Registered Psychiatric Nurses of Canada
Examination RPNCE Ultimate Exam
Questions With Correct Solutions,
Already Passed!!
1. A client with major depressive disorder states, “My family would be better off without
me.” What is the psychiatric nurse’s priority response?
A. Encourage the client to identify positive qualities
B. Ask directly whether the client is thinking about suicide
C. Explain that suicide will permanently affect the family
D. Redirect the conversation to coping skills
Correct answer: B. Ask directly whether the client is thinking about suicide
Explanation: Directly asking about suicide does not increase suicidal behavior. It allows the
nurse to assess the presence of suicidal thoughts, intent, plan, means, and immediacy of risk.
Statements suggesting hopelessness or perceived burdensomeness require immediate, therapeutic
assessment rather than reassurance or distraction. The nurse should subsequently determine the
level of risk and implement appropriate safety interventions.
2. A client experiencing auditory hallucinations says, “The voices are telling me to hurt my
roommate.” What should the nurse do first?
A. Tell the client the voices are not real
B. Ask the client to ignore the voices
C. Assess the content, intent, and ability to resist the command
D. Place the client in group therapy
Correct answer: C. Assess the content, intent, and ability to resist the command
Explanation: Command hallucinations involving harm require immediate assessment because
they may represent an imminent safety risk. The nurse should determine what the voices are
commanding, whether the client intends to comply, whether the client has access to means, and
whether the client can resist the commands. Arguing about whether hallucinations are real is
generally nontherapeutic.
3. Which finding is most characteristic of mania?
A. Psychomotor retardation
, B. Decreased need for sleep with increased energy
C. Social withdrawal and anhedonia
D. Slowed speech and impaired concentration
Correct answer: B. Decreased need for sleep with increased energy
Explanation: Mania commonly involves elevated, expansive, or irritable mood accompanied by
increased energy, decreased need for sleep, pressured speech, racing thoughts, distractibility,
increased goal-directed activity, and potentially risky behavior. A person experiencing mania
may sleep only a few hours and still report feeling energetic. Psychomotor retardation and social
withdrawal are more commonly associated with depression.
4. A client with schizophrenia says, “The government has implanted a tracking device in my
brain.” Which response is most therapeutic?
A. “That is impossible.”
B. “Why would the government want to track you?”
C. “I don't see evidence of a tracking device, but I understand that this feels frightening to
you.”
D. “You need to stop thinking about that.”
Correct answer: C. “I don't see evidence of a tracking device, but I understand that this
feels frightening to you.”
Explanation: The nurse should acknowledge the client’s emotional experience without
reinforcing the delusion. Arguing directly about the belief can increase defensiveness, while
agreeing with the delusion reinforces distorted thinking. Therapeutic communication focuses on
reality-based observations and the client’s feelings.
5. A client taking lithium reports severe diarrhea, vomiting, coarse tremors, and confusion.
What should the nurse suspect?
A. Therapeutic lithium effect
B. Lithium toxicity
C. Serotonin syndrome
D. Neuroleptic malignant syndrome
Correct answer: B. Lithium toxicity
Explanation: Severe gastrointestinal symptoms, coarse tremor, confusion, ataxia, and worsening
neurologic symptoms can indicate lithium toxicity. Dehydration can increase lithium
concentration and contribute to toxicity. The medication should be withheld according to
appropriate clinical direction, the prescriber should be notified urgently, and serum lithium and
relevant laboratory values should be assessed.
6. Which laboratory test is particularly important when monitoring a client receiving lithium
therapy?
A. Serum lithium concentration
, B. Troponin level
C. INR only
D. Serum amylase only
Correct answer: A. Serum lithium concentration
Explanation: Lithium has a relatively narrow therapeutic range, so serum concentrations must
be monitored. Kidney function and thyroid function are also important because lithium is
primarily eliminated through the kidneys and can affect thyroid function. Changes in hydration,
sodium balance, renal function, or interacting medications can alter lithium levels.
7. A client taking clozapine develops fever and a sore throat. What is the nurse’s priority
concern?
A. Hyperglycemia
B. Agranulocytosis
C. Hypertension
D. Constipation only
Correct answer: B. Agranulocytosis
Explanation: Clozapine can cause severe neutropenia/agranulocytosis, increasing the risk of
life-threatening infection. Fever and sore throat may be early signs of infection and require
prompt assessment and laboratory evaluation according to monitoring requirements. Clozapine
also carries other important risks, including myocarditis, seizures, metabolic effects, and severe
constipation.
8. Which medication is commonly used as an opioid antagonist in opioid overdose?
A. Naloxone
B. Lorazepam
C. Lithium
D. Olanzapine
Correct answer: A. Naloxone
Explanation: Naloxone is an opioid antagonist that can rapidly reverse opioid-induced
respiratory depression. Because its duration of action may be shorter than that of some opioids,
continued monitoring and repeat dosing may be necessary. Airway and breathing support remain
priorities even when naloxone is administered.
9. A client with alcohol withdrawal develops tremors, sweating, agitation, tachycardia, and
visual hallucinations. Which complication is most concerning?
A. Delirium tremens
B. Mild depression
C. Negative symptoms of schizophrenia
D. Panic disorder
, Correct answer: A. Delirium tremens
Explanation: Severe alcohol withdrawal can progress to delirium tremens, characterized by
severe autonomic hyperactivity, agitation, confusion or delirium, hallucinations, and potentially
seizures. It is a medical emergency. Benzodiazepines are commonly used in medically
supervised withdrawal protocols, with monitoring of vital signs, hydration, neurological status,
and withdrawal severity.
10. Which intervention is most appropriate when caring for a client experiencing acute
panic?
A. Provide lengthy explanations
B. Leave the client alone
C. Remain with the client and use short, calm statements
D. Encourage complex problem-solving
Correct answer: C. Remain with the client and use short, calm statements
Explanation: Severe anxiety reduces the person’s ability to process information. The nurse
should provide a calm presence, reduce environmental stimulation, use simple communication,
and promote controlled breathing when appropriate. Lengthy explanations and complicated
decisions should generally be postponed until anxiety decreases.
11. A client with obsessive-compulsive disorder repeatedly washes their hands until the skin
becomes damaged. What is the best initial nursing approach?
A. Shame the client for the behavior
B. Immediately prohibit all handwashing
C. Assess the obsession, compulsion, distress, and functional impact
D. Tell the client that the behavior is irrational
Correct answer: C. Assess the obsession, compulsion, distress, and functional impact
Explanation: OCD involves intrusive thoughts, images, or urges and repetitive behaviors or
mental acts performed to reduce distress. Assessment should determine the nature and severity of
symptoms and their impact on functioning. Abruptly eliminating compulsions can increase
anxiety, while structured evidence-based treatment generally involves gradual exposure and
response prevention.
12. Which statement best demonstrates therapeutic validation?
A. “You shouldn't feel that way.”
B. “Everyone has problems.”
C. “It sounds like this situation has been very frightening for you.”
D. “You are overreacting.”
Correct answer: C. “It sounds like this situation has been very frightening for you.”
Examination RPNCE Ultimate Exam
Questions With Correct Solutions,
Already Passed!!
1. A client with major depressive disorder states, “My family would be better off without
me.” What is the psychiatric nurse’s priority response?
A. Encourage the client to identify positive qualities
B. Ask directly whether the client is thinking about suicide
C. Explain that suicide will permanently affect the family
D. Redirect the conversation to coping skills
Correct answer: B. Ask directly whether the client is thinking about suicide
Explanation: Directly asking about suicide does not increase suicidal behavior. It allows the
nurse to assess the presence of suicidal thoughts, intent, plan, means, and immediacy of risk.
Statements suggesting hopelessness or perceived burdensomeness require immediate, therapeutic
assessment rather than reassurance or distraction. The nurse should subsequently determine the
level of risk and implement appropriate safety interventions.
2. A client experiencing auditory hallucinations says, “The voices are telling me to hurt my
roommate.” What should the nurse do first?
A. Tell the client the voices are not real
B. Ask the client to ignore the voices
C. Assess the content, intent, and ability to resist the command
D. Place the client in group therapy
Correct answer: C. Assess the content, intent, and ability to resist the command
Explanation: Command hallucinations involving harm require immediate assessment because
they may represent an imminent safety risk. The nurse should determine what the voices are
commanding, whether the client intends to comply, whether the client has access to means, and
whether the client can resist the commands. Arguing about whether hallucinations are real is
generally nontherapeutic.
3. Which finding is most characteristic of mania?
A. Psychomotor retardation
, B. Decreased need for sleep with increased energy
C. Social withdrawal and anhedonia
D. Slowed speech and impaired concentration
Correct answer: B. Decreased need for sleep with increased energy
Explanation: Mania commonly involves elevated, expansive, or irritable mood accompanied by
increased energy, decreased need for sleep, pressured speech, racing thoughts, distractibility,
increased goal-directed activity, and potentially risky behavior. A person experiencing mania
may sleep only a few hours and still report feeling energetic. Psychomotor retardation and social
withdrawal are more commonly associated with depression.
4. A client with schizophrenia says, “The government has implanted a tracking device in my
brain.” Which response is most therapeutic?
A. “That is impossible.”
B. “Why would the government want to track you?”
C. “I don't see evidence of a tracking device, but I understand that this feels frightening to
you.”
D. “You need to stop thinking about that.”
Correct answer: C. “I don't see evidence of a tracking device, but I understand that this
feels frightening to you.”
Explanation: The nurse should acknowledge the client’s emotional experience without
reinforcing the delusion. Arguing directly about the belief can increase defensiveness, while
agreeing with the delusion reinforces distorted thinking. Therapeutic communication focuses on
reality-based observations and the client’s feelings.
5. A client taking lithium reports severe diarrhea, vomiting, coarse tremors, and confusion.
What should the nurse suspect?
A. Therapeutic lithium effect
B. Lithium toxicity
C. Serotonin syndrome
D. Neuroleptic malignant syndrome
Correct answer: B. Lithium toxicity
Explanation: Severe gastrointestinal symptoms, coarse tremor, confusion, ataxia, and worsening
neurologic symptoms can indicate lithium toxicity. Dehydration can increase lithium
concentration and contribute to toxicity. The medication should be withheld according to
appropriate clinical direction, the prescriber should be notified urgently, and serum lithium and
relevant laboratory values should be assessed.
6. Which laboratory test is particularly important when monitoring a client receiving lithium
therapy?
A. Serum lithium concentration
, B. Troponin level
C. INR only
D. Serum amylase only
Correct answer: A. Serum lithium concentration
Explanation: Lithium has a relatively narrow therapeutic range, so serum concentrations must
be monitored. Kidney function and thyroid function are also important because lithium is
primarily eliminated through the kidneys and can affect thyroid function. Changes in hydration,
sodium balance, renal function, or interacting medications can alter lithium levels.
7. A client taking clozapine develops fever and a sore throat. What is the nurse’s priority
concern?
A. Hyperglycemia
B. Agranulocytosis
C. Hypertension
D. Constipation only
Correct answer: B. Agranulocytosis
Explanation: Clozapine can cause severe neutropenia/agranulocytosis, increasing the risk of
life-threatening infection. Fever and sore throat may be early signs of infection and require
prompt assessment and laboratory evaluation according to monitoring requirements. Clozapine
also carries other important risks, including myocarditis, seizures, metabolic effects, and severe
constipation.
8. Which medication is commonly used as an opioid antagonist in opioid overdose?
A. Naloxone
B. Lorazepam
C. Lithium
D. Olanzapine
Correct answer: A. Naloxone
Explanation: Naloxone is an opioid antagonist that can rapidly reverse opioid-induced
respiratory depression. Because its duration of action may be shorter than that of some opioids,
continued monitoring and repeat dosing may be necessary. Airway and breathing support remain
priorities even when naloxone is administered.
9. A client with alcohol withdrawal develops tremors, sweating, agitation, tachycardia, and
visual hallucinations. Which complication is most concerning?
A. Delirium tremens
B. Mild depression
C. Negative symptoms of schizophrenia
D. Panic disorder
, Correct answer: A. Delirium tremens
Explanation: Severe alcohol withdrawal can progress to delirium tremens, characterized by
severe autonomic hyperactivity, agitation, confusion or delirium, hallucinations, and potentially
seizures. It is a medical emergency. Benzodiazepines are commonly used in medically
supervised withdrawal protocols, with monitoring of vital signs, hydration, neurological status,
and withdrawal severity.
10. Which intervention is most appropriate when caring for a client experiencing acute
panic?
A. Provide lengthy explanations
B. Leave the client alone
C. Remain with the client and use short, calm statements
D. Encourage complex problem-solving
Correct answer: C. Remain with the client and use short, calm statements
Explanation: Severe anxiety reduces the person’s ability to process information. The nurse
should provide a calm presence, reduce environmental stimulation, use simple communication,
and promote controlled breathing when appropriate. Lengthy explanations and complicated
decisions should generally be postponed until anxiety decreases.
11. A client with obsessive-compulsive disorder repeatedly washes their hands until the skin
becomes damaged. What is the best initial nursing approach?
A. Shame the client for the behavior
B. Immediately prohibit all handwashing
C. Assess the obsession, compulsion, distress, and functional impact
D. Tell the client that the behavior is irrational
Correct answer: C. Assess the obsession, compulsion, distress, and functional impact
Explanation: OCD involves intrusive thoughts, images, or urges and repetitive behaviors or
mental acts performed to reduce distress. Assessment should determine the nature and severity of
symptoms and their impact on functioning. Abruptly eliminating compulsions can increase
anxiety, while structured evidence-based treatment generally involves gradual exposure and
response prevention.
12. Which statement best demonstrates therapeutic validation?
A. “You shouldn't feel that way.”
B. “Everyone has problems.”
C. “It sounds like this situation has been very frightening for you.”
D. “You are overreacting.”
Correct answer: C. “It sounds like this situation has been very frightening for you.”
