Mental Health and Psychiatric Nursing
What this domain tests
Mental Health and Psychiatric Nursing tests therapeutic communication, mental status assessment, suicide and violence risk, psychotropic medication monitoring, and legal boundaries of care.
Core rules
- Therapeutic communication is specific, present, and nonjudgmental: use open questions, reflection, clarification, and silence. Avoid false reassurance, why questions, and advice-giving.
- Mental status exam: appearance, behavior, speech, mood and affect, thought process and content, perception, cognition, insight, judgment.
- Suicide risk is stratified by ideation, plan, intent, means, and history. Ask directly; asking does not increase risk. Remove means, maintain observation, and document.
- No-harm contracts are not evidence-based and do not replace observation.
- Monitor psychotropic adverse effects: metabolic syndrome with antipsychotics, serotonin syndrome with SSRIs, lithium toxicity with dehydration, and extrapyramidal symptoms.
- Restraint and seclusion require a time-limited order, continuous monitoring, and debriefing; use only after less restrictive measures fail.
Worked example
A patient says, I have a plan to take all my pills tonight. What is the priority? Reasoning: this is imminent risk with a plan and means. Stay with the patient, ask directly about intent and access, remove or secure medications, initiate one-to-one observation, notify the provider, and document the assessment. Do not promise secrecy and do not leave the patient alone to fetch help.
Traps
- Responding with you will be fine or do not say that, which closes the conversation.
- Breaking confidentiality when it is not legally required.
- Assuming a calm, smiling patient is not suicidal.
- Documenting a safety plan without confirming the patient understands it.