Psychiatric and Mental Health Nursing
Psychiatric and Mental Health Nursing tests therapeutic communication, risk assessment and psychopharmacology safety rather than diagnosis recall. Many items are answered by choosing the response that explores the patient's own meaning instead of offering advice.
Therapeutic communication
Use open-ended questions, restating, reflection and clarification. Non-therapeutic responses include asking why, giving advice, false reassurance, changing the subject and approving or disapproving. Peplau's relationship phases are orientation, working and termination, with the working phase carrying the actual problem-solving.
Medication safety
Lithium has a narrow therapeutic range of 0.6–1.2 mEq/L; toxicity brings tremor, vomiting, diarrhoea, ataxia and confusion, and is precipitated by dehydration, thiazides and NSAIDs. Conventional antipsychotics cause dystonia, akathisia, parkinsonism and tardive dyskinesia; tardive dyskinesia does not respond to anticholinergics and may require stopping the drug.
Worked example
On day three of haloperidol a patient has temperature 39.5 °C, lead-pipe rigidity, labile blood pressure and creatine kinase of 20,000 U/L. Reasoning: this is neuroleptic malignant syndrome. Stop the antipsychotic immediately, notify the physician, cool the patient and anticipate dantrolene or bromocriptine. It is not akathisia, which presents as restless pacing without fever or rigidity.
Traps that cost marks
- Asking a suicidal patient about suicide does not increase risk; avoiding the question is the error.
- Interpreting akathisia as worsening anxiety and increasing the dose.
- Giving lithium with a thiazide diuretic.
- Breaking confidentiality without a legal exception such as a serious threat to an identifiable person.