Psychiatric and Mental Health Nursing
Psychiatric and Mental Health Nursing tests therapeutic communication, mental state assessment, risk assessment and psychotropic drug safety. The exam favours what-the-nurse-says-next items and questions on side-effects that become emergencies.
Therapeutic communication
Use open questions, reflection, clarification and silence. Accept the patient's feelings without accepting delusions as fact. Do not argue with or mock delusions; acknowledge the feeling and redirect to reality-based activity. Maintain confidentiality except where there is risk to self or others.
Assessment and risk
Mental state examination covers appearance, behaviour, speech, mood, thought, perception, cognition and insight. Ask directly about suicidal ideas, plan and means; asking does not plant the idea. High risk means constant observation, a safe environment and immediate referral.
Psychotropic safety
- Typical antipsychotics: extrapyramidal effects; treat acute dystonia with promethazine or an anticholinergic.
- Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, raised creatine kinase-stop the drug and seek urgent care.
- Lithium: therapeutic level roughly 0.6–1.2 mmol/L; toxicity causes tremor, vomiting and ataxia; monitor renal and thyroid function.
- SSRIs: serotonin syndrome with agitation, hyperthermia and clonus.
Worked example
A patient says, 'The radio is telling me to kill myself.' The nurse should not agree that the radio speaks, nor say 'That is nonsense.' Best response: 'That must be frightening. You are safe here, and I will stay with you.' Then assess suicidal intent and remove means. This validates emotion, avoids collusion and addresses risk.
Traps
Do not promise secrecy when risk exists. Do not restrain as a first response. Do not stop lithium abruptly. Confusion in an older patient may be delirium, not dementia.