Ontario PSW exam practice for the NACC PSW Final Exam

Question 1 · Mental Health, Cognitive Impairment and Responsive Behaviours

An 82-year-old resident with dementia paces the hallway and shouts at staff. What is your best initial action?

1. A

   Ask the resident to sit quietly in the room.

   Not this one. Asking the resident to sit quietly is incorrect because it ignores the underlying cause of the behaviour.

2. B

   Document the incident in the chart later today.

   Not this one. Documenting later is incorrect because immediate action is needed to support the resident.

3. C

   Apply a gentle restraint to keep the resident safe.

   Not this one. Applying a restraint is incorrect because restraints violate rights and require specific medical orders.

4. D

   Check for unmet needs like pain or hunger.

   Correct. Checking for unmet needs like pain or hunger is correct because responsive behaviours often signal an unmet need.

Responsive behaviours often express unmet physical or emotional needs. Investigating potential triggers helps address the root cause safely.

Question 2 · Daily Living, Household and Family Support

A middle-aged adult client recovering from a mild stroke is learning to eat independently. The client is slow and drops utensils frequently. What is the best restorative approach to support this client during a meal?

1. A

   Provide adaptive utensils and cue the client step-by-step to maintain their self-care skills.

   Correct. This option is correct because it uses restorative techniques, adaptive equipment, and cueing to promote maximum independence.

2. B

   Leave the client alone so they can practice without feeling rushed or observed.

   Not this one. This option creates a safety and choking hazard by leaving a recovering stroke client unattended while eating.

3. C

   Adjust the client's prescribed rehabilitation exercises during the meal to build hand strength.

   Not this one. This option represents an unauthorized modification of prescribed therapy outside the PSW scope.

4. D

   Feed the client the entire meal quickly to ensure adequate nutritional intake.

   Not this one. This option creates learned helplessness by taking over a task the client can partially perform.

Restorative approaches focus on maximizing remaining abilities through adaptive tools and gentle cueing. Providing adaptive equipment and coaching supports independence without taking over the task.

Question 3 · Assisting with Medication

An 82-year-old client in a hospital unit asks you to administer their scheduled oral pain medication because the nurse is busy. What is your correct response?

1. A

   Crush the pill in applesauce so the client can swallow it more easily.

   Not this one. Crushing medications without nursing direction alters dosing and is outside the PSW role.

2. B

   Ask the family member visiting at the bedside to give the pill.

   Not this one. Asking family to administer medication bypasses licensed care delivery.

3. C

   Administer the oral medication carefully as the client requested.

   Not this one. Administering oral medication violates PSW scope of practice in this setting.

4. D

   Explain that you cannot give oral medications and inform the nurse immediately.

   Correct. Informing the nurse upholds role boundaries and ensures client safety.

In hospitals and long-term care settings, PSWs do not administer oral medications. You must explain your role limitations and inform registered staff right away.

Question 4 · Observing, Reporting and Documenting

Which finding is an objective observation that a personal support worker reports to the nurse?

1. A

   The client has a red mark on the left elbow.

   Correct. This is correct because a visible red mark is an objective fact measured directly through sight.

2. B

   The client feels sad about the surgery.

   Not this one. This is incorrect because emotional states are subjective and cannot be directly measured with instruments.

3. C

   The client thinks the pain is moderate.

   Not this one. This is incorrect because personal pain ratings are subjective symptoms known only to the client.

4. D

   The client reports feeling dizzy.

   Not this one. This is incorrect because statements of feelings are subjective data reported directly by the client.

Objective observations are facts that you can see, hear, feel, or measure with your own senses. A red mark on the elbow is a visible physical finding that the personal support worker can directly observe.

Question 5 · Palliative and End-of-Life Care

Which action supports a palliative client's right to direct their own care?

1. A

   Excluding family members from care discussions to ensure complete privacy.

   Not this one. This is a wrong action because family relationships should be supported in palliative care.

2. B

   Following only the nurse's preferences without consulting the client.

   Not this one. This is incorrect because care must centre on the client's wishes, not just staff routines.

3. C

   Asking the client how they wish to schedule their daily personal care tasks.

   Correct. This is correct because it empowers the client to direct their own daily care.

4. D

   Deciding the daily routine for the client to save their remaining energy.

   Not this one. This is incorrect because making decisions for the client removes their personal autonomy.

Giving clients choices about their daily schedule respects their autonomy and dignity in palliative care.

Question 6 · Person-Centred Care and Communication

You are preparing to assist a resident with mild hearing loss during morning care. How should you initiate communication?

1. A

   Write all instructions on a notepad without speaking to avoid confusion.

   Not this one. This distractor is unnecessarily restrictive and ignores the resident's residual hearing capacity.

2. B

   Wait until family members arrive to translate your care instructions.

   Not this one. This distractor unnecessarily delays routine care and undermines resident independence.

3. C

   Approach from the front at eye level, speak clearly, and reduce background noise.

   Correct. This option is correct because facing the resident and reducing noise facilitates lip-reading and hearing.

4. D

   Stand behind the resident's wheelchair and speak loudly into their ear.

   Not this one. This distractor startles the resident and violates person-centred communication principles.

Approaching from the front at eye level and speaking clearly supports effective communication for clients with hearing loss while preserving dignity and person-centred care.

Question 7 · Safety, Infection Control and Abuse Prevention

Under the Fixing Long-Term Care Act, 2021, to whom must a PSW immediately report suspected resident abuse?

1. A

   The Ontario College of Social Workers.

   Not this one. The Ontario College of Social Workers regulates social workers and does not receive institutional abuse reports.

2. B

   The local municipal council representative.

   Not this one. Municipal council representatives have no regulatory role in receiving mandatory long-term care abuse reports.

3. C

   The family council president of the home.

   Not this one. The family council provides peer support and advocacy, not statutory oversight of abuse allegations.

4. D

   The Director at the Ministry of Long-Term Care.

   Correct. The Director at the Ministry of Long-Term Care is the legally mandated recipient under FLTCA s.28.

Under the Fixing Long-Term Care Act, 2021 section 28, anyone suspecting abuse must report it immediately to the Director. Staff who fail to report commit an offence under Ontario law. The other bodies listed lack statutory authority for these mandatory reports.

Question 8 · Interprofessional Team

A physiotherapist asks you to assist a resident with a new transfer technique. You have not been trained on this method. How should you respond?

1. A

   Advise the resident to remain in bed until the primary nurse becomes available.

   Not this one. Keeping the resident in bed without cause unnecessarily restricts mobility and fails to address the learning opportunity.

2. B

   Explain that you have not been trained yet and ask the therapist to demonstrate.

   Correct. Admitting lack of training and requesting instruction ensures safety and embraces collaborative team learning.

3. C

   Attempt the technique carefully while following the physiotherapist's verbal cues.

   Not this one. Attempting an unfamiliar transfer technique without previous instruction puts both the resident and worker at risk of injury.

4. D

   Refuse the task and state that transfer training is outside a worker's role.

   Not this one. PSWs routinely assist with mobility; outright refusal without seeking education harms team collaboration and care delivery.

PSWs have a duty to recognize their limitations and seek required instruction before performing unfamiliar techniques. Asking for a demonstration upholds resident safety while supporting interprofessional learning.

Question 9 · Body Systems and Health Conditions

A middle-aged client with multiple sclerosis reports increased fatigue and stiffness when attempting morning transfers. The personal support worker observes that the client's usual transfer time has doubled. What is the appropriate action?

1. A

   Modify the transfer technique to a faster method to reduce client exertion.

   Not this one. Modifying the transfer technique independently introduces fall risks and violates established safety procedures.

2. B

   Incorporate active range-of-motion exercises before attempting the transfer.

   Not this one. Incorporate exercises is outside the plan of care and may exacerbate fatigue in multiple sclerosis.

3. C

   Leave the client in bed to rest and complete household chores instead.

   Not this one. Leaving the client in bed ignores basic care needs and abandons the plan of care.

4. D

   Assist the client slowly using current techniques and report the fatigue to the supervisor.

   Correct. Assisting slowly using safe techniques and reporting fatigue correctly maintains safety while communicating health changes.

The worker must prioritize safe transfers using established techniques while recognizing and reporting changes in condition such as increased fatigue to the supervisor. Altering techniques or skipping care compromises safety.

Question 10 · PSW Role and Professional Practice

An elderly client insists on eating breakfast at noon and wearing evening clothes during the day, contrary to the suggested agency schedule. The client is cognitively intact and capable of making decisions. What is the most appropriate action for the personal support worker?

1. A

   Support the client's daily choices as outlined in the person-centred plan of care.

   Correct. Correct: This respects person-centred care and supports the client's autonomous choices.

2. B

   Notify the supervisor immediately that the client is refusing the standard morning routine.

   Not this one. Incorrect: This treats a normal preference as a critical incident report, misunderstanding client rights.

3. C

   Gently persuade the client to eat at the usual time to maintain proper digestion.

   Not this one. Incorrect: This uses persuasion to override personal preference, violating person-centred principles.

4. D

   Adjust the care schedule independently to match the client's preferred daily habits.

   Not this one. Incorrect: This exceeds the PSW role by independently altering the established agency plan of care.

Personal support workers provide person-centred care by respecting the client's autonomous choices and daily preferences. Forcing standard schedules ignores the person-centred approach required by the PSW role.