How depression is tested on the NCLEX-RN
Psychosocial Integrity items dominate, with Safety and Pharmacological Therapies overlap.
In mental health items, physical safety (suicide risk, harm to others) usually comes before other psychosocial goals. When in doubt, choose the answer that assesses risk directly or protects the client.
Recognize cues and warning signs
Changes in behavior can signal increasing risk.
| Category | Findings |
|---|---|
| Mood | Persistent sadness, hopelessness, anhedonia |
| Physical | Sleep and appetite changes, fatigue, psychomotor slowing |
| Cognitive | Poor concentration, indecision, guilt, worthlessness |
| Warning signs | Giving things away, sudden calm, goodbye messages, acquiring means |
Older adults may present with somatic complaints and confusion.
Take action: safety and communication
Interventions follow priority: safety, then physical needs, then therapeutic work.
| Therapeutic | Non-therapeutic |
|---|---|
| "Tell me more about what you are feeling." | "Everything will be fine." (false reassurance) |
| "I will sit with you for a while." (offering self) | "Why do you feel that way?" (demands explanation) |
| "You said you feel hopeless. Are you thinking of hurting yourself?" | "You have so much to live for." (minimizes) |
| Simple choices: "Would you like to shower now or after lunch?" | Open-ended choices that overwhelm |
Therapeutic communication is heavily tested.
Electroconvulsive therapy care
ECT is used for severe or treatment-resistant depression.
- Before: informed consent, NPO per protocol, remove dentures and jewelry, have the client void, baseline vitals.
- During: anesthesia and a muscle relaxant are given; the team monitors airway and vitals.
- After: side-lying position until awake, monitor airway and vitals, reorient; short-term confusion and memory loss are common.
- Headache and muscle aches can occur; fall precautions until fully alert.
NGN-style case
Applying the priority order to a new admission.
A client admitted for depression says, "My family would be better off without me. I have pills saved up at home." What is the nurse's best response?
- Recognize cues: hopelessness, statement of burden, mention of saved pills (means).
- Analyze: high suicide risk.
- Respond by asking directly about suicidal thoughts and plan.
- Report to the provider, institute observation per policy, and plan for removing means at home with family.
Answer. "Are you thinking about killing yourself?" Then initiate suicide precautions and report.