Practice Exam Flashcards
Ms. Jacobs, 48 years old, with a diagnosis of bipolar disorder, is admitted as an involuntary client. She is loud and swears often. She is wearing mismatched bright clothing and uses excessive makeup.
Three days after admission, Ms. Jacobs remains overactive. She paces and talks loudly. She slams the wall with her hands and makes threats when approached by staff. What should be the RPNs priority?
A) Encourage fluids at least every 30-60 mins
B) Protect her from self injury by increasing observation
C) Challenge her inappropriate behavior
D) Place her in seclusion room
B) Protect her from self injury by increasing observation
- The RPN needs to control the escalating behavior, the safety of the client is priority.
When Ms. Jacobs attends the programs unit meetings, she monopolizes the discussion. What should the RPN do first?
A) Offer olanzapine 5mg prn before meetings
B) Remain quiet to allow the group to deal with Ms. Jacobs
C) Set limits on Ms. Jacobs participation in group
D) Ignore the behavior and continue the meeting
C) Set limits on Ms. Jacobs participation in the group
- limit setting is key in treating a client with mania
The RPN approaches Ms. Jacobs to involve her in the unit program, she responds “I have no time for all this nonsense, I should be in Ottawa meeting with the Prime Minister.” What should the RPN do?
A) Reinforce Ms. Jacobs involvement in the program
B) Explore Ms. Jacobs delusional content with her
C) Redirect Ms. Jacobs to self-directed activities
D) Explain the implausibility of her statements
A) Reinforce Ms. Jacobs involvement in the program
- this helps the client to achieve stability and recovery
When the RPN enters the lounge, Ms. Jacob states “here comes miss fat ass with the fast past.” What would the RPNs most appropriate response be?
A) Ignore Ms. Jacobs behavior and talk to other clients
B) Confront Ms. Jacobs about the inappropriateness of her comment
C) Acknowledge Ms. Jacobs with a calm, matter-of-fact statement
D) Leave the room and discuss the incident with Ms. Jacobs later
C) Acknowledge Ms. Jacobs with a calm, matter-of-fact statement
- Nursing care of clients with bipolar disorder should be approached in a multifaceted and compassionate manner during acute illness
- behavior should be addressed as it presents at the time
- confrontation could jeopardize the therapeutic relationship
Ms. Jacobs approaches the RPN exhibiting pressured speech and pacing. She states “I feel hot, I’m burning up.” What is the RPNs priority action?
A) Redirect Ms. Jacobs to her room to relax
B) Assess Ms. Jacobs MAR
C) Assess Ms. Jacobs vitals
D) Offer Ms. Jacobs a glass of water
C) Assess Ms. Jacobs vital signs
- knowledge of the physiology of body temperature regulation is essential for assessing and evaluating the clients response to temperature alterations and for intervening safely
After 3 weeks of treatment, Ms. Jacobs manic symptoms have decreased. She indicates that her medications are slowing her down. She reports feeling tired and is sleeping more. What should the RPN do first?
A) Allow Ms. Jacobs to catch up on her sleep
B) Assess Ms. Jacobs for symptoms of depression
C) Reassure Ms. Jacobs that she is improving
D) Consult recreation therapy for activities for Ms. Jacobs to engage in
B) Assess Ms. Jacobs for symptoms of depression
- feeling tired and sleeping more are overt signs of depression Bipolar disorder can feature depression
Jimmy, 3 years old, is referred with a differential diagnosis of Autism Spectrum Disorder. During the initial interview, his mother relates the following information. “Something is wrong with Jimmy and I don’t know what to do. Up to the age of 18 months, he appeared to be developing normally. Since then, he has become more withdrawn and has started to bite himself and bang his head.”
Jimmy’s mother appears very anxious and is tearful during the interview. What should be the RPNs most appropriate response?
A) “It sounds like you’re saying that you are not a good mother”
B) “You don’t know what to do about Jimmy’s behavior”
C) “What is most upsetting about this for you?”
D) “Do you think Jimmy’s behavior is not what it should be?”
C) “What is most upsetting about this for you?”
- parents of children with ASD can experience mental health issues as do their children
What is indicative of ASD?
A) Engaging in imaginative play
B) Displaying borderline or impaired intelligence
C) Interrupting and intruding on others
D) Having an aversion to loud noises and bright lights
D) Having an aversion to loud noises and bright lights
When planning care with Jimmy’s mother, what nursing intervention should the registered psychiatric nurse implement first?
A) Decreasing social interaction
B) Increasing physical contact
C) Encouraging self-stimulating behavior
D) Providing direction and maintaining structure
D) Providing direction and maintaining structure
- providing direction and maintaining structure would provide the foundation for individualized intervention plans
What are the most appropriate actions to manage Jimmy’s behavior?
A) Redirect Jimmy and provide positive reinforcement
B) Increase environmental stimulation and activities
C) Increase frequency of public interactions and role-play
D) Decrease family interactions and explore medication options
A) Redirect Jimmy and provide positive reinforcement
- managing ASD with redirection and positive reinforcement is recommended
Anne, 13 years old, is admitted to the unit. Anne is exhibiting symptoms of depression, not attending school, and not attending to her hygiene. Her homeroom teacher suspected she was being sexually abused by her father because of the change in her attitude whenever her father was mentioned and because of her comments about “being mom when mom is away” Investigation by social workers has resulted in the father facing criminal charges relating to sexual abuse.
The RPN is assessing Anne’s psychological status. What is a common behavioural clue of sexual abuse?
A) Openly discussing her relationship with her father
B) Distancing herself from her siblings and mother
C) Difficulty adapting to the hospital routine
D) Displaying clinging behaviours with peers
B) Distancing herself from her siblings and mother
- a child in dispair is reluctant to reattach to family
Anne asks the RPN questions such as “What is happening to my Dad?” and “Have I hurt him by talking to my teacher?” What should the RPN do?
A) Suggest that Anne not worry about her father
B) Question Anne about her family experience
C) Ask Anne to explore her personal feelings of inadequacy
D) Validate Anne’s concerns about her father
D) Validate Anne’s concerns about her father
- using validation allows the RPN to explore Anne’s feelings without alienation
Anne expresses anger to the RPN about her father. What is the RPNs most effective psychiatric nursing intervention?
A) Assure Anne that her father will not hurt her again
B) Support her in dealing with anger by teaching her distraction
C) Use role play to facilitate exploration of her experience
D) Explain that anger is normal adaptive coping and allow expression of feelings
D) Explain that anger is a normal adaptive coping and allow expression of feelings
- it is important to acknowledge that angeris a normal part of the situation and needs to be expressed
Anne is about to be discharged. She states “everyone at school knows my dad abused me” How should the RPN respond?
A) Provide education to her school peers regarding mental health
B) Contact the community social services worker
C) Refer Anne to an assertiveness training program
D) Recomend that Anne be home schooled
B) Contact the community social services worker
- the social worker has the knowledge and expertise to intervene of behalf of Anne
Mr. Alberts, 58 years old, is married and has 2 sons. He is admitted to the psychiatric inpatient unit for treatment of depression. He has parkinsons disease which has forced his recent retirement.
Until his retirement, what did his career and activities provide opportunity for?
A) Integrity versus despair
B) Intimacy versus isolation
C) Identity and role confusion
D) Generativity versus stagnation
D) Generativity versus stagnation
- these tasks are appropriate for middle adulthood (30-65)
Which parkinsonian symptoms would make it difficult to assess Mr. Albert’s depression?
A) Slowed thought process and emotional lability
B) Bradykinesia and mask like affect
C) Postural instability, voluntary movements
D) Flat affect and ataxia
B) Bradykinesia and mask like affect
Mr. Alberts is sitting alone following his wife’s visit. He states to the RPN “I know my family would be better off without me” During the next half hour, he makes several comments about feeling useless and wishing he were dead. What is the priority action?
A) Increase observation level and tell him how much his family values him
B) Complete a Mini-Mental State Exam (MMSE)
C) Assess the environment and increase observation level
D) Ask him to seek out staff rather than harm himself
C) Assess the environment and increase observation level
- This addresses immediate safety concerns for the client
Mr. Alberts’ family experiences difficulty coping with his diagnosis. What is the RPNs role with the family?
A) Encourage the family to learn about his disease and access resources
B) Suggest more family outings
C) Discuss disability insurance options and right to choose
D) Refer the family to social work
A) Encourage the family to learn about his disease and access resources
- this advocates for client care and wellness
Mr. Alberts is preparing to go home. What should the RPN include in his discharge teaching?
A) Recommend that he make appropriate adjustments to his expectations
B) Encourage him to use a wheelchair and restrict leisure activities
C) Remind him to participate in religious or cultural healing regularly
D) Reinforce the impact of exercise and rest on relapse prevention
D) Reinforce the impact of exercise and rest on relapse prevention
- this is evidence-supported practice for preventing relapse
Mr. Martin, 42 years old, was admitted at 2000 for evaluation of recent behavioural changes. Over the past 3 days, he has become increasingly irritable, shouting at his children for no apparent reason, confused regarding his work schedule, restless and unable to sit for more than 10 minutes.
Mr. Martin’s wife indicates that 3 days ago, her husband slipped on an icy sidewalk, fell and hit the right side of his head. There is moderate swelling on the right side of Mr. Martin’s head. What should the RPN do first?
A) Encourage sleep on his left side to prevent thrombosis
B) Initiate a neurological assessment every 2 hours
C) Assess for post-traumatic amnesia
D) Contact physician for CT scan order
B) Initiate a neurological assessment every 2 hours
- this is best practice for objective data collection for head injury
- an assessment is required to collect data to justify a request for a CT scan
What is the most reliable index of Mr. Martin’s neurological status?
A) Vital signs
B) Level of consciousness
C) Pupilary reaction
D) Motor activity
B) Level of consciousness
- this is a sensitive and early indication of neurological trauma
- patients can have stable vital signs even with neurological trauma
What would indicate increased increased intracranial pressure?
A) Increased drowsiness and rising blood pressure
B) Increased drowsiness and decreased temperature
C) Reports of tinnitus and rising blood pressure
D) Reports of tinnitus and decreased temperature
A) Increased drowsiness and rising blood pressure
- a change in LOC and an increase in systolic blood pressure would indicate increased intracranial pressure
- hyperthermia would be a symptom
Mr. Martin suddenly begins to vomit, inaddition to the onset of vomiting, what would indicate the need for immediate medical attention?
A) Increase in respiratory rate
B) Nystagmus during lateral gaze
C) Decrease in swallowing
D) Severe headache
D) Severe headache
- vomiting and severe headache could be signs of increased intracranial pressure
Mr. Morrow, 32 years old, is admitted to the unit earing a bra and panties, skin-tight shorts and a shirt. He believes his medications are female hormones. He writes numerous letters to the Prime Ministerand the local police when staff members respond in a way he does not like.
Just admitted, Mr. Morrow is dishevelled, malodorous, delusional and hungry, but co-operative. What are the priority RPN actions?
A) Administer medications to decrease delusions
B) Provide food and assess environmental setting
C) Start a nursing history and encourage independence
D) Remain in his room until he tends to his activities of daily living
B) Provide food and assess environmental setting
- ensuring client safety and providing nourishment are the priority actions
Mr. Morrow writes or phones authority figures and brags that a picture of him is worth one million dollars, what should the RPN do initially?
A) Listen to his beliefs and focus on feelings rather than content of delusions
B) Interact with him for short periods providing reality-based feedback
C) Confront him about his altered thought process
D) Redirect him to activity group
B) Interact with him for short periods providing reality-based feedback
- The RPN needs to reinforce reality. Long discussions do not decrease delusional disorders
- The RPN should be providing reality-based feedback
After the RPN talks to him about his identity, Mr. Morrow begins pacing and becomes verbally abusive saying he will instruct the CIA to have the RPN killed, how should the RPN proceed?
A) Place him in seclusion and increase observation level
B) Give him the choice of an oral or IM medication
C) Prepare an IM medication and have team members assist in administering it
D) Discuss the best approach with team members and recommend p.r.n. use of medication
D) Discuss the best approach with team members and recommend p.r.n. use of medication
- least restrictive and collaborative measures are best practice
- safety is paramount, team involvement is required when a client is verbally abusive
- least restrictive intervention possible
Mr. Morrow has been on his regular medication Haldol (haloperidol) 5mg twice daily for 3 days. He is experiencing muscle spasms, eyes rotating upwards, and protrusion of the tongue. What are these symptoms of?
A) Pseudo-parkinsonism
B) Akathisia
C) Dystonia
D) Akinesia
C) Dystonia
The RPN determines that he is experiencing extrapyramidal symptoms. Which p.r.n. medication should the RPN anticipate?
A) diazepam (Valium) 5mg
B) lorazepam (Ativan) 2mg
C) atropine sulphate (Atropine) 1ml
D) benztropine (Cogentin) 2mg
D) benztropine (Cogentin) 2 mg
- this medication blocks cholinergic activity that causes parkinsonian symptoms
Mr. Ostrowski, 42 years old, has a long history of alcohol use. He has recently been fired from his job. He has just admitted himself to the drug and alcohol detoxification centre. He is anxious and has not had a drink in the past 72 hours.
Mr. Ostrowski says to the RPN “you can’t make me stop drinking, I’m leaving” What is the most appropriate response?
A) Initiate discharge process
B) Encourage client to remain in treatment
C) Inform client that he would be signing out against medical advice
D) Offer ordered p.r.n. anxiolytic
B) Encourage client to remain in treatment
- in spite of the voluntary status, the RPN has an obligation to ensure that the client understands the consequences of his actions
What bests describes delirium tremens?
A) A rhythmic tremor of the hands that increases with intentional movement
B) A fearful, excited state and perceptual disturbances
C) A genralized shaking of the body, most noticeable in the resting state
D) Gross incoordination and disorganization of both speech and muscle activity
B) A fearful, excited state and perceptual disturbances
- these are features of alcohol withdrawal delirium
Later in the shift, the RPN notices that Mr. Ostrowski is becoming more agitated and confused, often calling the RPN by his wife’s name. He brushes at his clothing and shouts “help get these bugs off me!” What should be the priority intervention?
A) Place him in a low stimuli environment
B) Administer ordered p.r.n. diazepam (Valium)
C) Physically restrain him to promote safety
D) Administer ordered p.r.n. olanzapine
B) Administer ordered p.r.n. diazepam (Valium)
- diazepam is used to reduce symptoms and prevent seizures in delirium tremens
- antipsychotics are not used in the treatment of withdrawal symptoms
The client has vomited on his shirt. When the RPN offers Mr. O a gown to put on, he makes a series of obscene remarks and then purposefully strikes the RPNs arm. What would be the priority action?
A) Request assistance to help change client’s gown
B) Increase observation level to every 15 minutes
C) Ask him to control himself and calm down
D) Request additional staff for constant observation
D) Request additional staff for constant observation
- the level of observation should match the intensity of the risk
- just changing the gown doesn’t address the safety issue
- q15 obs is too low
- the client is unable to respond to rational direction
The morning after his admission, Mr. O is oriented. As the RPN is getting ready to leave, he says “I don’t remember anything about last night, but I must have been pretty nasty.” What would be the RPNs best therapeutic strategy?
A) Safety and security
B) Validation
C) Structured interaction
D) Open communication
D) Open communication
- This invites him to participate in a therapeutic relationship
- client is no longer an immediate safety risk
The following evening, his wife comes to visit him. She says to the RPN, “I’ve really tried to help him, I don’t know what to do.” What should the RPN do?
A) Identify enabling behaviours
B) Complete a family assessment including a genogram
C) Engage the wife in conversation about what has worked in the past
D) Refer the wife to alcoholics anonymous
C) Engage the wife in conversation about what has worked in the past
- this facilitates the recovery model
Mr. Watson, 23 years old with a diagnosis of schizophrenia, is admitted to the unit after an acute episode of psychosis. Before admission, he was able to function marginally in his own apartment. He often ran out of money by the end of the month because he smokes 25 cigarettes a day. He has been threatened twice with eviction for not keeping his place clean. His mother often comes to clean his apartment since she is worried about her son ending up on the street.
Mr. Watson did not respond well to his previous antipsychotic medication. His psychiatrist has decided to start clozapine (Clozaril). Mr. Watson has also been diagnosed with chronic asthma.
The RPN gives Mr. W his p.r.n. bronchial inhalers for shortness of breath. 15 minutes later, the RPN notices that Mr. W’s face shows pallor and he has nasal flaring. He is also having difficulty talking. What should the RPN do?
A) Arrange immediate medical intervention
B) Repeat p.r.n. bronchial inhaler
C) Encourage stress management techniques
D) Give p.r.n. lorazepam
A) Arrange immediate medical intervention
- This is a medical emergency. He is having a serious asthma attack and requires medical intervention that the psychiatry unit is unable to provide
Mr. Watson is scheduled for his first dose of clozapine. What information should the RPN provide the client?
A) The need for blood work once a week
B) To avoid taking this medication with grapefruit juice
C) The need for blood work once a month
A) The need for blood work once a week
- Health Canada mandates that blood work must be done weekly for the first 6 months
Mr. W has been given nicotine replacement therapy but is requesting to have a cigarette outside. What should the RPN do to promote long-term well being?
A) Provide health teaching regarding smoking and asthma
B) Refer Mr. W to a tobacco cesation therapist
C) Ask the physician to discontinue the nicotine patch prior to Mr. Watson going off unit
D) Warn Mr. W of the dangers of smoking while wearing a nicotine patch
A) Provide health teaching regarding smoking and asthma
- this promotes strategies that could improve Mr. Watsons long-term well being
Mr. W’s family hears that a trial of clozapine has been ordered and they are quite concerned. They have heard that a number of people have died while on this medication. What should the psychiatric nurse do?
A) Suggest that the family research the medication on the internet
B) Provide the family with information including the risk and benefits of clozapine
C) Validate their fears and reassure the family that they have nothing to worry about
D) Connect the family to social worker
B) Provide the family with information including the risks and benefits of clozapine
Mr. W is 10 days into the clozapine trial. His blood work indicates that his white blood cell count and absolute neutrophil count are within normal range, but his troponins, creating kinase and C-reactive protein are elevated. His temperature is 38.1 and he reports fatigue. What should the RPN be concerned about?
A) Agranulocytosis
B) Myocarditis
C) Neuroleptic malignant syndrome
D) Acute infection
B) Myocarditis
- the client is within 8 weeks of the commencement of clozapine and has elevated troponins, creatine kinase, and c-reactive protein. These are all markers for myocarditis
Mr. Watson has been stabalized. The RPN is doing discharge planning with Mr. W. His family insists that he be placed in a residential facility but Mr. W refuses. What should the RPN do?
A) Facilitate Mr. W moving back to his apartment and suggest recovery-based supports
B) Support his family in completing a referral for Mr. W to live in a residential facility
C) Refer Mr. W to a social worker for a capacity assessment
D) Explore residential facility options with Mr. W
A) Facilitate Mr. W moving back to his apartment and suggest recovery-based supports
- The client has the right to live at risk, the client may be willing to accept supports if it means being able to stay in his own place
