Therapeutic Communication: The Foundation of Psych Nursing
Therapeutic communication is the most heavily tested mental health concept on the NCLEX. Know the difference between therapeutic and non-therapeutic responses. Therapeutic techniques include: open-ended questions ('Tell me more about how you're feeling'), reflecting ('You seem worried about...'), silence (allowing the patient to process), and empathy ('That must be very difficult for you'). Non-therapeutic responses to avoid: false reassurance ('Everything will be fine'), giving advice ('You should...'), asking 'why' questions (puts patient on the defensive), changing the subject, and approval/disapproval. The NCLEX typically presents a patient statement and asks you to choose the most therapeutic response.
Psychiatric Disorders and Their Nursing Management
Key disorders for the NCLEX: Major Depression (assess for suicide risk, SSRIs take 2-4 weeks to work, teach patients to report increased energy with persistent depression — highest suicide risk), Bipolar Disorder (lithium therapeutic level 0.6-1.2 mEq/L, monitor thyroid and renal function, maintain sodium and fluid intake), Schizophrenia (positive symptoms: hallucinations, delusions — treat with antipsychotics; negative symptoms: flat affect, social withdrawal — harder to treat), Anxiety Disorders (GAD, panic disorder, OCD, PTSD — benzodiazepines for acute anxiety, SSRIs for long-term management), Personality Disorders (borderline — splitting, self-harm; antisocial — manipulation; maintain firm, consistent boundaries).
Psychotropic Medications and Side Effect Management
The NCLEX tests pharmacological management of psychiatric disorders extensively. SSRIs (fluoxetine, sertraline): first-line for depression, takes 2-4 weeks, watch for serotonin syndrome (hyperthermia, agitation, myoclonus). Lithium: narrow therapeutic index (0.6-1.2 mEq/L), requires regular serum monitoring, toxicity signs include coarse tremors, diarrhea, confusion. Typical antipsychotics (haloperidol): extrapyramidal symptoms (EPS) — dystonia, akathisia, tardive dyskinesia. Atypical antipsychotics (clozapine): monitor for agranulocytosis with regular CBC. MAOIs: strict tyramine dietary restrictions to prevent hypertensive crisis. Benzodiazepines: risk of dependence, monitor for respiratory depression, antidote is flumazenil.
Crisis Intervention and Suicide Assessment
The NCLEX tests your ability to assess and intervene in psychiatric crises. Suicide assessment: directly ask about suicidal ideation, plan, means, and intent. Higher risk factors include: previous attempt (strongest predictor), specific plan with available means, hopelessness, recent loss, substance abuse, and social isolation. The highest-risk period is when a severely depressed patient suddenly appears to improve (they may have made the decision and feel relief). Interventions: ensure safety (remove harmful objects, one-to-one observation), establish a therapeutic alliance, create a safety plan, and maintain a non-judgmental approach. For aggressive patients: de-escalation first, least restrictive interventions, PRN medications, and seclusion/restraint only as a last resort.