RPNCE - Registered Psychiatric Nurse of Canada Examination Quality Care and Client Safety Questions and Answers — Questions and Answers
Question 1: An RPN is admitting a client with a history of recurrent self-harm to an acute inpatient psychiatric unit. To ensure the safety of the client and the milieu, which of the following is the highest priority nursing action during the admission process?
- Orienting the client to the unit's daily schedule and activities.
- Introducing the client to their roommate and other clients in the dayroom.
- Completing a thorough search of the client's belongings for hazardous items. (Correct answer)
- Developing a long-term, goal-oriented recovery plan with the client.
Correct answer: Completing a thorough search of the client's belongings for hazardous items.
The highest priority is to ensure the immediate safety of the client and others on the unit. A thorough search of belongings for contraband or potentially harmful items (e.g., sharp objects, ligatures, non-prescribed substances) directly addresses the risk of self-harm and is a critical first step in creating a safe therapeutic environment. [16, 25]
Question 2: An 82-year-old client is admitted to a geriatric psychiatry unit for management of severe depression and is started on a new antidepressant known to cause orthostatic hypotension. The client also has a slow, shuffling gait. The RPN's priority safety intervention is to:
- encourage participation in group therapy to improve mood.
- implement a comprehensive fall prevention protocol. (Correct answer)
- request a nutritional consult to address potential weight loss.
- provide a quiet, low-stimulation environment to reduce anxiety.
Correct answer: implement a comprehensive fall prevention protocol.
This client has multiple significant risk factors for falls: advanced age, a shuffling gait (mobility impairment), and a new medication with a side effect of orthostatic hypotension. Therefore, implementing a comprehensive fall prevention protocol (e.g., ensuring a clear path, using a bed alarm, assisting with ambulation, regular toileting) is the priority intervention to prevent injury. [21, 30]
Question 3: What is the primary purpose of conducting a medication reconciliation for a client upon admission, transfer, and discharge from a healthcare facility?
- To create the most accurate and complete list of the client's current medications to prevent medication errors. (Correct answer)
- To educate the client about the side effects of each new medication prescribed during their stay.
- To determine which medications are covered by the client's provincial or private insurance plan.
- To simplify the client's medication regimen by discontinuing non-essential prescriptions.
Correct answer: To create the most accurate and complete list of the client's current medications to prevent medication errors.
Medication reconciliation is a formal process to create the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician's admission, transfer, and/or discharge orders. Its primary purpose is to prevent adverse drug events by identifying and resolving discrepancies. [6, 7, 12]
Question 4: A client on an inpatient unit is becoming increasingly agitated, pacing rapidly, and speaking loudly to others. According to the principle of least restraint, what is the RPN's most appropriate initial action?
- Administering a prescribed PRN dose of an antipsychotic medication immediately.
- Placing the client in the seclusion room to prevent escalation.
- Calling a 'code white' to assemble a response team for a potential takedown.
- Approaching the client calmly and attempting verbal de-escalation techniques. (Correct answer)
Correct answer: Approaching the client calmly and attempting verbal de-escalation techniques.
The principle of least restraint requires that healthcare providers use the least restrictive and intrusive interventions first. Verbal de-escalation is the initial and most appropriate response to manage agitation, as it is non-coercive and respects the client's autonomy while attempting to ensure safety. [10, 18, 27]
Question 5: Which of the following best describes the primary goal of completing an incident report after a client experiences a medication error, even if no harm occurred?
- To provide documentation for potential legal action by the client.
- To discipline the staff member who made the error.
- To identify system-level issues and improve processes to prevent future errors. [1, 2] (Correct answer)
- To inform the prescribing physician that their order was not followed correctly.
Correct answer: To identify system-level issues and improve processes to prevent future errors. [1, 2]
The fundamental purpose of incident reporting in a modern patient safety culture is not to assign blame but to learn from failures and near misses. By analyzing incident reports, organizations can identify patterns, systemic vulnerabilities, and opportunities to improve processes, ultimately enhancing patient safety for everyone. [1, 2, 4]
Question 6: An RPN is caring for a client who has been placed in seclusion as a last resort due to imminent risk of harm to others. Which ongoing nursing intervention is the highest priority for ensuring the client's safety?
- Continuously monitoring the client's vital signs, circulation, and respiratory status. (Correct answer)
- Offering the client fluids and an opportunity for toileting every four hours.
- Documenting the client's verbal responses to the intervention in the chart.
- Processing the event with the client to identify triggers for the behaviour.
Correct answer: Continuously monitoring the client's vital signs, circulation, and respiratory status.
The client's physiological stability is the most immediate priority. Seclusion and restraint carry risks of physical harm. Canadian standards require frequent, direct observation and monitoring of the client's physical well-being, including vital signs and breathing, to ensure their safety throughout the intervention. While other options are important, they are secondary to ensuring the client is physiologically safe. [19, 23]
RPNCE - Registered Psychiatric Nurse of Canada Examination Quality Care and Client Safety Questions and Answers
An RPN is admitting a client with a history of recurrent self-harm to an acute inpatient psychiatric unit.
To ensure the safety of the client and the milieu, which of the following is the highest priority nursing action during the admission process?