Mental Health
Psychosocial Integrity questions test how you communicate, how you keep clients safe and how well you understand psychiatric medications. The best answers are usually client-centered, honest and focused on safety. This topic covers the patterns that come up again and again.
Key facts
- Therapeutic responses reflect feelings and invite the client to say more. Avoid giving advice or false reassurance.
- Ask directly about suicidal thoughts and plans. Asking does not increase the risk.
- Safety comes first: remove dangerous items and increase observation as ordered.
- Lithium has a narrow therapeutic range. Watch for toxicity signs such as vomiting, tremor and confusion.
- Signs of neuroleptic malignant syndrome: high fever, muscle rigidity and changes in mental status.
- Serotonin syndrome can follow when serotonergic drugs are combined.
Therapeutic communication
Choose answers that acknowledge feelings, use open-ended questions and stay with the client. Examples include 'Tell me more about that' and 'You seem upset.'
Avoid 'why' questions, changing the subject, sharing personal stories or promising that everything will be fine. These close down the conversation.
Suicide and safety
When a client shows warning signs, ask directly whether they are thinking of harming themselves and whether they have a plan. A specific plan with access to the means raises the level of risk.
A sudden improvement in mood in a depressed client can sometimes mean they have made a decision to act, so continued close observation is important.
Psychiatric medications
Antipsychotics can cause movement disorders and metabolic changes. Lithium requires steady fluid and sodium intake and regular blood level checks.
SSRIs may take several weeks to reach full effect. Teach clients not to stop them suddenly, and to report any worsening of mood.
Crisis and de-escalation
With an escalating client, keep a calm voice, give them space, set clear limits and stay safe yourself. Restraints are a last resort and must follow orders and policy.
After a crisis, review what happened with the client and the team to prevent it from happening again.
Practice: 3 original questions
1. A client says, 'Nobody would miss me if I were gone.' What is the nurse's best response?
Answer and rationale
Correct: B. Asking directly about suicidal thoughts is the safest and most therapeutic response. It allows an accurate risk assessment.
2. A client taking lithium has vomiting, a coarse tremor and confusion. What should the nurse do?
Answer and rationale
Correct: B. These are signs of lithium toxicity. Hold the drug, notify the provider and expect a blood level check.
3. Which statement is the best example of therapeutic communication?
Answer and rationale
Correct: C. Reflecting the client's feelings encourages them to keep talking. The other responses give false reassurance, advice or a judgmental 'why'.
Related Nurseclex guides
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