CPNRE - Canadian Practical Nurse Registration Examination Mental Health Nursing Concepts Questions and Answers 1 — Questions and Answers
Question 1: A client diagnosed with major depressive disorder tells the practical nurse, 'It's pointless. Nothing will ever get better for me.' Which of the following is the most therapeutic response by the nurse?
- You need to have a more positive outlook on life.
- Why do you feel that way? What has happened?
- I understand you're feeling hopeless right now. I'll sit with you for a while. (Correct answer)
- Don't worry, everyone feels down sometimes. You'll feel better tomorrow.
Correct answer: I understand you're feeling hopeless right now. I'll sit with you for a while.
The correct response is to acknowledge and validate the client's feelings of hopelessness without judgment (empathy) and to offer self (presence). This builds trust and shows support. Giving advice, asking 'why' questions, and offering false reassurance are non-therapeutic techniques that can minimize the client's feelings and block communication.
Question 2: A practical nurse is caring for a client who has been taking a first-generation antipsychotic medication for several years. The nurse observes the client exhibiting involuntary, repetitive facial movements, including lip-smacking and grimacing. The nurse recognizes these signs as being consistent with which condition?
- Akathisia
- Tardive dyskinesia (Correct answer)
- Acute dystonia
- Neuroleptic malignant syndrome
Correct answer: Tardive dyskinesia
Tardive dyskinesia is a serious, often irreversible side effect of long-term antipsychotic use, characterized by involuntary and repetitive movements of the face, limbs, and trunk. Akathisia is motor restlessness, acute dystonia involves sudden muscle spasms, and neuroleptic malignant syndrome is a life-threatening reaction involving fever and rigidity.
Question 3: A client is admitted to the mental health unit after a family member reports they have been giving away prized possessions and talking about 'ending it all.' Which of the following is the priority assessment for the practical nurse to complete?
- Determining the client's recent stressors and coping mechanisms.
- Assessing for a specific suicide plan and its lethality. (Correct answer)
- Exploring the client's family and social support system.
- Obtaining a detailed history of past psychiatric admissions.
Correct answer: Assessing for a specific suicide plan and its lethality.
While all options are components of a thorough assessment, the immediate priority is to determine the client's current risk for suicide. This involves directly asking about suicidal ideation, the existence of a specific plan, and the lethality of that plan (e.g., access to means). This information is critical for ensuring immediate client safety.
Question 4: A client who was recently passed over for a promotion at work tells the practical nurse, 'It's probably for the best. The extra responsibility would have been too stressful anyway.' The nurse identifies this as an example of which defense mechanism?
- Projection
- Denial
- Sublimation
- Rationalization (Correct answer)
Correct answer: Rationalization
Rationalization is a defense mechanism where an individual creates logical-sounding excuses for a disappointing or unacceptable outcome to make it seem more acceptable. The client is reframing the situation to protect themselves from the disappointment of not getting the promotion. Projection involves attributing one's own unacceptable feelings to someone else. Denial is refusing to acknowledge reality. Sublimation is channeling unacceptable impulses into socially acceptable actions.
Question 5: During which phase of the therapeutic nurse-client relationship is a plan of care implemented and the client is encouraged to problem-solve and test new behaviours?
- Working phase (Correct answer)
- Orientation phase
- Termination phase
- Pre-interaction phase
Correct answer: Working phase
The working phase is the core of the therapeutic relationship where the nurse and client actively work towards achieving the goals established in the orientation phase. This includes implementing interventions, problem-solving, overcoming resistance, and evaluating progress. The orientation phase is for establishing trust, the termination phase is for ending the relationship, and the pre-interaction phase occurs before the nurse meets the client.
Question 6: A client in a common area of the psychiatric unit becomes visibly upset, pacing and speaking loudly. What is the practical nurse's most appropriate initial action?
- Tell the client to lower their voice and sit down immediately.
- Approach the client in a calm manner, maintain a safe distance, and ask what is troubling them. (Correct answer)
- Call security for a show of force to prevent escalation.
- Ignore the behaviour, as acknowledging it may reinforce it.
Correct answer: Approach the client in a calm manner, maintain a safe distance, and ask what is troubling them.
The most appropriate initial action is to use verbal de-escalation techniques. Approaching calmly, respecting personal space, and using a non-confrontational, inquisitive tone can help identify the source of agitation and resolve it at the lowest level of intervention. Commanding the client, calling security prematurely, or ignoring the behaviour are all likely to escalate the situation.
CPNRE - Canadian Practical Nurse Registration Examination Mental Health Nursing Concepts Questions and Answers 1
A client diagnosed with major depressive disorder tells the practical nurse, 'It's pointless.
Nothing will ever get better for me.' Which of the following is the most therapeutic response by the nurse?