Psychosocial Integrity
What this domain tests
Therapeutic communication, coping, mental status, crisis, and psychiatric emergencies. Communication items reward open-ended leads, reflection, silence, and clarifying feelings ('tell me more about that'). They punish false reassurance ('everything will be fine'), 'why' questions, arguing with delusions, and giving advice.
Core concepts
Know the defense mechanisms (denial, projection, displacement, rationalization, sublimation, regression) and that they are unconscious. Know the mental status exam components: appearance, mood and affect, thought process and content, cognition, judgment, insight. Grief is individualized and not a linear checklist. Nursing boundaries matter - no self-disclosure, no gifts, no special relationships.
High-risk situations
Suicide risk is assessed by asking directly; a 'no-harm contract' is not a substitute for observation and environmental safety (ligature-free room, close observation, search of belongings). Alcohol withdrawal can progress to seizures and delirium tremens - benzodiazepines are the treatment, thiamine is given before or with glucose to prevent Wernicke encephalopathy. Opioid withdrawal is intensely uncomfortable but rarely fatal. In eating disorders, refeeding syndrome (hypophosphatemia, arrhythmias) is the early danger, so monitor electrolytes and weight carefully.
Traps
Items that let a suicidal client keep a belt or that reduce observation after a promise. Items where the nurse argues with a delusion - instead, acknowledge the feeling without confirming the content. Items where the nurse shares personal history to 'relate.'
Worked rule
Ask directly about suicide, then act on safety: observation level, environment, and multidisciplinary follow-up come before talk therapy.