Mental health and psychiatric nursing
Mental health nursing tests the therapeutic relationship, risk assessment and the recognition of psychiatric emergencies, including those caused by medication or physical illness. Items often ask for the best response rather than the correct fact.
Therapeutic communication
- Use open questions, reflection, paraphrasing, silence and clarification. Avoid false reassurance, why questions, advising or colluding with delusional content.
- Keep professional boundaries: self-disclosure, gifts and social contact need reflection and often refusal.
- Assess mental state systematically: appearance and behaviour, speech, mood and affect, thought form and content, perception, cognition, insight and risk.
Risk assessment
Ask directly about suicidal thoughts, plan, intent, means and previous attempts; direct questions do not increase risk. Record protective factors, remove means where possible, agree a safety plan, and share information with the team on a need-to-know basis.
Emergencies and drugs
- Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability, raised creatine kinase, after antipsychotics. Stop the drug, cool, hydrate, escalate.
- Serotonin syndrome: clonus, hyperreflexia, agitation, fever.
- Lithium: therapeutic 0.6-1.2 mmol/L. Tremor, vomiting, ataxia and confusion suggest toxicity; hold the dose, check the level and renal function, hydrate.
- Alcohol withdrawal: benzodiazepines, thiamine, fluid and electrolyte correction, monitored scoring.
Worked example
A patient on lithium presents with coarse tremor, vomiting and confusion, level 1.9 mmol/L. Reasoning: this is toxicity, likely precipitated by dehydration or a NSAID. The nurse withholds the next dose, obtains fluids and renal function, monitors neurology and escalates; it is not simply a side-effect to document.
Traps that cost marks
Assuming agitation is psychiatric when hypoglycaemia, hypoxia, pain or delirium can mimic it; using restraint without de-escalation first; promising confidentiality absolutely.