Psychosocial, Behavioral, and Mental Health
Therapeutic Communication and Risk Assessment
Mental health questions test therapeutic communication, safety, and medication knowledge. Use open-ended questions, reflection, and silence; avoid false reassurance, advice-giving, and "why" questions that sound accusatory. Assess suicide risk directly and calmly - asking about suicide does not increase risk. Know signs of withdrawal and intoxication, and understand that the priority in acute psychiatric care is safety: environmental safety, close observation, and removing harmful objects. Know key medication classes and side effects: antipsychotics cause extrapyramidal symptoms and, rarely, neuroleptic malignant syndrome; SSRIs carry serotonin syndrome risk; lithium requires level monitoring and hydration.
Traps to Watch
Questions often present a patient in crisis and ask for the first action - safety and assessment come before teaching or discharge planning. Do not promise confidentiality when there is imminent risk to self or others. Do not argue with delusions; acknowledge the feeling without confirming the belief. Also, distinguish expected grief from depression by duration and functional impact.
Rule of Thumb
When a question asks for the nurse's first response, choose the option that keeps the patient safe and gathers more information.
Worked Example
A patient says, "I have nothing to live for." The best response is to ask directly and calmly whether the patient is thinking about suicide, then assess plan and intent and maintain safety precautions.