Registered Psychiatric Nurses of Canada Examination (RPNCE) Practice test

What should the RPN assess first for Mrs. Sparrow, who is confused and disoriented?

1. Dementia

2. Delirium

3. Adjustment disorder

4. Substance use disorder

The correct answer is: Delirium

In the scenario presented, the first priority for the Registered Practical Nurse (RPN) should be to assess for delirium. This condition typically presents with sudden onset confusion, disorientation, and altered levels of consciousness, and it is often reversible if the underlying cause is identified and treated promptly. Given that Mrs. Sparrow is showing signs of confusion and disorientation, this suggests a potential acute change in mental status, which aligns with the characteristics of delirium. Assessing for delirium is crucial because it can be caused by various medical issues, including infections, metabolic disturbances, or medication side effects. Identifying delirium early can lead to timely interventions that may prevent further complications. On the other hand, while dementia is a valid concern for patients showing cognitive impairment, its onset is usually gradual and progressively worsens over time, making it less likely to be the immediate cause in this case of acute confusion. Adjustment disorders typically arise in response to a specific stressor and may involve mood or behavioral changes but are not characterized primarily by acute cognitive disturbances. Substance use disorders could contribute to confusion, but without immediate assessment, the acute presentation is more closely aligned with delirium. Thus, focusing first on delirium is crucial in a clinical assessment where confusion and