Mental Health Nursing Concepts Flashcards

A client with schizophrenia who has been stable on haloperidol for 18 months suddenly develops muscle rigidity, hyperthermia (40.2°C), diaphoresis, and a blood pressure of 160/100 mmHg. The PN's MOST urgent priority is to:

Answer: Discontinue the haloperidol immediately and notify the physician

This presentation is consistent with Neuroleptic Malignant Syndrome (NMS), a life-threatening emergency caused by antipsychotic medications. The cardinal features — muscle rigidity, hyperthermia, autonomic instability, and altered consciousness — require immediate discontinuation of the offending antipsychotic and urgent physician notification. NMS carries a significant mortality risk if the causative agent is not stopped promptly. Lorazepam alone does not address the underlying cause. Toxicology screening and cooling measures, while potentially part of broader management, are secondary to stopping the drug and escalating care.

During a therapeutic interaction, a client with borderline personality disorder (BPD) tells the PN, 'You are the only nurse who truly understands me — all the others are cold and don't care.' The MOST therapeutically appropriate response by the PN is:

Answer: 'I'm glad you feel supported. Let's also explore how to build those connections with the rest of the team.'

The client is exhibiting 'splitting,' a core defense mechanism in BPD where individuals perceive people as entirely good or entirely bad. The therapeutic goal is to gently challenge this black-and-white thinking without dismissing the client's feelings. Option D validates the therapeutic relationship while actively redirecting toward reality-based thinking and broader support, which addresses the splitting behavior therapeutically. Option A reinforces the idealization and splitting. Option B colludes with the devaluation of other staff. Option C corrects without building on the therapeutic opportunity the moment presents.

A client is admitted after a serious suicide attempt. During assessment, which finding would be the GREATEST cause for concern regarding imminent re-attempt risk?

Answer: The client states they regret surviving the attempt and had made detailed preparations beforehand

Regret about surviving combined with evidence of high-intent planning (detailed preparations) are among the strongest predictors of imminent and high-lethality re-attempt. This indicates both high motivation and the capacity to execute a plan, placing this client at the highest risk level. Option B shows protective factors (guilt/shame, help-seeking behavior). Option C features lower historical lethality and robust social support, both of which are protective. Option D shows limited insight but behavioral compliance with safety planning, which is a moderate risk profile. The combination of intent (regret of survival) and planning capacity in Option A is most alarming.

A client on a secure psychiatric unit is prescribed clozapine for treatment-resistant schizophrenia. On day 14 of therapy, routine bloodwork reveals an absolute neutrophil count (ANC) of 1.3 × 10⁹/L. What is the CORRECT nursing action?

Answer: Withhold the next dose and notify the prescriber immediately, as this represents mild neutropenia

An ANC between 1.0–1.5 × 10⁹/L indicates mild neutropenia (Grade 2) under clozapine monitoring protocols. At this threshold, the current dose should be withheld and the prescriber notified immediately. Clozapine can cause agranulocytosis, a potentially fatal drop in neutrophils, requiring vigilant ANC monitoring. Permanent discontinuation is required at ANC < 1.0 × 10⁹/L (Grade 3 or worse). Continuing without intervention (Options A and D) is unsafe at this ANC level. The correct action is to withhold and escalate — not to permanently discontinue yet, as this ANC level may be reversible with dose adjustment or temporary suspension.

A client with a history of alcohol use disorder is admitted for detoxification. On assessment 36 hours after last drink, the PN notes the following: HR 118, diaphoresis, tremor, and the client reports hearing voices calling their name. The PN correctly interprets this as:

Answer: Alcoholic hallucinosis, which can occur with a clear sensorium during acute withdrawal

Alcoholic hallucinosis presents as auditory hallucinations occurring during or shortly after alcohol withdrawal, characteristically with a relatively clear sensorium (the client is not confused, disoriented, or delirious). It typically emerges 12–48 hours after cessation. This distinguishes it from delirium tremens (DTs), which involves global confusion, autonomic instability, and typically peaks at 48–72 hours. Wernicke's encephalopathy presents with the classic triad of ophthalmoplegia, ataxia, and confusion. Korsakoff's psychosis is a chronic amnestic disorder following untreated Wernicke's. The key differentiating feature here is intact consciousness with isolated hallucinations at 36 hours.

A PN is working with a client who has major depressive disorder and is starting electroconvulsive therapy (ECT). The client asks, 'What is the most common side effect I should expect after each treatment?' The MOST accurate response is:

Answer: 'Temporary memory difficulties and confusion immediately after the procedure are very common.'

The most common and expected side effects of ECT are post-ictal confusion and short-term memory impairment (both anterograde and retrograde amnesia), occurring immediately after each treatment session. Clients should be oriented, monitored, and supported during this recovery period. Significant hypotension (Option A) is not a typical expected post-ECT side effect; transient cardiovascular changes occur intraoperatively. Persistent tremor (Option C) is not a recognized common ECT side effect. Succinylcholine is used for neuromuscular blockade, but prolonged weakness lasting 24 hours (Option D) is not a typical outcome in standard ECT protocols. Memory and confusion effects are so well-established that informed consent discussions specifically include them.