Mental Health and Psychiatric Nursing
Mental Health and Psychiatric Nursing tests therapeutic communication, mental status assessment, suicide and violence risk, legal boundaries, de-escalation, and psychotropic medication monitoring. Questions often ask for the most therapeutic response or the safest immediate action.
Core rules and concepts
- Therapeutic communication. Use open-ended questions, reflection, clarification, and silence. Accept the patient's feelings without arguing about delusions. Avoid advice, false reassurance, 'why' questions, and changing the subject.
- Risk assessment. Ask directly about suicidal ideation, plan, intent, access to means, and protective factors. A patient with a plan and means needs immediate safety measures, close observation, and removal of harmful objects. A no-harm contract alone is not sufficient protection.
- Mental status exam. Assess appearance, behavior, speech, mood, affect, thought process and content, perception, cognition, insight, and judgment. Delirium is acute, fluctuating, and often caused by medical illness; dementia is chronic and progressive.
- Legal issues. Involuntary admission requires dangerousness or grave disability under local law. Confidentiality yields to imminent danger and mandated reporting. Restraints and seclusion are emergency measures, require a provider order and monitoring, and must be the least restrictive option.
- Medications. Typical antipsychotics cause extrapyramidal symptoms; treat acute dystonia with benztropine or diphenhydramine. Neuroleptic malignant syndrome causes fever, rigidity, and autonomic instability. Lithium toxicity causes tremor, vomiting, ataxia, and confusion. SSRIs can cause serotonin syndrome with agitation, clonus, and hyperthermia.
- Milieu. Maintain safety, consistency, and structured activities. De-escalate with calm speech, personal space, and offering choices.
Worked example
A patient with schizophrenia says, 'The CIA is putting poison in my food.' The nurse should not argue or agree. A therapeutic response is: 'That sounds frightening. I don't see anything in the food, and I'll stay with you while you eat.' This acknowledges the feeling, gently reality-tests, and supports safety without reinforcing the delusion.
Traps that cost marks
- Asking 'Why do you feel that way?' or giving false reassurance.
- Leaving a suicidal patient alone after a verbal no-harm promise.
- Treating agitation with restraint before trying verbal de-escalation and medication.
- Missing medical causes of psychosis or delirium.