Psychiatric nursing questions on the NCLEX require a different kind of thinking — therapeutic communication, clinical safety judgment, and knowledge of psychiatric medications. Here's what you need to know.
Therapeutic Communication: The Rules That Always Apply
Therapeutic communication questions ask what the nurse says. The correct answer almost always: reflects feelings, uses open-ended questions, avoids judgment, and keeps focus on the patient. The wrong answers: offer advice, offer false reassurance, change the subject, or ask "why" questions.
Therapeutic responses:
- "Tell me more about what you're feeling."
- "It sounds like you're feeling overwhelmed."
- "What does that experience feel like for you?"
- Sitting with the patient in silence (presence is therapeutic)
Non-therapeutic responses (avoid):
- "Everything will be okay." (false reassurance)
- "Why did you do that?" (why questions are judgmental)
- "Let's talk about something more positive." (changing subject)
- "I know exactly how you feel." (generalizing)
Suicide Risk Assessment
The NCLEX tests your ability to identify risk factors and appropriate interventions. High risk factors: specific plan, means available, prior attempts (strongest predictor), male gender, elderly, social isolation, substance use, recent loss.
Highest priority nursing intervention: maintain one-to-one supervision and ensure a safe environment (remove items that could be used for self-harm). Safety assessment before therapeutic communication in acute suicidal crisis.
Defense Mechanisms You Must Know
| Mechanism | Definition | Example |
|---|---|---|
| Denial | Refusing to acknowledge reality | "I don't have a drinking problem." |
| Projection | Attributing own feelings to others | "Everyone here is angry at me." |
| Rationalization | Justifying behavior with logical-sounding reasons | "I drink to relax after work." |
| Displacement | Redirecting emotion to a safer target | Slamming doors after a bad day at work |
| Regression | Returning to earlier developmental behavior | Adult becoming dependent and demanding when ill |
| Sublimation | Channeling unacceptable urges productively | Exercising when angry |
Psychiatric Medications: High-Yield Side Effects
Antipsychotics (typical and atypical)
EPS (extrapyramidal symptoms) with typicals: akathisia (restlessness), dystonia (muscle spasms), pseudoparkinsonism, tardive dyskinesia (late-onset, potentially irreversible). Treat EPS with benztropine or diphenhydramine. Neuroleptic malignant syndrome (NMS) is a life-threatening emergency: hyperthermia, rigidity, altered mental status, autonomic instability.
SSRIs and SNRIs
Serotonin syndrome: agitation, tremor, clonus, hyperthermia — differentiate from NMS (rigidity vs. clonus). Start low, go slow. Sexual dysfunction is common. Monitor for increased suicidal ideation in the first 2–4 weeks of treatment (especially in adolescents).
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