CPMHN(C) cheat sheet

Scope of practice is defined by state nurse practice acts, licensure, certification, and employer policy; registered nurses may not independently prescribe or diagnose unless authorized by law.

The nursing process follows ADPIE: assessment, diagnosis, planning, implementation, and evaluation; psychiatric-mental health nursing applies it to biological, psychological, social, and spiritual domains.

Therapeutic use of self is a planned, boundary-limited use of the nurse's communication, insight, and personality to promote patient growth; it is not social friendship or self-disclosure for the nurse's benefit.

Peplau's model identifies orientation, working, and termination phases; termination includes exploring feelings about separation and planning for future coping.

Trauma-informed care uses the 4 R's: realize trauma is widespread, recognize its signs, respond with integrated knowledge, and resist re-traumatization.

For agitation without imminent danger, de-escalation is first-line: reduce stimulation, maintain safe space, use calm verbal engagement, offer choices, and set clear limits.

Restraint or seclusion requires a licensed independent practitioner's order, time-limited renewal, face-to-face evaluation, continuous monitoring, and documentation per regulation.

Neuroleptic malignant syndrome presents with rigidity, hyperthermia, autonomic instability, and altered mental status; stop the antipsychotic, obtain emergency medical care, and monitor complications.

Serotonin syndrome presents with clonus, hyperreflexia, agitation, hyperthermia, and autonomic instability; stop serotonergic agents and seek urgent treatment.

The mental status examination documents appearance, behavior, speech, mood and affect, thought process and content, perception, cognition, insight, and judgment.

Suicide risk assessment asks directly about ideation, intent, plan, means access, prior attempts, substance use, and protective factors; asking does not increase risk.

Violence risk increases with prior violence, substance intoxication, command hallucinations, access to weapons, and recent threats; document and escalate according to policy.

Delirium is acute and fluctuating with inattention and altered awareness; dementia is chronic and progressive; delirium is a medical emergency requiring cause identification.

Alcohol withdrawal severity is quantified with CIWA-Ar and treated symptom-triggered with benzodiazepines; untreated severe withdrawal can cause seizures, delirium tremens, and death.

Opioid withdrawal is measured with COWS and is rarely fatal; treatment includes comfort measures, clonidine, and buprenorphine or methadone when appropriate.

Refeeding syndrome risk is high in severe malnutrition, low BMI, rapid weight loss, and electrolyte abnormalities; monitor phosphate, potassium, magnesium, and cardiac status.

A measurable care plan states the problem, patient-centered goal, specific interventions, timeframe, and evaluation method; goals are realistic and written with the patient when possible.

Cultural assessment includes the patient's explanatory model, identity, language, acculturation, stressors, supports, and experiences of discrimination, which shape symptoms and engagement.

Peplau's therapeutic relationship phases are orientation, working, and termination; each phase has distinct tasks, and termination addresses separation and future coping.

Transference is the patient's redirection of past feelings onto the nurse; countertransference is the nurse's reaction to the patient; both are recognized and managed, not acted out.

Professional boundaries prohibit romantic or sexual relationships, exploitative dual relationships, and gifts that create obligation; limited self-disclosure is used only when it serves the patient.

Active listening includes silence, open-ended questions, clarification, reflection, paraphrasing, and summarization; these encourage the patient to elaborate.

Nontherapeutic responses include advice-giving, false reassurance, minimizing, changing the subject, excessive 'why' questions, and premature problem-solving.

Motivational interviewing uses OARS: open-ended questions, affirmations, reflections, and summaries; resistance is rolled with rather than confronted.

Limit setting is stated clearly and respectfully: name the behavior, describe its impact, state the expected behavior, and identify consequences.

Use a trained medical interpreter for limited-English-proficiency patients; avoid using family members for confidential or clinically complex communication.

Crisis communication uses short sentences, validation of emotion, concrete information, and repeated safety assessment; avoid arguments and excessive detail.

CBT targets cognitive distortions and maladaptive behaviors; exposure and response prevention is first-line psychotherapy for OCD; DBT targets emotion dysregulation and self-harm.

DBT modules are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness; skills are taught and practiced between sessions.

SSRIs are first-line for major depression and many anxiety disorders; therapeutic onset is 2-6 weeks; youth require monitoring for increased suicidality early in treatment.

Lithium therapeutic range is about 0.6-1.2 mEq/L; toxicity signs include coarse tremor, vomiting, diarrhea, confusion, ataxia, and seizures; monitor renal and thyroid function.

Clozapine requires absolute neutrophil count monitoring because of agranulocytosis risk; fever or infection warrants immediate blood count and urgent review.

Antipsychotics can cause extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, and metabolic syndrome; monitor weight, glucose, lipids, and movements.

ECT is indicated for severe depression, catatonia, psychotic disorders, and acute suicidality when rapid response or medication failure occurs; memory effects are common and usually improve.

Naloxone reverses opioid overdose but is shorter-acting than many opioids; monitor for recurrent respiratory depression and repeat dosing as needed.

Milieu therapy uses safety, structure, norms, community meetings, and therapeutic activities to promote interpersonal learning and reality testing.

The CHIME framework describes recovery as connectedness, hope and optimism, identity, meaning and purpose, and empowerment.

Recovery-oriented care is person-centered, strengths-based, and supports shared decision-making and community inclusion rather than symptom elimination alone.

Assertive community treatment is a multidisciplinary, low-caseload, 24-hour team providing in-vivo services for people with severe mental illness and frequent hospitalization.

Individual placement and support is supported employment that emphasizes competitive jobs, rapid job search, ongoing coaching, and integration with mental health treatment.

High expressed emotion in families, especially criticism, hostility, and overinvolvement, predicts relapse in schizophrenia; family psychoeducation and communication training reduce risk.

Harm reduction reduces substance-related harm through naloxone, sterile supplies, safer-use education, and low-barrier treatment without requiring abstinence first.

Metabolic health promotion for people taking antipsychotics includes baseline and periodic weight, waist circumference, blood pressure, glucose, and lipid monitoring.

Stigma reduction uses person-first language, contact-based education, accurate information, and challenging discriminatory policies and jokes.

A crisis plan or WRAP identifies triggers, early warning signs, coping strategies, supports, and emergency contacts before a crisis occurs.

Core ethical principles are autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity; conflicts are resolved through ethics consultation and applicable law.

Valid informed consent requires capacity, voluntariness, disclosure of risks, benefits, alternatives, and consequences, and patient understanding; emergency exceptions are narrow.

Confidentiality is protected by HIPAA and professional ethics; exceptions include imminent danger, duty to warn or protect, abuse reporting, and court orders.

Involuntary commitment generally requires mental illness plus dangerousness to self or others, grave disability, or inability to meet basic needs, with due process and periodic review.

Mandatory reporting laws require reporting suspected child abuse, elder or dependent-adult abuse, and specified communicable diseases or unsafe conditions to designated authorities.

Restraint and seclusion are emergency interventions of last resort; they require a practitioner order, time limits, monitoring, face-to-face evaluation, and debriefing.

Delegation to unlicensed assistive personnel is limited to stable, predictable tasks; assessment, teaching, evaluation, and clinical judgment remain nursing responsibilities.

SBAR communicates situation, background, assessment, and recommendation; closed-loop confirmation reduces handoff errors.

Documentation is objective, timely, factual, and complete; late entries are labeled as late and never altered to conceal omissions.