Registered Psychiatric Nurses of Canada Examination (RPNCE) Practice test

What should the RPN do first when observing a client punch another client and approach the nursing station with clenched fists?

1. Call for assistance

2. Approach calmly and ask what happened

3. Direct the client to go to their room

4. Tell the client that violence is not permitted

The correct answer is: Call for assistance

When a Registered Psychiatric Nurse observes a potentially violent incident, such as one client punching another and then approaching the nursing station with clenched fists, the priority should always be the safety of all individuals involved. Initiating a call for assistance ensures that additional support is on the way, which is crucial in maintaining a safe environment. This proactive step helps to manage the situational risks effectively, as it mobilizes other staff members trained to deal with escalations. Addressing the situation calmly, while critical in a different context, without sufficient support can pose significant risks both to the staff member and to the clients. Similarly, directing the client to their room or engaging them with a verbal warning about violence does not adequately address the immediate risk. Ensuring collective safety through increased personnel presence is paramount in situations where aggression is displayed. In this scenario, calling for assistance sets the stage for a safe intervention and illustrates a foundational principle in psychiatric nursing—prioritizing safety in crisis situations.