PSW MCQ 2 — Questions and Answers

Question 1: A PSW is preparing to serve a meal to a client with dysphagia. Which consistency of food has been ordered?

Regular diet with no modifications
Pureed food and thickened fluids as specified by the speech-language pathologist (Correct answer)
Clear liquid diet only
Soft foods with thin liquids

Correct answer: Pureed food and thickened fluids as specified by the speech-language pathologist

Clients with dysphagia require modified food textures and thickened fluids as prescribed by the speech-language pathologist to reduce the risk of aspiration.

Dysphagia (difficulty swallowing) places clients at serious risk of aspiration — food or liquid entering the airway and lungs, which can cause aspiration pneumonia, a potentially fatal condition. A speech-language pathologist (SLP) assesses the client's swallowing function and prescribes the appropriate diet texture using the International Dysphagia Diet Standardisation Initiative (IDDSI) framework, which ranges from Level 0 (thin liquids) to Level 7 (regular/easy to chew). The PSW must follow the prescribed diet exactly — never give thinner liquids or harder foods than ordered. When assisting with meals, the PSW should ensure the client is sitting upright at 90 degrees, eating slowly, and remaining upright for at least 30 minutes after eating. Any coughing, choking, or wet/gurgly voice during meals must be reported immediately.

Question 2: Which of the following actions by a PSW would be considered a breach of professional boundaries?

Listening attentively to a client's concerns
Accepting a monetary gift from a client (Correct answer)
Encouraging a client to participate in recreational activities
Reporting a change in a client's behaviour to the nurse

Correct answer: Accepting a monetary gift from a client

Accepting monetary gifts from clients crosses professional boundaries. PSWs must maintain a caring but professional relationship and decline gifts of significant value.

Professional boundaries are the limits that define the therapeutic relationship between a healthcare provider and client. They protect both the client (from exploitation) and the PSW (from allegations of impropriety). Accepting money or gifts of significant value from a client creates an inappropriate obligation and may constitute financial exploitation, particularly if the client has cognitive impairment. Other boundary violations include sharing personal problems with clients, developing romantic or sexual relationships, showing favouritism, accepting loans, or performing tasks outside the care plan for personal reasons. Most healthcare organizations have policies requiring PSWs to decline gifts and report any offers to their supervisor. Small tokens of appreciation (a card, homemade cookies shared with the team) are generally considered appropriate, but monetary gifts are not.

Question 3: A PSW is caring for a client who uses oxygen therapy. Which safety precaution is most important?

Keep the oxygen tank near a heat source for easy access
Ensure no open flames, smoking, or spark-producing devices are near the oxygen source (Correct answer)
Allow the client to adjust the oxygen flow rate independently
Store oxygen tanks horizontally on the floor

Correct answer: Ensure no open flames, smoking, or spark-producing devices are near the oxygen source

Oxygen supports combustion, making fire a serious hazard. No smoking, open flames, or electrical spark-producing devices should be within 3 metres of the oxygen source.

Oxygen is not flammable itself, but it is an oxidizer — meaning it causes other materials to ignite more easily and burn much faster and hotter than they would in normal air. This makes fire safety the most critical concern when caring for clients on oxygen therapy. Key safety measures include: maintaining a smoke-free environment (no smoking within at least 3 metres/10 feet), keeping away from open flames (candles, gas stoves, fireplaces), avoiding petroleum-based products near the face (Vaseline, oil-based lip balm — use water-based products instead), ensuring electrical equipment is in good repair (no frayed cords that could spark), and posting 'Oxygen in Use' signs. Oxygen tanks must be stored upright and secured to prevent falling. The PSW must never adjust the flow rate — only a regulated health professional can change the prescribed flow. Any signs of respiratory distress should be reported immediately.

Question 4: When measuring a client's blood pressure, the PSW obtains a reading of 88/52 mmHg. This reading indicates:

Normal blood pressure
Hypertension
Hypotension (Correct answer)
The equipment is malfunctioning

Correct answer: Hypotension

A blood pressure of 88/52 mmHg is below the normal range and indicates hypotension (low blood pressure). This should be reported to the supervisor.

Blood pressure is measured in millimetres of mercury (mmHg) and expressed as systolic over diastolic pressure. Normal adult blood pressure is generally considered to be around 120/80 mmHg. Hypertension (high blood pressure) is typically defined as readings consistently at or above 140/90 mmHg. Hypotension (low blood pressure) is generally defined as systolic pressure below 90 mmHg. A reading of 88/52 mmHg indicates hypotension, which can cause symptoms such as dizziness, lightheadedness, fainting, blurred vision, and fatigue. The PSW should report this reading to the nurse immediately, keep the client safe (seated or lying down to prevent falls), and recheck the reading if requested. Common causes include dehydration, blood loss, certain medications, and heart conditions. The PSW should also compare the reading to the client's baseline, as some individuals normally run lower.

Question 5: A client with dementia becomes agitated and begins pacing. What is the most appropriate PSW response?

Restrain the client in a chair for their safety
Approach calmly, speak in a soothing voice, and try to redirect the client to a calming activity (Correct answer)
Ignore the behaviour as it will pass on its own
Raise your voice to get the client's attention

Correct answer: Approach calmly, speak in a soothing voice, and try to redirect the client to a calming activity

The PSW should remain calm, use a gentle tone, and try to redirect the client to a soothing activity. Physical restraints should never be used as a first response to agitation.

Agitation and pacing are common behavioural and psychological symptoms of dementia (BPSD). These behaviours often communicate an unmet need — pain, hunger, need for toileting, overstimulation, or anxiety. The PSW should first ensure the environment is safe (remove tripping hazards from the pacing path), approach the client calmly from the front, use a soft and reassuring voice, and attempt to identify and address the underlying cause. Redirection techniques include offering a favourite snack, suggesting a familiar activity (folding towels, looking at photos), playing calming music, or going for a walk together. Physical restraints are a last resort that require a physician's order and are heavily regulated under Ontario's FLTCA — they are never an appropriate first response. Raising one's voice or arguing with a person with dementia typically escalates agitation. All behavioural episodes should be documented and reported.

Question 6: Which type of isolation precautions requires the PSW to wear a gown, gloves, and mask before entering the client's room?

Standard precautions only
Contact precautions
Droplet precautions
Airborne precautions with N95 respirator, plus gown and gloves (Correct answer)

Correct answer: Airborne precautions with N95 respirator, plus gown and gloves

Airborne precautions (for diseases like tuberculosis) require an N95 respirator, gown, and gloves. The client is placed in a negative-pressure room.

Infection control uses a tiered approach to precautions. Standard precautions (hand hygiene, PPE based on anticipated exposure) apply to ALL clients. Transmission-based precautions are added when a specific pathogen is identified: Contact precautions (gown + gloves) for infections spread by direct/indirect contact like MRSA or C. difficile. Droplet precautions (surgical mask + gown + gloves) for infections spread by large respiratory droplets like influenza or COVID-19. Airborne precautions (N95 respirator + gown + gloves, negative-pressure room) for infections spread by tiny airborne particles that remain suspended in the air, such as tuberculosis, measles, and varicella (chickenpox). The N95 respirator must be fit-tested for each worker to ensure an adequate seal. PSWs must be trained in proper donning (putting on) and doffing (removing) of all PPE to prevent self-contamination.

PSW MCQ 2

A PSW is preparing to serve a meal to a client with dysphagia.
Which consistency of food has been ordered?