PRACTICE TEST
I. Use the following information to answer the next 6 questions:
Ms. Jacobs, 48 years old, with a dx of bipolar disorder, is admitted as an involuntary
client. She presents as overactive and grandiose. She is loud and swears often. She is
wearing mismatched bright clothing and uses excessive makeup.
1.) Three days after admission, Ms. Jacobs remains overactive. She paces and talks
loudly. She slams the wall with her hands and makes threatening and obscene
gestures when approached by staff. What should be the RPN’s priority?
a.) Encourage fluids at least q30-60mins.
Although fluids would be important, safety is the priority concern.
b.) Protect her from self-injury by increasing observation.
The RPN needs to control the escalating behaviour. Safety of the client is a
priority.
c.) Challenge her inappropriate behaviour.
The RPN should not challenge the behaviour. This may escalate the situation.
d.) Place her in a seclusion room.
Although seclusion could be used in a similar situation, this would not
guarantee the safety of the client.
Application, Quality Care and Client Safety
References: Halter (2014), p. 268-269; Austin & Boyd p. 461
2.) When Ms. Jacobs attends the program’s unit meetings, she monopolizes the
discussion. What should the RPN do first?
a.) Offer olanzapine (Zyprexa) 5mg prn before meetings.
Medication is not the first option to address problematic behaviours.
b.) Remain quiet to allow the group to deal with Ms. Jacobs.
The RPN should address this issue instead of the group.
c.) Set limits on Ms. Jacob’s participation in the group.
Limit-setting is key when treating a client with mania.
d.) Ignore the behaviour and continue the meeting.
This does not establish consequences for unacceptable behaviour.
Application, Body of Knowledge and Application
Halter (2014) p. 267; Townsend (2015) p. 508
,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 PM.” What should the RPN do?
a.) Reinforce Ms. Jacobs’ involvement in the program.
This helps the client to achieve stability and recovery.
b.) Explore Ms. Jacobs’ delusional content with her.
This may reinforce the delusional content.
c.) Redirect Ms. Jacobs to self-directed activities.
Redirecting does not provide support and promote recovery.
d.) Explain the implausibility of her statements.
This will challenge her delusions, thereby compromising the therapeutic
relationship.
Critical thinking, Therapeutic relationships and therapeutic use of self
Halter (2014) p. 271; Austin & Boyd p. 456
4.) When the RPN enters the lounge, Ms. Jacobs states, “Here comes Ms. Fat Ass
with the fast past.” What would be the RPN’s most appropriate response?
a.) Ignore Ms. Jacobs’ behaviour and talk to other clients.
This does not enhance or support the therapeutic relationship.
b.) Confront Ms. Jacobs about the inappropriateness of her comment.
Confrontation could jeopardize the therapeutic relationship.
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.
d.) Leave the room and discuss the incident with Ms. Jacobs later.
The behaviour should be addressed as it presents at the time.
Application, Therapeutic Relationships and Therapeutic Use of Self
Austin & Boyd p461; Halter p271
,5.) Ms. Jacobs approaches the RPN exhibiting pressured speech and pacing. She
states, “I feel hot, I’m burning up!” What is the RPN’s priority action?
a.) Redirect Ms. Jacobs to her room to relax.
This is not appropriate without conducting a physical assessment.
b.) Assess Ms. Jacobs’ blood glucose level.
This is not the first-line treatment; there is nothing in the client’s history
about glucose irregularities.
c.) Assess Ms. Jacobs’ VS.
Knowledge of the physiology of body temperature regulation is essential for
assessing and evaluating the client’s response to temperature alterations and
for intervening safely.
d.) Redirect Ms. Jacobs to a unit activity.
This does not address or assess the immediate physical presentation.
Critical thinking, Body of Knowledge and Application
Potter & Perry (2014) p494; Jarvis (2014) p155
6.) After 3wks of tx, Ms. Jacobs’ manic symptoms have decreased. She indicates that
her meds 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.
The drowsiness may be secondary to depression.
b.) Assess Ms. Jacobs for symptoms of depression.
Feeling tired and sleeping more are overt signs of depression. Bipolar
disorder can feature depression.
c.) Reassure Ms. Jacobs that she is improving.
The RPN should not give false reassurance.
d.) Consult Recreation Therapy for activities for Ms. Jacobs to engage in.
The nursing process requires assessment to proceed to other interventions.
Critical thinking, Body of Knowledge and Application
Townsend (2015) p474; Halter p238-239
, II. Use the following information to answer the next 4 questions:
Jimmy, 3yo, 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 18mos, he
appeared to be developing normally. Since then, he has become more withdrawn
and has started to bite himself and bang his head.”
7.) Jimmy’s mother appears very anxious and is tearful during the interview. What
should be the RPN’s most appropriate response?
a.) “It sounds like you’re saying that you are not a good mother.”
This may place a value judgment on the parent.
b.) “You don’t know what to do about Jimmy’s behaviour.”
The RPN is assuming what the mother is thinking.
c.) “What is the most upsetting part of this for you?”
Parents of children with autism spectrum disorder can experience mental
health issues as do the children.
d.) “Do you think Jimmy’s behaviour is not what it should be?”
This statement is not supportive because the parent is asking for help.
Moreover, this statement does not recognize the expressed emotions.
Application, Therapeutic Relationships and Therapeutic Use of Self
Potter & Perry p243; Austin & Boyd p732
8.) What is indicative of autism spectrum disorder?
a.) Engaging in imaginative play
Engaging in imaginative play is normal childhood behaviour.
b.) Displaying borderline or impaired intelligence
Impaired intelligence is not a diagnostic feature of autism spectrum disorder.
c.) Interrupting and intruding on others
This is not a behaviour of autism spectrum disorder.
d.) Having an aversion to loud noises and bright lights
Having an aversion to loud noises and bright lights is a feature of autism
spectrum disorder according to DSM-5.
Knowledge/Comprehension, Body of Knowledge and Application
APA DSM-5 p50; Thapar et al. (2015) p665
I. Use the following information to answer the next 6 questions:
Ms. Jacobs, 48 years old, with a dx of bipolar disorder, is admitted as an involuntary
client. She presents as overactive and grandiose. She is loud and swears often. She is
wearing mismatched bright clothing and uses excessive makeup.
1.) Three days after admission, Ms. Jacobs remains overactive. She paces and talks
loudly. She slams the wall with her hands and makes threatening and obscene
gestures when approached by staff. What should be the RPN’s priority?
a.) Encourage fluids at least q30-60mins.
Although fluids would be important, safety is the priority concern.
b.) Protect her from self-injury by increasing observation.
The RPN needs to control the escalating behaviour. Safety of the client is a
priority.
c.) Challenge her inappropriate behaviour.
The RPN should not challenge the behaviour. This may escalate the situation.
d.) Place her in a seclusion room.
Although seclusion could be used in a similar situation, this would not
guarantee the safety of the client.
Application, Quality Care and Client Safety
References: Halter (2014), p. 268-269; Austin & Boyd p. 461
2.) When Ms. Jacobs attends the program’s unit meetings, she monopolizes the
discussion. What should the RPN do first?
a.) Offer olanzapine (Zyprexa) 5mg prn before meetings.
Medication is not the first option to address problematic behaviours.
b.) Remain quiet to allow the group to deal with Ms. Jacobs.
The RPN should address this issue instead of the group.
c.) Set limits on Ms. Jacob’s participation in the group.
Limit-setting is key when treating a client with mania.
d.) Ignore the behaviour and continue the meeting.
This does not establish consequences for unacceptable behaviour.
Application, Body of Knowledge and Application
Halter (2014) p. 267; Townsend (2015) p. 508
,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 PM.” What should the RPN do?
a.) Reinforce Ms. Jacobs’ involvement in the program.
This helps the client to achieve stability and recovery.
b.) Explore Ms. Jacobs’ delusional content with her.
This may reinforce the delusional content.
c.) Redirect Ms. Jacobs to self-directed activities.
Redirecting does not provide support and promote recovery.
d.) Explain the implausibility of her statements.
This will challenge her delusions, thereby compromising the therapeutic
relationship.
Critical thinking, Therapeutic relationships and therapeutic use of self
Halter (2014) p. 271; Austin & Boyd p. 456
4.) When the RPN enters the lounge, Ms. Jacobs states, “Here comes Ms. Fat Ass
with the fast past.” What would be the RPN’s most appropriate response?
a.) Ignore Ms. Jacobs’ behaviour and talk to other clients.
This does not enhance or support the therapeutic relationship.
b.) Confront Ms. Jacobs about the inappropriateness of her comment.
Confrontation could jeopardize the therapeutic relationship.
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.
d.) Leave the room and discuss the incident with Ms. Jacobs later.
The behaviour should be addressed as it presents at the time.
Application, Therapeutic Relationships and Therapeutic Use of Self
Austin & Boyd p461; Halter p271
,5.) Ms. Jacobs approaches the RPN exhibiting pressured speech and pacing. She
states, “I feel hot, I’m burning up!” What is the RPN’s priority action?
a.) Redirect Ms. Jacobs to her room to relax.
This is not appropriate without conducting a physical assessment.
b.) Assess Ms. Jacobs’ blood glucose level.
This is not the first-line treatment; there is nothing in the client’s history
about glucose irregularities.
c.) Assess Ms. Jacobs’ VS.
Knowledge of the physiology of body temperature regulation is essential for
assessing and evaluating the client’s response to temperature alterations and
for intervening safely.
d.) Redirect Ms. Jacobs to a unit activity.
This does not address or assess the immediate physical presentation.
Critical thinking, Body of Knowledge and Application
Potter & Perry (2014) p494; Jarvis (2014) p155
6.) After 3wks of tx, Ms. Jacobs’ manic symptoms have decreased. She indicates that
her meds 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.
The drowsiness may be secondary to depression.
b.) Assess Ms. Jacobs for symptoms of depression.
Feeling tired and sleeping more are overt signs of depression. Bipolar
disorder can feature depression.
c.) Reassure Ms. Jacobs that she is improving.
The RPN should not give false reassurance.
d.) Consult Recreation Therapy for activities for Ms. Jacobs to engage in.
The nursing process requires assessment to proceed to other interventions.
Critical thinking, Body of Knowledge and Application
Townsend (2015) p474; Halter p238-239
, II. Use the following information to answer the next 4 questions:
Jimmy, 3yo, 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 18mos, he
appeared to be developing normally. Since then, he has become more withdrawn
and has started to bite himself and bang his head.”
7.) Jimmy’s mother appears very anxious and is tearful during the interview. What
should be the RPN’s most appropriate response?
a.) “It sounds like you’re saying that you are not a good mother.”
This may place a value judgment on the parent.
b.) “You don’t know what to do about Jimmy’s behaviour.”
The RPN is assuming what the mother is thinking.
c.) “What is the most upsetting part of this for you?”
Parents of children with autism spectrum disorder can experience mental
health issues as do the children.
d.) “Do you think Jimmy’s behaviour is not what it should be?”
This statement is not supportive because the parent is asking for help.
Moreover, this statement does not recognize the expressed emotions.
Application, Therapeutic Relationships and Therapeutic Use of Self
Potter & Perry p243; Austin & Boyd p732
8.) What is indicative of autism spectrum disorder?
a.) Engaging in imaginative play
Engaging in imaginative play is normal childhood behaviour.
b.) Displaying borderline or impaired intelligence
Impaired intelligence is not a diagnostic feature of autism spectrum disorder.
c.) Interrupting and intruding on others
This is not a behaviour of autism spectrum disorder.
d.) Having an aversion to loud noises and bright lights
Having an aversion to loud noises and bright lights is a feature of autism
spectrum disorder according to DSM-5.
Knowledge/Comprehension, Body of Knowledge and Application
APA DSM-5 p50; Thapar et al. (2015) p665
