved for severe reactions such as airway compromise or cardiovascular collapse. Trendelenburg positioning is not indicated for allergic reactions. Prompt recognition and action help prevent progression to more serious complications.

Question 5

A patient with heart failure requires contrast imaging. The provider orders aggressive IV hydration.

What should the radiology nurse do?

A. Carry out the order without question
B. Advocate for individualized hydration strategy
C. Cancel the procedure
D. Administer diuretics independently

Correct Answer: B

Explanation:
Patients with heart failure are at risk for fluid overload and pulmonary edema. The nurse must advocate for individualized hydration, balancing renal protection with cardiac safety. Independent medication changes are outside scope, and cancellation is not automatic. CRN exams emphasize advocacy and interdisciplinary communication.

Question 6

Which vital sign change may indicate an early vasovagal reaction during a radiologic procedure?

A. Hypertension and tachycardia
B. Hypotension and bradycardia
C. Hypertension and bradycardia
D. Fever and tachypnea

Correct Answer: B

Explanation:
A vasovagal reaction occurs due to stimulation of the vagus nerve, often triggered by anxiety, pain, or needle insertion. Early signs include hypotension and bradycardia, accompanied by pallor, diaphoresis, and dizziness. Recognizing these changes early allows the radiology nurse to intervene by positioning the patient supine, elevating the legs, and monitoring vital signs. Hypertension and tachycardia are more consistent with anxiety or pain responses rather than vasovagal syncope.

Question 7

Which patient statement requires immediate follow-up before a CT scan with contrast?

A. “I have seasonal allergies.”
B. “I am mildly claustrophobic.”
C. “I take metformin for diabetes.”
D. “I had an X-ray last year.”

Correct Answer: C

Explanation:
Patients taking metformin require careful evaluation before contrast administration because of the risk of lactic acidosis if renal function is impaired. The radiology nurse must verify recent kidney function tests and follow institutional protocols regarding withholding metformin before and after contrast exposure. Seasonal allergies and claustrophobia do not directly contraindicate contrast use, and prior X-ray history is not relevant. Identifying medication-related risks is a critical nursing responsibility in radiologic care.

Question 8

What is the primary purpose of time-out procedures in interventional radiology?

A. Reducing patient anxiety
B. Ensuring accurate documentation
C. Preventing wrong-site or wrong-procedure errors
D. Allowing equipment calibration

Correct Answer: C

Explanation:
The time-out procedure is a standardized safety practice designed to prevent wrong-patient, wrong-site, or wrong-procedure errors. It involves verifying patient identity, procedure, site, and consent before starting. Radiology nurses actively participate in this process to promote patient safety and compliance with regulatory standards. While time-outs may indirectly reduce anxiety and improve documentation accuracy, their primary purpose is error prevention during invasive or high-risk radiologic procedures.

Question 9

Which laboratory value is most critical to review prior to administering iodinated contrast?

A. Hemoglobin
B. White blood cell count
C. Serum creatinine
D. Platelet count

Correct Answer: C

Explanation:
Serum creatinine reflects renal function and is essential in determining a patient’s ability to safely clear iodinated contrast material. Elevated creatinine levels increase the risk of contrast-induced nephropathy. Radiology nurses must verify current lab values, especially in elderly patients or those with diabetes, dehydration, or kidney disease. While hemoglobin, WBC count, and platelets are important in other clinical contexts, they do not directly impact contrast clearance.

Question 10

A patient undergoing moderate sedation begins to show early signs of hypoventilation.

Which findings support this assessment? (Select all that apply)

A. Rising end-tidal CO₂
B. Oxygen saturation of 98%
C. Shallow respirations
D. Decreasing capnography waveform amplitude
E. Bradycardia

Correct Answers: A, C, D

Explanation:
Hypoventilation is best detected by ventilatory indicators, not oxygenation alone. Rising ETCO₂ and decreased waveform amplitude indicate reduced ventilation. Shallow respirations further support this. Normal SpO₂ is a trap—it may remain normal despite CO₂ retention. Bradycardia is not an early sign of hypoventilation and would suggest a different process.

Question 11

Which patient condition places them at the highest risk for complications during moderate sedation?

A. Controlled hypothyroidism
B. History of obstructive sleep apnea
C. Mild anemia
D. Seasonal allergies

Correct Answer: B

Explanation:
Patients with obstructive sleep apnea (OSA) are at increased risk during moderate sedation due to airway obstruction and hypoventilation. Sedatives depress respiratory drive and muscle tone, which can worsen airway collapse in OSA patients. Radiology nurses must identify this risk during pre-procedure screening, ensure appropriate monitoring, and be prepared for airway support. Controlled hypothyroidism, mild anemia, and seasonal allergies do not pose the same level of sedation-related respiratory risk.

Question 12

What is the primary nursing responsibility immediately after an interventional radiology procedure?

A. Removing all monitoring devices
B. Documenting procedure duration only
C. Assessing the puncture site and vital signs
D. Transporting the patient back to the unit

Correct Answer: C

Explanation:
After an interventional radiology procedure, the nurse’s priority is monitoring patient stability, which includes frequent assessment of vital signs and the puncture or access site for bleeding, hematoma, or infection. Early detection of complications such as hemorrhage or hypotension is critical. Documentation and transport are important but secondary. Continuous post-procedure assessment helps prevent life-threatening complications and supports safe recovery.

Question 13

Which sign suggests local anesthetic toxicity during a radiologic procedure?

A. Hypotension and pallor
B. Ringing in the ears and metallic taste
C. Bradycardia and hypothermia
D. Productive cough

Correct Answer: B

Explanation:
Early signs of local anesthetic systemic toxicity (LAST) include neurological symptoms such as tinnitus (ringing in the ears), metallic taste, dizziness, and circumoral numbness. These symptoms may progress to seizures or cardiac arrhythmias if not addressed promptly. Radiology nurses must recognize these early warning signs, stop medication administration, and notify the provider immediately. Prompt intervention can prevent severe complications.

Question 14

Which factor most increases a patient’s exposure to radiation during fluoroscopy?

A. Patient age
B. Procedure duration
C. Body temperature
D. Heart rate

Correct Answer: B

Explanation:
Procedure duration is the most significant contributor to radiation exposure during fluoroscopy. The longer fluoroscopy is used, the greater the cumulative radiation dose. Radiology nurses help minimize exposure by assisting with efficient workflow, proper patient positioning, and advocating for radiation safety principles such as ALARA (As Low As Reasonably Achievable). Age, temperature, and heart rate do not directly affect radiation dose.

Question 15

What is the best nursing action if a patient becomes hypotensive after contrast administration?

A. Administer oral fluids
B. Lower the head of the bed
C. Stop contrast and initiate emergency protocol
D. Continue monitoring only

Correct Answer: C

Explanation:
Sudden hypotension following contrast administration may indicate a severe adverse reaction, including anaphylaxis. The nurse must immediately stop the contrast, maintain IV access, initiate emergency response protocols, and notify the provider. Supportive care such as oxygen, IV fluids, and medications may be required. Simply lowering the bed or monitoring without intervention could delay lifesaving treatment.

Question 16

Which assessment finding requires immediate reporting after arterial catheter removal?

A. Mild bruising at the site
B. Small amount of dried blood
C. Expanding hematoma
D. Slight tenderness

Correct Answer: C

Explanation:
An expanding hematoma indicates ongoing bleeding and potential vascular compromise, requiring immediate intervention. Radiology nurses must apply pressure, assess distal pulses, and notify the provider promptly. Mild bruising, tenderness, and minimal dried blood are common and typically not emergent. Early recognition of serious complications prevents hemorrhage and tissue damage.

Question 17

Which action best reduces the risk of contrast extravasation?

A. Using the smallest catheter possible
B. Warming the contrast agent
C. Checking IV patency before injection
D. Injecting contrast rapidly

Correct Answer: C

Explanation:
Ensuring IV patency before contrast injection is the most effective way to prevent extravasation. The nurse should flush the IV, assess for pain or resistance, and confirm proper placement. Extravasation can cause tissue injury and pain. Rapid injection and inappropriate catheter selection may increase risk. Warming contrast may improve patient comfort but does not prevent infiltration.

Question 18

Which patient instruction is most important after receiving sedatives?

A. Resume normal activities immediately
B. Avoid driving for 24 hours
C. Increase caffeine intake
D. Skip meals

Correct Answer: B

Explanation:
Sedatives impair judgment, coordination, and reaction time even after the procedure appears complete. Patients must be instructed to avoid driving for at least 24 hours to prevent accidents. Radiology nurses play a key role in reinforcing post-procedure safety instructions. Encouraging normal activity, caffeine intake, or skipping meals can be unsafe or inappropriate.

Question 19

Which nursing action supports infection prevention in interventional radiology?

A. Limiting patient movement
B. Using sterile technique during procedures
C. Encouraging early ambulation
D. Reducing procedure time

Correct Answer: B

Explanation:
Strict sterile technique is essential in interventional radiology to prevent infections, especially during invasive procedures involving vascular access. Radiology nurses assist with sterile field setup, proper hand hygiene, and monitoring for breaches in aseptic technique. While reducing procedure time and limiting movement may help, sterile technique is the most critical infection prevention measure.

Question 20

Which symptom indicates a delayed contrast reaction?

A. Bronchospasm during injection
B. Hypotension immediately post-procedure
C. Rash appearing 24–72 hours later
D. Seizure within minutes

Correct Answer: C

Explanation:
Delayed contrast reactions typically occur 24 to 72 hours after contrast exposure and often present as skin rashes, itching, or mild swelling. Immediate reactions such as bronchospasm, hypotension, or seizures occur during or shortly after injection. Radiology nurses should educate patients about delayed symptoms and advise them to seek medical attention if reactions occur after discharge.

Question 21

Which patient is at highest risk for bleeding complications after biopsy?

A. Patient with controlled asthma
B. Patient taking anticoagulants
C. Patient with mild dehydration
D. Patient with anxiety

Correct Answer: B

Explanation:
Patients taking anticoagulant medications have a significantly increased risk of bleeding following invasive procedures such as biopsies. Radiology nurses must verify medication history, lab values, and provider clearance before the procedure. Asthma, dehydration, and anxiety do not directly increase bleeding risk. Proper pre-procedure assessment is essential for patient safety.

Question 22

What is the nurse’s role in radiation safety?

A. Adjusting imaging exposure settings
B. Interpreting radiation dose reports
C. Educating patients on radiation risks
D. Approving imaging protocols

Correct Answer: C

Explanation:
Radiology nurses play a vital role in patient education regarding radiation risks and safety measures. While technologists adjust exposure settings and radiologists approve protocols, nurses help patients understand procedures, alleviate anxiety, and reinforce safety principles. Clear communication improves patient cooperation and promotes informed consent.

Question 23

Which indicator suggests adequate recovery from moderate sedation?

A. Stable vital signs and alertness
B. Persistent drowsiness
C. Nausea and vomiting
D. Oxygen requirement

Correct Answer: A

Explanation:
Adequate recovery from moderate sedation is indicated by stable vital signs, alert mental status, and the ability to maintain airway reflexes. Persistent drowsiness, nausea, or oxygen dependency suggest incomplete recovery and require continued monitoring. Radiology nurses must assess readiness for discharge using standardized recovery criteria.

Question 24

Which nursing action is essential when caring for a patient with claustrophobia during MRI?

A. Proceed quickly without explanation
B. Apply physical restraints
C. Provide reassurance and coping strategies
D. Cancel the procedure immediately

Correct Answer: C

Explanation:
Patients with claustrophobia benefit from clear explanations, reassurance, and coping strategies such as breathing techniques or music. Radiology nurses help reduce anxiety and improve cooperation. Restraints and rushing the patient increase distress, while immediate cancellation may not be necessary if anxiety can be managed safely.

Question 25

Which finding indicates possible contrast extravasation?

A. Sudden cough
B. Local swelling and pain at IV site
C. Drop in oxygen saturation
D. Bradycardia

Correct Answer: B

Explanation:
Contrast extravasation presents with localized swelling, pain, and tightness at the injection site. Early identification allows prompt intervention, including stopping the injection and elevating the limb. Systemic symptoms such as cough or oxygen desaturation suggest other complications. Radiology nurses must closely observe IV sites during contrast administration.

Question 26

During moderate sedation for an interventional procedure, a patient becomes restless, oxygen saturation drops from 98% to 90%, and capnography shows rising end-tidal CO₂.

What should the nurse do first?

A. Administer reversal agents
B. Reposition airway and stimulate patient
C. Stop the procedure and document
D. Increase IV fluids

Correct Answer: B

Explanation:
The findings indicate early hypoventilation and airway obstruction, not yet respiratory arrest. The first intervention is airway repositioning (chin lift/jaw thrust) and verbal or tactile stimulation. Reversal agents may be needed later but are not first-line. Documentation and fluids do not correct ventilation. CRN-level questions emphasize recognizing early respiratory compromise and intervening before deterioration.

Question 27

Which symptom suggests anaphylaxis rather than a mild contrast reaction?

A. Itching
B. Sneezing
C. Facial swelling and airway compromise
D. Mild nausea

Correct Answer: C

Explanation:
Facial swelling and airway compromise are hallmark signs of anaphylaxis, a life-threatening emergency requiring immediate intervention. Mild symptoms such as itching, sneezing, or nausea suggest less severe reactions. Radiology nurses must rapidly differentiate reaction severity to initiate appropriate emergency protocols.

Question 28

Which intervention best supports patient comfort during lengthy procedures?

A. Restricting communication
B. Maintaining proper positioning
C. Limiting vital sign checks
D. Reducing sedation monitoring

Correct Answer: B

Explanation:
Proper patient positioning reduces discomfort, prevents pressure injuries, and supports procedural success during long radiologic exams. Radiology nurses assess alignment, padding, and patient tolerance throughout the procedure. Communication and monitoring should never be reduced, as they are essential for safety and comfort.

Question 29

Which assessment is essential before discharging a post-procedure patient?

A. Skin color only
B. Pain score and vital signs
C. Imaging results
D. Provider schedule

Correct Answer: B

Explanation:
Before discharge, radiology nurses must assess pain level, vital signs, mental status, and procedural site to ensure patient stability. Imaging results are interpreted by the provider and do not determine discharge readiness. Comprehensive assessment helps prevent post-discharge complications.

Question 30

A 68-year-old patient with diabetes and stage 3 chronic kidney disease is scheduled for a CT angiogram with iodinated contrast. The patient reports poor oral intake for the past 24 hours.

What is the most appropriate nursing priority before proceeding?

A. Administer contrast as ordered
B. Encourage hydration and notify the provider
C. Premedicate with antihistamines
D. Reduce contrast dose independently

Correct Answer: B

Explanation:
This patient presents with multiple risk factors for contrast-induced nephropathy: diabetes, chronic kidney disease, and dehydration. The nurse’s priority is to optimize renal perfusion by addressing hydration status and notifying the provider before contrast exposure. Proceeding without intervention significantly increases risk for acute kidney injury. Nurses do not independently adjust contrast dose, and antihistamines address allergic risk, not nephrotoxicity. Early advocacy is a key CRN competency.