RPNCE - Registered Psychiatric Nurse of Canada Examination Crisis and Suicide Intervention Questions and Answers — Questions and Answers
Question 1: A client in the emergency department who recently lost their job states, 'I just can't see a way out. Everything is pointless.' What is the Registered Psychiatric Nurse's (RPN) PRIORITY action?
- Explore the client's feelings about their job loss in detail.
- Ask a direct question about suicidal thoughts and plans. (Correct answer)
- Develop a long-term coping skills plan with the client.
- Contact the client's family for collateral information.
Correct answer: Ask a direct question about suicidal thoughts and plans.
The client's statements indicate hopelessness, a significant risk factor for suicide. The RPN's immediate priority, consistent with RPNCE competencies for crisis intervention, is to assess for safety. Directly asking about suicidal thoughts, intent, and plan is the most critical first step to determine the level of risk and the necessary interventions. While other options are therapeutic, they are secondary to ensuring the client's immediate safety.
Question 2: When assessing a client's risk for suicide, an RPN differentiates between static and dynamic risk factors. Which of the following is a dynamic risk factor?
- A family history of suicide.
- A previous suicide attempt two years ago.
- A recent diagnosis of a chronic medical illness.
- Acute feelings of hopelessness and social isolation. (Correct answer)
Correct answer: Acute feelings of hopelessness and social isolation.
Dynamic risk factors are factors that can change over time and are important targets for intervention. These include the client's current mental state (e.g., hopelessness), social support level, and access to lethal means. Static risk factors are historical and cannot be changed, such as a history of previous attempts, family history, or chronic diagnoses. Understanding this difference is key to effective safety and treatment planning.
Question 3: A high school student is referred to the school RPN due to overwhelming anxiety about graduating and moving away to university. The student reports difficulty sleeping and concentrating. According to crisis theory, what type of crisis is this student most likely experiencing?
- Maturational (Correct answer)
- Situational
- Adventitious
- Existential
Correct answer: Maturational
A maturational crisis (or developmental crisis) occurs in response to predictable life transitions that require the adoption of new coping skills, such as graduating, getting married, or retiring. A situational crisis is precipitated by a sudden, unexpected external event, and an adventitious crisis results from a disaster or traumatic event.
Question 4: An RPN is working with a voluntary client who has a specific, lethal plan to end their life and refuses all safety planning. The RPN determines the client is at imminent risk. What is the most appropriate next step for the RPN?
- Document the client's refusal and discharge them with a follow-up appointment.
- Ask the client to sign a 'no-suicide contract' as a final intervention.
- Initiate proceedings for an involuntary psychiatric assessment. (Correct answer)
- Respect the client's autonomy and right to refuse treatment.
Correct answer: Initiate proceedings for an involuntary psychiatric assessment.
When a client is deemed to be at imminent risk of harming themselves and lacks the capacity to make safe decisions, the RPN has an ethical and legal obligation to protect them. Respecting autonomy does not apply when a client's life is in immediate danger due to a mental health crisis. Initiating an involuntary assessment under the provincial Mental Health Act is the necessary step to ensure safety and provide treatment.
Question 5: When using Roberts' Seven-Stage Crisis Intervention Model, which stage involves the RPN helping the client understand the connection between a precipitating event and their current state of distress?
- Establish rapport and rapidly establish the relationship.
- Generate and explore alternatives.
- Deal with feelings and emotions.
- Identify the major problems or crisis precipitants. (Correct answer)
Correct answer: Identify the major problems or crisis precipitants.
Stage 3 of Roberts' model is 'Identify the major problems or crisis precipitants.' This stage involves exploring the 'last straw' or the specific event that triggered the crisis, and helping the client connect that event to their overwhelming feelings and inability to cope.
Question 6: An RPN is working in a community that has recently experienced the suicide of a prominent member. The RPN is asked to help organize a response for the community. This type of intervention is known as:
- Tertiary prevention.
- Postvention. (Correct answer)
- Primary prevention.
- Critical incident stress debriefing.
Correct answer: Postvention.
Postvention refers to the supportive and therapeutic activities provided to survivors after a suicide has occurred. The goal is to facilitate grieving, reduce trauma, and mitigate the risk of contagion (copycat suicides) within the community or family. While it is a form of tertiary prevention, 'postvention' is the more specific and accurate term. Critical Incident Stress Debriefing is a specific model that may be used as part of a postvention effort, but postvention is the broader term for the overall response.
RPNCE - Registered Psychiatric Nurse of Canada Examination Crisis and Suicide Intervention Questions and Answers
A client in the emergency department who recently lost their job states, 'I just can't see a way out.
Everything is pointless.' What is the Registered Psychiatric Nurse's (RPN) PRIORITY action?