1. A PSW is assisting a client with morning oral care. The client has natural teeth and reports that their gums have been bleeding when brushed for the past several days. The PSW documents and reports this finding. While waiting for the nurse's follow-up, what is the correct approach to continue oral care?
- A. Discontinue all oral care until the nurse has assessed the client's gums to avoid worsening the bleeding
- B. Continue brushing with firm pressure to remove plaque, as gum bleeding is always caused by inadequate cleaning
- C. Continue oral care using a soft-bristled toothbrush with gentle technique, rinsing with water, and monitoring for increased bleeding ✓
- D. Apply gauze soaked in hydrogen peroxide to the bleeding areas before brushing to disinfect the gums
Oral care must continue to prevent aspiration of oral bacteria and maintain hygiene. A soft-bristled toothbrush used with gentle technique minimizes trauma to inflamed gums while still cleaning effectively. Discontinuing oral care creates aspiration pneumonia risk; aggressive brushing worsens gingival damage; hydrogen peroxide is not appropriate for routine oral care by a PSW and can damage oral tissues. The PSW monitors, reports, and documents changes in bleeding.
2. A PSW is caring for a client with advanced chronic obstructive pulmonary disease (COPD) who has a documented care plan indicating a low-flow oxygen prescription. During personal care, the PSW notices the client's lips and fingertips appear bluish, the client is using accessory neck and shoulder muscles to breathe, and they can only speak two to three words between breaths. What is the most appropriate PSW action?
- A. Increase the oxygen flow rate on the concentrator to relieve the client's distress, then continue with personal care.
- B. Reassure the client that this breathing pattern is normal for COPD and proceed slowly with the care routine.
- C. Stop personal care immediately, ensure the client is in an upright position, call for emergency assistance, and stay with the client until help arrives. ✓
- D. Offer the client a glass of cold water, encourage slow deep breaths, and monitor for ten minutes before deciding whether to call the supervisor.
Cyanosis (bluish discolouration of lips and fingertips), use of accessory muscles, and the ability to speak only two to three words between breaths are signs of severe respiratory distress requiring immediate emergency intervention. A PSW must never independently adjust prescribed oxygen flow rates, as doing so is outside PSW scope of practice and can be dangerous in COPD clients who rely on a hypoxic drive. The correct action is to stop all activity, position the client upright to maximize lung expansion, activate emergency services, and remain with the client to provide reassurance and monitor until help arrives.
3. A PSW notices that a client with moderate dementia becomes extremely agitated whenever care tasks are rushed or when more than one person speaks to them at once. This reaction — characterized by an intense, disproportionate emotional response to a trigger — is most accurately described as which of the following?
- A. Sundowning
- B. Delirium
- C. Catastrophic reaction ✓
- D. Confabulation
A catastrophic reaction is an intense, overwhelming emotional or behavioural response (crying, shouting, striking out, panic) triggered by overstimulation, task demands that exceed the client's cognitive capacity, or environmental stressors. It is distinct from sundowning (time-of-day agitation pattern), delirium (acute onset global confusion from a medical cause), and confabulation (unconscious fabrication of memories). PSWs should recognize triggers and adjust the pace and environment of care to prevent catastrophic reactions.
4. A PSW is transferring a client from a wheelchair to a bed using a gait belt and stand-pivot technique. As the client stands, the PSW notices the client's knees are buckling. What is the most appropriate immediate response?
- A. Encourage the client verbally to push through the weakness and complete the stand.
- B. Block the client's knees with the PSW's knees to provide support and guide the client back to a sitting position on the wheelchair. ✓
- C. Quickly pivot the client toward the bed and lower them onto the mattress before their knees give out entirely.
- D. Release the gait belt and reach for the bed rail to steady yourself before assisting further.
When a client's knees buckle during a transfer, the immediate priority is to prevent a fall while protecting both the client and the PSW. The PSW should use their knees to block the client's knees (providing external support), maintain a firm grip on the gait belt, and guide the client back to the seated position in the wheelchair. Attempting to rush the pivot to the bed increases fall risk; releasing the gait belt removes the primary means of control.
5. During an outbreak of influenza in a long-term care home, the facility implements a no-visitation policy and cohorts ill residents. A PSW who is assigned to the outbreak unit asks whether they may also be assigned to the non-outbreak unit the same day to cover a staffing shortage. What is the most appropriate response based on IPAC outbreak principles?
- A. The PSW may float between units as long as they perform hand hygiene and change their uniform between assignments
- B. The PSW should not be assigned to both units during an active outbreak, as this risks transmitting the pathogen from the outbreak unit to the non-outbreak unit ✓
- C. The PSW may float if they wear a surgical mask throughout their entire shift on both units
- D. Floating between units is only restricted for PSWs who are showing symptoms of influenza themselves
During a declared outbreak, Ontario IPAC and Public Health Ontario guidelines recommend cohorting staff to outbreak units to prevent transmission of the outbreak pathogen to unaffected areas. Even asymptomatic staff can carry and shed influenza virus. Hand hygiene and masking alone do not eliminate the risk of transmission via clothing or indirect contact when moving between outbreak and non-outbreak units. The facility's outbreak management plan should restrict staff movement, and the PSW should communicate the staffing concern to their supervisor rather than floating independently.
6. A PSW notices that a client nods and says 'yes' to every question asked, but their facial expression and body language suggest they may not actually understand. What is the most likely explanation, and what should the PSW do?
- A. The client is being cooperative; no further action is needed.
- B. The client may be experiencing language or cognitive barriers; the PSW should use simpler language, visual cues, and check for understanding by asking the client to demonstrate or explain in their own words. ✓
- C. The client is probably embarrassed and will understand better if the PSW speaks more quickly to avoid drawing attention to the confusion.
- D. The client's agreement is sufficient consent; the PSW should proceed with care as planned.
Clients may agree without true understanding due to language barriers, cognitive impairment, cultural communication styles, or a desire to please. True informed consent requires actual comprehension. The PSW should use plain language, visual demonstrations, and 'teach-back' techniques (asking the client to explain or demonstrate) to verify understanding. Speaking faster or assuming agreement constitutes consent are both inappropriate and unsafe practices under Ontario PSW standards.
7. A PSW notices that the client's care plan has not been updated in over six months, even though the client's condition has noticeably changed. The PSW believes some of the care directives in the plan are now outdated. What is the most appropriate action?
- A. Continue following the existing care plan exactly as written until officially told otherwise
- B. Modify the care approaches independently based on current observations to best meet the client's needs
- C. Document specific observations about the changes in the client's condition and report to the supervisor so the care plan can be reviewed and updated by the appropriate team ✓
- D. Ask the client's family to request a care plan update from the agency on the PSW's behalf
PSWs do not have the authority to independently modify a care plan, even when they recognize it may be outdated. Their role is to observe, document, and communicate changes to the appropriate regulated health professional or supervisor. Accurate observation and timely reporting are core PSW responsibilities that trigger a formal care plan review. Ignoring the issue or acting outside the plan without authorization both compromise client safety and professional standards.
8. According to Piaget's theory of cognitive development, a 9-year-old child who understands that a ball of clay rolled into a snake shape still contains the same amount of clay has achieved:
- A. Object permanence
- B. Conservation ✓
- C. Abstract reasoning
- D. Egocentrism
Conservation is the understanding that quantity, mass, or volume remains the same despite changes in shape or appearance, and is a hallmark achievement of Piaget's concrete operational stage (ages 7–11). Object permanence is achieved in infancy (sensorimotor stage). Abstract reasoning develops in the formal operational stage (adolescence). Egocentrism is a characteristic of the preoperational stage and involves inability to take another's perspective, not a cognitive achievement.
9. A PSW is assisting a client with moderate cognitive impairment during morning dressing. The client picks up their shirt and attempts to put it on independently, though they are doing it incorrectly and slowly. According to person-centred care and rehabilitation principles, what is the most appropriate response?
- A. Take the shirt from the client and dress them efficiently to complete the task on time
- B. Correct the client's technique immediately and guide each movement step by step to ensure it is done properly
- C. Allow the client to continue their attempt, offering verbal cues and hand-over-hand guidance only if needed, to support independence ✓
- D. Redirect the client to a different activity and return to dressing once the client is calmer and more cooperative
Person-centred care and rehabilitation principles emphasize supporting maximum client independence and preserving existing abilities. A PSW should use a least-restrictive approach: allow the client to attempt the task, provide verbal prompts and cueing, and offer physical assistance only as needed. Taking over the task removes independence and dignity; immediate correction can be discouraging and increase resistance; redirection is appropriate for refusal, not a participation attempt.
10. An older adult client with type 2 diabetes reports numbness and tingling in both feet and tells the PSW that they sometimes cannot feel when their feet touch the floor. The PSW should recognize this as which condition and respond how?
- A. Diabetic peripheral neuropathy; inspect the client's feet carefully at each visit, ensure safe footwear is worn, and report any skin changes or injuries to the supervisor. ✓
- B. Normal aging of the nervous system; reassure the client that decreased sensation in the feet is expected and no special measures are needed.
- C. Peripheral vascular disease; apply a warm foot soak daily to improve circulation and sensation.
- D. Deep vein thrombosis; elevate the feet above heart level and massage the calves to restore blood flow.
Numbness, tingling, and reduced sensation in the feet in a client with diabetes is consistent with diabetic peripheral neuropathy, caused by chronic high blood glucose damaging peripheral nerves. Because the client cannot feel pain or pressure, injuries can go unnoticed and lead to serious complications including ulcers and infection. The PSW role includes systematic foot inspection at each visit, ensuring properly fitting footwear is worn at all times, and reporting any new skin breakdown, blisters, or wounds to the supervisor promptly. Warm soaks are contraindicated in diabetes due to burn risk, and massage over possible thrombosis sites is contraindicated.