Mental Health Nursing Study Guide

Therapeutic communication is the purposeful use of communication techniques to build a trusting nurse-client relationship and promote the client's well-being. Key therapeutic techniques include open-ended questions (cannot be answered with yes or no), reflection (repeating or rephrasing the client's words to encourage exploration), active listening, silence (allowing the client time to think and process), and offering self (making yourself available without conditions). Non-therapeutic communication techniques are frequently tested on the NCLEX and include giving false reassurance ("Everything will be fine"), asking "why" questions (puts the client on the defensive), giving advice (removes client autonomy), changing the subject (dismisses the client's concerns), and agreeing or disagreeing with the client's delusions or hallucinations. When a client expresses emotional distress, the nurse should first acknowledge the feeling before addressing any practical concerns. For example, if a client says "I feel like nobody cares about me," a therapeutic response is "It sounds like you are feeling alone. Tell me more about what you are experiencing." This validates the client's emotion and invites further exploration. Avoid jumping to reassurance or problem-solving before the client feels heard.

Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression and many anxiety disorders. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro). It takes 2-4 weeks for full therapeutic effect. The most serious adverse effect is serotonin syndrome, which presents with agitation, hyperthermia, diaphoresis, tachycardia, and muscle rigidity. Risk increases when SSRIs are combined with MAOIs, tramadol, or triptans. Antipsychotics are divided into first-generation (typical) and second-generation (atypical). First-generation antipsychotics like haloperidol (Haldol) and chlorpromazine carry a higher risk of extrapyramidal symptoms (EPS) including dystonia, akathisia, parkinsonism, and tardive dyskinesia. Second-generation antipsychotics like risperidone, olanzapine, and quetiapine have lower EPS risk but higher risk of metabolic syndrome (weight gain, hyperglycemia, dyslipidemia). Neuroleptic malignant syndrome (NMS) is a rare but life-threatening reaction to antipsychotics characterized by hyperthermia, muscle rigidity, altered consciousness, and autonomic instability. Lithium remains the gold standard for bipolar disorder. The therapeutic level is 0.6-1.2 mEq/L, with toxicity beginning at 1.5 mEq/L. Signs of lithium toxicity progress from GI symptoms (nausea, vomiting, diarrhea) to neurological symptoms (coarse tremors, confusion, seizures). Clients must maintain adequate sodium and fluid intake because sodium depletion and dehydration increase lithium levels. Monitor renal and thyroid function regularly.

Suicide assessment is a critical nursing responsibility. Use a direct approach and ask the client specifically about suicidal thoughts, plans, and means. Asking about suicide does not increase the risk. Risk factors include previous attempts (strongest predictor), specific plan with access to means, recent loss, substance abuse, hopelessness, social isolation, and being male and elderly. A client who suddenly appears calm and at peace after a period of severe depression may have made the decision to complete suicide and requires heightened observation. For clients on suicide precautions, nursing interventions include one-to-one observation or every 15-minute checks (per facility policy and acuity), removing all potentially harmful objects (sharps, belts, shoelaces, cords), keeping the client in a safe environment close to the nursing station, checking the mouth after medication administration to ensure swallowing, and documenting observations accurately. De-escalation techniques are essential for managing aggressive or agitated clients. Maintain a calm, non-threatening stance. Use a low, steady voice. Offer choices to help the client feel in control. Maintain a safe distance and never turn your back on an agitated client. If verbal de-escalation fails, chemical restraint (medication) may be used before physical restraint. Restraints are always a last resort and require a provider order, continuous monitoring, and documentation of neurovascular checks and release attempts every 2 hours.