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.
b.) Protect her from self-injury by increasing observation.
c.) Challenge her inappropriate behaviour.
d.) Place her in a seclusion room.
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.
b.) Remain quiet to allow the group to deal with Ms. Jacobs.
c.) Set limits on Ms. Jacob’s participation in the group.
d.) Ignore the behaviour and continue the meeting.
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.
b.) Explore Ms. Jacobs’ delusional content with her.
c.) Redirect Ms. Jacobs to self-directed activities.
d.) Explain the implausibility of her statements.
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.
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.
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.
b.) Assess Ms. Jacobs’ blood glucose level.
c.) Assess Ms. Jacobs’ VS.
d.) Redirect Ms. Jacobs to a unit activity.
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.
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.
,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.”
b.) “You don’t know what to do about Jimmy’s behaviour.”
c.) “What is the most upsetting part of this for you?”
d.) “Do you think Jimmy’s behaviour is not what it should be?”
8.) What is indicative of autism spectrum disorder?
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
9.) When planning care with Jimmy’s mother, what nursing intervention should the RPN implement first?
a.) Decreasing social interaction
b.) Increasing physical contact
c.) Encouraging self-stimulating behaviour
d.) Providing direction and maintaining structure
10.) What are the most appropriate actions to manage Jimmy’s behaviour?
a.) Redirect Jimmy and give 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.
, III. Use the following information to answer the next 4 questions:
Anne, 13yo, is admitted to the unit. Anne is exhibiting symptoms of depression, not attending to hygiene and
not attending school. Her home room teacher suspected that she was being sexually abused by her father
because of the change in her attitude whenever her father was mentioned and because of comments about
“being mom when Mom is away.” Investigation by social workers has resulted in the father facing criminal
charges relating to sexual abuse.
11.) The RPN is assessing Anne’s psychological status. What is a common behavioural clue of sexual abuse?
a.) Openly discussing the relationship with her father
b.) Distancing herself from siblings and mother
c.) Difficulty adapting to hospital routine
d.) Displaying clinging behaviours with peers
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 experiences.
c.) Ask Anne to explore her personal feelings of inadequacy.
d.) Validate Anne’s concerns about her father.
13.) Anne expresses anger to the RPN about her father. What is the RPN’s 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.
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 the school peers regarding mental health.
b.) Contact the community social services worker.
c.) Refer Anne to an assertiveness training program.
d.) Recommend that Anne be home schooled.
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.
b.) Protect her from self-injury by increasing observation.
c.) Challenge her inappropriate behaviour.
d.) Place her in a seclusion room.
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.
b.) Remain quiet to allow the group to deal with Ms. Jacobs.
c.) Set limits on Ms. Jacob’s participation in the group.
d.) Ignore the behaviour and continue the meeting.
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.
b.) Explore Ms. Jacobs’ delusional content with her.
c.) Redirect Ms. Jacobs to self-directed activities.
d.) Explain the implausibility of her statements.
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.
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.
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.
b.) Assess Ms. Jacobs’ blood glucose level.
c.) Assess Ms. Jacobs’ VS.
d.) Redirect Ms. Jacobs to a unit activity.
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.
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.
,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.”
b.) “You don’t know what to do about Jimmy’s behaviour.”
c.) “What is the most upsetting part of this for you?”
d.) “Do you think Jimmy’s behaviour is not what it should be?”
8.) What is indicative of autism spectrum disorder?
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
9.) When planning care with Jimmy’s mother, what nursing intervention should the RPN implement first?
a.) Decreasing social interaction
b.) Increasing physical contact
c.) Encouraging self-stimulating behaviour
d.) Providing direction and maintaining structure
10.) What are the most appropriate actions to manage Jimmy’s behaviour?
a.) Redirect Jimmy and give 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.
, III. Use the following information to answer the next 4 questions:
Anne, 13yo, is admitted to the unit. Anne is exhibiting symptoms of depression, not attending to hygiene and
not attending school. Her home room teacher suspected that she was being sexually abused by her father
because of the change in her attitude whenever her father was mentioned and because of comments about
“being mom when Mom is away.” Investigation by social workers has resulted in the father facing criminal
charges relating to sexual abuse.
11.) The RPN is assessing Anne’s psychological status. What is a common behavioural clue of sexual abuse?
a.) Openly discussing the relationship with her father
b.) Distancing herself from siblings and mother
c.) Difficulty adapting to hospital routine
d.) Displaying clinging behaviours with peers
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 experiences.
c.) Ask Anne to explore her personal feelings of inadequacy.
d.) Validate Anne’s concerns about her father.
13.) Anne expresses anger to the RPN about her father. What is the RPN’s 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.
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 the school peers regarding mental health.
b.) Contact the community social services worker.
c.) Refer Anne to an assertiveness training program.
d.) Recommend that Anne be home schooled.
