Practice Exam

Question 1

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

Answer 1

B) Protect her from self injury by increasing observation

- The RPN needs to control the escalating behavior, the safety of the client is priority.

Question 2

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

Answer 2

C) Set limits on Ms. Jacobs participation in the group

- limit setting is key in treating a client with mania

Question 3

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

Answer 3

A) Reinforce Ms. Jacobs involvement in the program

- this helps the client to achieve stability and recovery

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

B) Assess Ms. Jacobs for symptoms of depression

- feeling tired and sleeping more are overt signs of depression Bipolar disorder can feature depression

Question 7

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?”

Answer 7

C) “What is most upsetting about this for you?”

- parents of children with ASD can experience mental health issues as do their children

Question 8

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

Answer 8

D) Having an aversion to loud noises and bright lights

Question 9

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

Answer 9

D) Providing direction and maintaining structure

- providing direction and maintaining structure would provide the foundation for individualized intervention plans

Question 10

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

Answer 10

A) Redirect Jimmy and provide positive reinforcement

- managing ASD with redirection and positive reinforcement is recommended

Question 11

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

Answer 11

B) Distancing herself from her siblings and mother

- a child in dispair is reluctant to reattach to family

Question 12

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

Answer 12

D) Validate Anne’s concerns about her father

- using validation allows the RPN to explore Anne’s feelings without alienation

Question 13

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

Answer 13

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

Question 14

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

Answer 14

B) Contact the community social services worker

- the social worker has the knowledge and expertise to intervene of behalf of Anne

Question 15

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

Answer 15

D) Generativity versus stagnation

- these tasks are appropriate for middle adulthood (30-65)

Question 16

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

Answer 16

B) Bradykinesia and mask like affect

Question 17

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

Answer 17

C) Assess the environment and increase observation level

- This addresses immediate safety concerns for the client

Question 18

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

Answer 18

A) Encourage the family to learn about his disease and access resources
- this advocates for client care and wellness

Question 19

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

Answer 19

D) Reinforce the impact of exercise and rest on relapse prevention
- this is evidence-supported practice for preventing relapse

Question 20

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

Answer 20

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

Question 21

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

Answer 21

B) Level of consciousness

• this is a sensitive and early indication of neurological trauma
• patients can have stable vital signs even with neurological trauma

Question 22

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

Answer 22

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

Question 23

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

Answer 23

D) Severe headache

- vomiting and severe headache could be signs of increased intracranial pressure

Question 24

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

Answer 24

B) Provide food and assess environmental setting

- ensuring client safety and providing nourishment are the priority actions

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

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

Answer 27

C) Dystonia

Question 28

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

Answer 28

D) benztropine (Cogentin) 2 mg | - this medication blocks cholinergic activity that causes parkinsonian symptoms

Question 29

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

Answer 29

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

Question 30

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

Answer 30

B) A fearful, excited state and perceptual disturbances | - these are features of alcohol withdrawal delirium

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

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

Answer 33

D) Open communication - This invites him to participate in a therapeutic relationship - client is no longer an immediate safety risk

Question 34

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

Answer 34

C) Engage the wife in conversation about what has worked in the past - this facilitates the recovery model

Question 35

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

Answer 35

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

Question 36

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

Answer 36

A) The need for blood work once a week | - Health Canada mandates that blood work must be done weekly for the first 6 months

Question 37

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

Answer 37

A) Provide health teaching regarding smoking and asthma | - this promotes strategies that could improve Mr. Watsons long-term well being

Question 38

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

Answer 38

B) Provide the family with information including the risks and benefits of clozapine

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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

Question 41

The RPN is working on a geriatric assessment unit and admits Mr. Youngblood. He is 70 years old and lives in a nearby First Nations Community. He has a diagnosis of dementia and type 2 diabetes but has not responded to oral hypoglycemic agents. Humulin (R) insulin is ordered. Which of the following symptoms would suggest that Mr. Youngblood has hypoglycemia? A) Nausea, vomiting, flushed skin B) Pallor, fatigue, dyspnea C) Hyperpnea, drowsiness, fever D) Irritability, diaphoresis, trembling

Answer 41

D) Irritability, diaphoresis, trembling

Question 42

What should the RPN do immediately if signs of hypoglycemia are present? A) Utilize glucometer and test urine glucose B) Administer insulin and offer dextrose tablets C) Withhold insulin and administer glucose D) Utilize glucometer and notify the physician

Answer 42

C) Withhold insulin and administer glucose - this is the correct protocol - the physician does not need to be notified unless the patients condition deteriorates

Question 43

Mr. Y's condition has stabalized. He is being discharged and has been prescribed metformin HCl (Glucophage) What should the RPN teach Mr. Y about metformin HCl? A) It may cause indigestion and dry mouth B) It may cause headaches and bloating C) It may cause weight gain and metallic taste D) It may cause nausea and vomiting

Answer 43

D) It may cause nausea and vomiting

Question 44

The RPN is teaching Mr. Y about self-foot care. What should be included in the teaching? A) Encourage circulation by rubbing with a towel B) Wear open-toed shoes C) Remove calluses and corns promptly D) Change socks daily

Answer 44

D) Change socks daily

Question 45

While preparing the client's discharge, the RPN observes that the community to which Mr. Youngblood is returning, lacks access to support services. How should the RPN address the situation? A) Engage community leaders in a discussion to identify the community health-care priorities B) Suggest that Mr. Y move to the nearest urban community in order to have access to services C) Instruct the community about its lack of resources and support D) Initiate fundamental changes for essential health promotion and opportunity

Answer 45

A) Engage community leaders in a discussion to identify the community health-care priorities - the RPN is advocating for community empowerment in a manner consistent with community development principles

Question 46

Jane, 17 years old, is referred by her school counsellor to the community mental health centre. Jane, who has been academically strong, very outgoing, and socially active, has become increasingly reclusive, is skipping classes and avoiding her friends. The relationship with her parents has deteriorated. Her mother accompanies her to the interview. The RPN introduces herself and explains that she will first see Jane alone. What does the RPN hope achieve by assessing Jane on her own? A) To establish a rapport with her B) To explore her feelings toward her mother C) To establish authenticity in the therapeutic relationship I D) To observe self-awareness in the reflective process

Answer 46

A) To establish rapport with her | - This is the RPNs primary task in order to establish interpersonal relationship

Question 47

Jane says "I've got so many problems - where do I start? My mother is my biggest problem - she's always interfering with my life" What therapeutic communication strategy should the RPN use?" A) Reflecting B) Exploring C) Therapeutic use of silence D) Restating

Answer 47

B) Exploring | - the RPN should explore the feelings/thoughts underlying the client's statement and get more information

Question 48

Jane bursts into tears, "Do you really want to know what's wrong with me? I think I have a sexually transmitted infection." What should the RPN assess first? A) Age of first sexual activity B) Names of her contacts C) Her symptoms D) Use of contraceptives

Answer 48

C) Her symptoms - The RPN needs to establish the facts of whether she has a sexually transmitted infection before proceeding with protocol

Question 49

Jane reveals that she has had a "lot of boyfriends" with whom she has been sexually active. What is important for the registered psychiatric nurse to do? A) Be aware of areas of conflict relating to the RPNs own attitudes and feelings about sexual issues B) Validate and confirm that her behaviour is becoming common among girls of her age C) Assess whether Jane's sexual behaviour is due to an adjustment disorder D) Using the principles of self-disclosure, share own thoughts and feelings about adolescent sexual activity

Answer 49

A) Be aware of areas of conflict relating to the RPNs own attitudes and feelings about sexual issues - RPNs should be aware of any biases that may impact client-centred care

Question 50

Mrs. Wilson, 70 years old, is admitted to the older adult unit with a diagnosis of dementia. She is accompanied by her daughter. Mrs. Wilson has been neglecting her hygiene, is forgetful and argumentative, and seldom sleeps. Mrs. Wilson's affect and emotional responses are inappropriate. The daughter states that she can no longer care for her mother at home. During a family meeting, Mrs. Wilson's daughter discloses that she is feeling guilty about her mother's hospitalization. What is the most appropriate response by the RPN? A) Explain that RPNs have specialized knowledge of working with dementia B) Reassure the daughter that she has made the right decision C) Ask her to elaborate on her thoughts and feelings D) Explain best practices for dementia home care

Answer 50

C) Ask her to ellaborate on her thoughts and feelings | - This response will support and empower the daughter

Question 51

What is most important for the RPN to inform Mrs. Wilson's family about dementia? A) The use of visual aids will improve Mr. Wilson's prognosis B) Medication will help Mrs. Wilson improve her memory C) Mrs. Wilson may become more irritable and disoriented over time D) Early intervention with dementia prevents memory loss

Answer 51

C) Mrs. Wilson may become more irritable and disoriented over time - Dementia is a progressive degenerative illness and includes mood changes and loss of orientation over time

Question 52

The RPN has completed a MMSE (mini mental state examination). What is the purpose of the MMSE? A) To diagnose cognitive function and track changes B) To screen cognitive function and to track changes C) To diagnose cognitive function and to screen mood D) To screen cognitive function and to screen mood

Answer 52

B) To screen cognitive function and to track changes | - The MMSE screens for cognitive dysfunction , does NOT screen mood, SI

Question 53

During the day, Mrs. Wilson is pleasant and co-operative. At night, she yells, strips off her bedclothes and tries to get into bed with other clients. What should the RPN do? A) Reinforce the need for her to settle and get some sleep B) Keep her in seclusion overnight to promote safety C) Administer p.r.n. sedation and put up her bed rails D) Assess for pain, hunger, urinary retention, and constipation

Answer 53

D) Assess for pain, hunger, urinary retention, and constipation - physical conditions associated with sundowning are pain and unmet needs such as hunger and elimination - sedation would increase her risk of falls - seclusion is not necessarily safer

Question 54

Mrs. Wilson stumbles to the floor and receives a laceration to her forehead. Her daughter insists that Mrs. Wilson be restrained to prevent further injuries. How should the RPN initially respond to the request? A) Inform the daughter that restraints are no longer used in practice B) Phone the attending physician for a restraint order C) Provide teaching regarding the use of restraints D) Educate the daughter on the use of medication to manage symptoms

Answer 54

C) Provide teaching regarding the use of restraints | - restraints can increase the risk of falls, not lower the risk

Question 55

Ms. Lee, 19 years old, is a first-year university student admitted to hospital because of self-inflicted lacerations. She is diagnosed with borderline personality disorder. What best indicates the need for the hospitalization of clients with borderline personality disorder? A) Suicidal behaviour B) Affective instability C) Escalation of superficial cutting D) Pseudo-psychosis

Answer 55

A) Suicidal behaviour - hospitalization is a priority for any life-threatening situation - escalated superficial cutting may not require hospitalization

Question 56

Ms. Lee's psychiatrist and primary RPN meet with her at the onset of admission to discuss her treatment plan. Which of the following is essential in developing a plan of care? A) Allowing Ms. Lee to be autonomous in her care planning B) Setting realistic, time-focused goals C) Encouraging Ms. Lee to develop relationships D) Promoting self-medication practices

Answer 56

B) Setting realistic, time-focused goals - to enhance treatment, it is important to make an individual plan and set realistic goals - relationships are often impaired in BPD, getting into another relationship may increase the crisis level - she needs a consistent environment where boundaries are set in order to manage to current crisis

Question 57

What behaviour should the RPN expect to see during Ms. Lee's hospitalization? A) Isolating herself in hospital room B) Evading personal relationships C) Frequent crises and dysfunctional relationships D) Lacking remorse and disregarding unit milieu

Answer 57

C) Frequent crises and dysfunctional relationships | - people with BPD often blame and attack others. This leads to stormy relationships and frequent crises

Question 58

During the RPNs shift, Ms. Lee superficially cuts her wrists. What should the RPN do? A) Address Ms. Lee's behaviour in a matter of fact manner B) Restrict Ms. Lee's access to unit activities C) Focus on Ms. Lee's behaviour and impact on the unit D) Transfer Ms. Lee to the emergency department

Answer 58

A) Address Ms. Lee's behaviour in a matter of fact manner - self-destructive behaviour should be addressed in a non-judgemental, matter of fact manner. Alternative to self-harm behaviour should be brainstormed

Question 59

Ms. Lee's splitting behaviours have increased. How would these behaviours most likely affect staff? A) Agreement regarding treatment goals and cohesiveness B) Tension between staff members and uncomfortable feelings C) Awareness of the need to support Ms. Lee's behaviours D) Conflict within Ms. Lee's group sessions

Answer 59

B) Tension between staff members and uncomfortable feelings | - splitting behaviours can create tensions and disharmony

Question 60

The primary RPN meets with Ms. Lee to discuss her discharge goals. What is the most appropriate goal for discharge? A) Involving others in problem solving B) Developing a support network outside the hospital C) Encouraging independence from the treatment team D) Increasing emotional regulation skills

Answer 60

D) Increasing emotional regulation skills | - Increased emotional regularity is the target goal to decreaseself-harm and impulsivity

Question 61

Jill, 6 years old, is brought in by her mother. Jill has circular burns on the palms of her hands. Her mother states that they are a result of a fall against a radiator the evening before. The RPN suspects child abuse. Initially, Jill appears very passive yet hypervigilant. What factor is most likely to support suspected abuse? A) Jill willingly answer the RPNs questions B) The burn pattern does not match the mothers explanation of the incident C) Jill's mother seems concerned about the permanent effects of the injury D) Jill is the youngest child in her family

Answer 61

B) The burn pattern does not match the mothers explanation of the incident

Question 62

What is the best approach for the RPN to use with Jill? A) Explain to Jill that anything she says is kept secret B) Interview Jill and her mother separately C) Ask Jill if she would want the authorities involved D) Tell Jill that her mother will not be angry if she talks about what happened

Answer 62

B) Interview Jill and her mother separately

Question 63

During Jill's physical assessment, the RPN discovers multiple bruises on her body. Which characteristics of her bruises would lead the RPN to suspect abuse? A) Predominately over bony areas of the body B) Recent looking and located on the lower half of the child C) Located on soft tissue and bony areas of the back of the child D) Primarily to soft tissue areas of the body in varying stages of healing

Answer 63

D) Primarily to soft tissue areas of the body in varying stages of healing - bruising from abuse can be located anywhere on the child but abuse over time can cause bruises at different stages of healing

Question 64

What are the most common consequences of child abuse and neglect? A) Hyperactivity and delayed physiological development B) Aggression directed at others or self and developmental delays C) Oppositional behaviours and motor skill impairment D) Learning disabilities and neurological impairment

Answer 64

B) Aggression directed at other or self and developmental delays

Question 65

Mr. Green, 55 years old, has a diagnosis of panic disorder and a family history of cardiovascular disease. His father died prematurely of coronary artery disease. He is admitted to the unit and reports extreme fatigue and difficulty coping with daily activities. He describes himself as "fairly fit". He goes to the gym five times per week. While walking around the unit, Mr. Green suddenly tells the RPN that he thinks he is having a heart attack. What should the RPN expect if Mr. Green were experiencing a myocardial infarction? A) Gasping, shaking, profuse sweating, increased urinary output, hypotension B) Nausea and vomiting, irregular pulse, hypotension, blurred vision C) Chest pain, pale skin, rapid and thready pulse, hypertension D) Chest pain, apprehension, bradycardia, hypertension

Answer 65

C) Chest pain, pale skin, rapid and thready pulse, hypertension

Question 66

Three days post-myocardial infarction, the RPN finds Mr. Green pacing in his room. The RPN assesses that he is diaphoretic and having difficulty breathing. What should the RPN do first? A) Document observations B) Call a code blue C) Obtain his vitals D) Advise him to rest in bed

Answer 66

C) Obtain his vitals - vital signs are obtained any time there is a change in the client's physical status

Question 67

As Mr. Green improves, his physician prescribes a gradual increase in physical activities. What is the best action? A) Assist Mr. Green in modifying his usual pattern of activities B) Consult with the physician to be more specific about the parameters C) Allow Mr. Green to decide how much he is capable of doing for himself D) Advise Mr. Green that some level of discomfort is normal

Answer 67

A) Assist Mr. Green in modifying his usual pattern of activities - cardiac rehabilitation is an individualized process, and some lifestyle modifications may be needed - consulting the doctor does not use critical nursing reasoning

Question 68

Mrs. Green informs the RPN that her husband has been talking to her about their life together. She is upset because her husband keeps telling her that if anything should happen to him, he wants her to get married again. What should the RPN do? A) Spend some time with Mr. Green in order to document his concerns B) Tell Mrs. Green that the physician will be informed her husband is distressed C) Schedule a family meeting to discuss Mr. Green's future D) Reassure Mrs. Green that expressing such feelings is common at this time

Answer 68

D) Reassure Mrs. Green that expressing such feelings is common at this time - this is a common reaction to any illness that may be life-threatening. This is a form of anticipatory grief.

Question 69

Mr. Green tells the registered psychiatric nurse that he is worried his sexual relationship with his wife will change as a result of his recent myocardial anfarction. What should the RPN do initially? A) Encourage him to discuss these feelings with his wife B) Encourage Mr. Green and his wife to discuss this with a psychologist C) Spend some time with Mr. Green encouraging him to express his fears D) Refer him to his physician to discuss his concerns

Answer 69

C) Spend some time with Mr. Green encouraging him to express his fears

Question 70

The RPN observes an interaction in which a staff member is verbally demanding towards a client. What should the RPN do? A) Speak to the staff member privately to express concern B) Acknowledge that everyone hashad a bad day occasionally C) Document the incident and send a copy to the nurse in charge D) Notify the patient advocate about the incident

Answer 70

A) Speak to the staff member privately to express concern

Question 71

The RPN recieves a physicians order that a client is to be administered haloperidol 50 mg IM stat. What should the RPN do? A) Give the medication immediately and chart B) Call the physician and clarify the order C) Contact immediate supervisor D) Check with another graduate nurse

Answer 71

B) Call the physician and clarify the order

Question 72

According to mental health legislation, which of the following situations would meet the criteria for involuntary admission? A) Mr. Jones is talking to himself on the street. He has a history of schizophrenia B) A wife reports that her husband believes he is receiving personal messages from the television C) Mr. Walton has a history of depression and is yelling at people on the street to stay away from him or else D) Mrs. Miller's university grades are dropping because she is too anxious to go to class

Answer 72

C) Mr. Walton has a history of depression and is yelling at people on the street to stay away from him or else

Question 73

Mr. Luis, 35 years old, reports to the RPN that he has had recurrent symptoms of pounding heart, chest pain, shortness of breath, and sweating. Whats is the most likely psychiatric diagnosis? A) Generalized anxiety disorder B) Panic disorder C) Acute stress disorder D) Cyclothymic disorder

Answer 73

B) Panic disorder

Question 74

Mr. Constantine, 52 years old, is concerned about his level of alcohol use and its impact on his physical health. How should the RPN initially respond? A) Educate the client on theories of change B) Advise the client book and appointment with his primary care physician C) Explore the client's desire to change D) Provide the client with information on self-help groups

Answer 74

C) Explore the client's desire to change - with substance use, interventions should match the client's readiness to change

Question 75

Mrs. Glover, 53 years old, is being discharged from the hospital tomorrow following treatment for depression. She tells the RPN that she cannot wait to go home but she appears pale and nervous. What should the RPN do? A) Review discharge planning and community supports B) Consult with the social worker regarding her discharge plan C) Ackowledge her progress throughout her admission D) Ask her if she has any concerns about going home

Answer 75

D) Ask her if she has any concerns about going home

Question 76

The RPN is caring for Mr. Chung, 83 years old, who is on bed rest and has developed pneumonia. What action is the most appropriate for the RPN to ask the health-care worker to perform? A) Suctioning secretions B) Administering a bed bath C) Positioning in prone position D) Giving the family an update

Answer 76

B) Administering a bed bath

Question 77

The RPN at an acute care unit forgot to complete their daily charting before going home. What should the RPN do? A) Provided nothing critical occurred, documentation is not required B) Phone a nursing colleague and ask they update the charting C) Update charting next shift and mark it as a late entry D) Notify the physician of the omission

Answer 77

C) Update charting next shift and mark it as a late entry - this is the standard legal way to deal with a late entry

Question 78

Mr. Kowalski, 26 years old, has been diagnosed with an acute psychotic episode and is being treated with multiple medications, including two antipsychotics. His blood pressure becomes unstable and his temperature is 39. He reports muscle stiffness and is sweating profusely. These symptoms subside after discontinuation of the medication. What is the suspected diagnosis? A) Extrapyramidal side effects B) Metabolic syndrome C) Neuroleptic malignant syndrome D) Tardive dyskinesia

Answer 78

C) NMS

Question 79

Which therapeutic relationship skills should the RPN posses? A) Empathy, defocusing, rationality B) Positive attitude, self-disclosure, and accurate interpretation C) Confidentiality, clarification, and validation D) Acceptance, advising, and social inclusion

Answer 79

C) Confidentiality, clarification, and validation

Question 80

Mrs. Taylor, 36 years old, is being admitted to the detoxification unit for alcohol abuse. She has been consuming 14 oz of vodka daily for the past year. What early symptoms of alcohol withdrawal should the RPN monitor? A) Disorientation, diaphoresis and hallucinations B) Abdominal distension, jaundice, and restlessness C) Hypertension, increased heart rate and tremors D) Sleepiness, sweating, dehydration

Answer 80

C) Hypertension, increased heart rate, tremors

Question 81

Mr. Chang, 32 years old, is found lying on the floor unconscious during hourly rounds. What should the RPN do first? A) Take a set of complete neurovital signs B) Call another nurse to assist him to a seated position C) Check his circulation, airway, and breathing D) Activate a code and call the on-call psychiatrist

Answer 81

C) Check his circulation, airway, and breathing

Question 82

A client's heart rate is 48 beats/min. Which medication should be withheld until the RPN consults with a physician? A) Prednisone B) Cimetidine C) Haloperidol D) Digoxin

Answer 82

D) Digoxin

Question 83

Mr. Jones, 25 years old, has been prescribed risperidone for severe and persistent schizophrenia. What is the most appropriate initial dosage? A) 12.5 mg IM B) 25 mg IM C) 37.5 mg IM D) 50 mg IM

Answer 83

B) 25 mg IM - this is an ideal starting dosage for someone with severe and persistent schizophrenia

Question 84

In developing a care plan for a client, what nursing measures can be initiated to prevent falls? A) Review medication and discourage use of shoes B) Decrease clutter and serve meals in bed C) Assist with toileting and review vital signs D) Apply physical restraints and place call bell within reach

Answer 84

C) Assist with toileting and review vital signs - most falls happen when a pt is attempting to get out of bed to use the washroom - assessing BP is appropriate to determine presence of postural hypotension

Question 85

The RPN receives a medication order and recognizes that the dosage is too high and potentially toxic. The RPN brings the concern to the physician, who makes it clear that the order was intended as written and wants the client to receive that dosage. What should the RPN do? A) Administer the medication as prescribed B) Document the conversation with the physician and administer the medication as prescribed C) Refuse to administer the medication D) Discuss appropriate doasge with the pharmacist to guide decision making

Answer 85

C) Refuse to administer the medication - the RPN is responsible for protecting client safety, regardless of documentation

Question 86

A clinet is engaged in IV drug use. The RPN is implementing health teaching using a harm reduction approach. What information should the RPN provide? A) Explain the health outcomes associated with IV drug use B) Provide the location of needle exchange centres C) Explore reasons for IV drug use D) Refer the client to NA

Answer 86

B) Provide the location of needle exchange centers - harm reduction involves accepting alternatives to abstinence and reducing barriers to treatment by providing user friendly access

Question 87

Mr. Bure, 72 years old, who only speaks Russian, was admitted to an inpatient unit with a diagnosis of major depression. The RPN reads in his community notes that he belongs to the Russian Orthodox Church and attends services three times per week. What should the RPN do to address Mr. Bure's needs? A) Contact Mr. Bure's daughter to determine spiritual needs B) Contact Mr. Bure's priest to ask him about Mr. Bure's needs C) Research the Russian orthodox faith and implement dietary considerations D) Through a Russian interpreter, ask Mr. Bure what his spiritual needs are

Answer 87

D)Through a Russian interpreter, ask Mr. Bure what his spiritual needs are - this allows the client to express what is spiritually important to him - contacting his daughter/priest would be a breach of confidentiality

Question 88

Ms. Benson, 21 years old has a diagnosis of social anxiety disorder. The RPN suggests that Ms. Benson try going out with some friends this weekend. Ms. Benson is resistant to this idea. What is the RPN's best therapeutic response? A) Remind Ms. Benson that her anxiety will increase is she does not go B) Ask Ms. Benson about her own ideas of what to try C) Let Ms. Benson know that it is okay that she is not yet ready to change D) Ask Ms. Benson why she does not want to go out with her friends

Answer 88

B) Ask Ms. Benson about her own ideas of what to try - this response demonstrates recognition of resistance and gives the client the opportunity to make changes on her own terms, if that is what she is ready to do - asking why she does not want to could be seen as challenging and is likely to increase resistance

Question 89

The RPN is designated as the charge nurse. How can the RPN promote staff cohesiveness? A) Assign work equitably and implement work incentives B) Provide feedback and champion innovation C) Work independently towards goals and articulate a vision D) Avoid conflict and competing priorities

Answer 89

B) Provide feedback and champion innovation - providing feedback, promoting teamwork and championing innovation are key components of positive leadership quality

Question 90

A 15 year old female with a history of juvenile diabetes has been admitted into the eating disorder unit. What should the registered psychiatric nurse do first? A) Enroll the client in group therapy on cognitive distortions B) Give education regarding long-term effects of poor glucose control C) Implement a plan to manage blood sugars and insulin doses D) Refer to dietician to negotiate and create an eating plan

Answer 90

C) Implement a plan to manage blood sugars and insulin doses - diabulima is one way people with type 1 diabetes incorrectly attempt to control weight - (not taking insulin in attempt to lose weight)

Question 91

The RPN is working the night shift on an adult mental health inpatient unit. During chart audit, the RPN notices that a client who is scheduled for ECT the next morning does not have the informed consent form signed. It is charted that the psychiatrist has explained the treatment and the client stated that she understood. What should the RPN do? A) Cancel the ECT treatment for the next day and document B) Ask the client's next of kin to sign the consent form C) Allow the ECT to proceed as oral consent has been documented D) Contact the physician to have the form signed and proceed with ECT treatment

Answer 91

D) Contact the physician to have the form signed and proceed with ECT treatment - Physicians are responsible for clients signing the consent after explaining the procedure

Question 92

The RPN is facilitating a group for mothers with postpartum depression. Many of the members are struggling to find child care. What strategy should the RPN implement? A) Contact the media to increase community awareness of the issue B) Inquire with local agencies to explore child care options C) Direct the mothers to utilize family members for child care D) Acknowledge that the frustrations are part of postpartum depression

Answer 92

B) Inquire with local agencies to explore child care options - engaging community stakeholders is a strategy that can assist the RPN with finding alternative child care for mothers

Question 93

The RPN is attending the teams' interdisciplinary meeting for the first time. What should the RPN do? A) Know client base and engage effectively B) Review theoretical knowledge and identify individual roles C) Be respectful and defer to other team members D) Sit quietly and observe the process

Answer 93

A) Know client base and engage effectively - the RPNs expected role and responsibilities include acting as a productive team player and sharing relevant information about the clients

Question 94

The parents of Andrew, 16 years old, report that he has recently been engaging in reckless driving and marijuana use and is unable to see his behaviour as dangerous. His parents are requesting information to develop improved understanding of their son's egocentric behaviours. What teaching should the RPN provide? A) Insight impairment B) Sense of invulnerability C) Lack of maturity D) Peer pressure

Answer 94

B) Sense of invulnerability - a sense of invulnerability in adolescents leads to risk taking behaviour

Question 95

Clients are reporting that they feel disconnected from staff. How can the RPN ensure a positive therapeutic milieu? A) Ensuring conversation on medication rounds B) Ensuring that staff are clearly visible at the workstation C) Promoting a peer support group on the unit D) Setting aside time for structured interactions

Answer 95

D) Setting aside time for structured interactions - RPNs are responsible for ensuring that clients' psychological needs are met. Structured interaction is intended to teach clients better ways of communicating

Question 96

Mr. Kent, a 24 year old soldier in the army, has completed an overseas duty. He has been experiencing increased anger, mood swings, and sleep disturbances. Mr. Kent has seen several soldiers with similar symptoms released from the military after being labelled an " administrative burden". What should the RPN recognize as a barrier to treatment? A) Denial B) Sleep deprivation C) Impulse control D) Stigma

Answer 96

D) Stigma

Question 97

A voluntary client refused to take his oral medications. The RPN witnessed 3 staff members physically restrain the client and force him to take his medication. What should the RPN do first? A) Discuss concerns with the staff members involved B) Report the incident to the nurse in charge C) Report the incident to the regulatory body D) Advise the client that his legal rights have been violated

Answer 97

B) Report the incident to the nurse in charge - this option recognizes the legal right of the voluntary client to refuse treatment. The RPN advocates for the client and raises the issue to the next level

Question 98

The RPN has administered PRN medications over the past 6 hours and was unable to document. What should the RPN do? A) Ask the staff members assigned to the clients to document the medication B) Document the PRN medication administration as a late entry C) Document in the MAR and chart on the next shift D) Place a sticky note in the chart as a reminder to document later

Answer 98

B) Document the PRN medication administration as a late entry - after 6 hours, this is a late entry

Question 99

A client on the psychiatric unit displays negative and hostile behaviour similar to that of the RPN's sister. What are the characteristics of self-awareness? A) Demonstrating one's beliefs, judgements, and limitations B) Understanding one's thoughts and biases and their effect on others C) Maintaining one's professionalism, subjectivity and respect D) Demonstrating one's openness, biases, and professionalism

Answer 99

B) Understanding one's thoughts and biases and their effect on others

Question 100

The RPN sees a nursing colleague kissing a recently discharged client. What should the RPN do? A) Report what was observed to the unit supervisor B) Immediately report this to the regulatory authority C) Report the incident to the police D) Talk with the nursing colleague directly before reporting it to anyone

Answer 100

A) Report what was observed to the unit supervisor - although the RPN should speak with the colleague, there has been a breach of boundaries that is the RPNs duty to report