Psychiatric and Mental Health Nursing
Core concepts
Psychiatric nursing emphasizes safety, therapeutic communication, assessment, and medication knowledge. Understand mental status examination, suicide and violence risk assessment, therapeutic nurse-client boundaries, crisis intervention, and legal-ethical issues such as informed consent, confidentiality, and involuntary commitment criteria. Know major categories of psychotropic drugs and their key adverse effects: antipsychotics can cause extrapyramidal symptoms and metabolic effects; lithium requires level monitoring and hydration awareness; antidepressants may increase suicide risk early in treatment, especially in young clients.
Traps to watch
Do not argue with delusions or hallucinations; acknowledge the client’s feelings without validating the false belief. Avoid false reassurance such as “Everything will be fine.” A no-suicide contract does not guarantee safety; direct assessment and environmental safety are required. In mania, set limits calmly and consistently while protecting the client and others. In depression, remember that a sudden calm or improved mood may still carry suicide risk. For antipsychotic side effects, distinguish acute dystonia from akathisia and tardive dyskinesia; report abnormal movements.
Worked example
A client says, “The voices tell me to hurt myself.” The best initial response is direct safety assessment: ask about intent, plan, means, and immediate risk, then remove hazards and follow observation and reporting policy. Do not respond only with “Those voices are not real.”
Exam approach
Prioritize safety over insight, education, or group therapy. Choose responses that reflect feelings, ask open questions, and set clear limits. Reject options that challenge delusions, promise confidentiality when safety is at risk, or delay emergency intervention.