Mental Health Nursing Concepts Flashcards

A practical nurse is caring for a client with schizophrenia who has been stable on clozapine for 8 months. The client's weekly CBC reveals an absolute neutrophil count (ANC) of 1,400 cells/mm³, down from 2,100 last week. What is the nurse's priority action?

Answer: Withhold clozapine and notify the prescriber immediately, as this ANC indicates agranulocytosis risk

An ANC of 1,400 cells/mm³ falls into the 'neutropenia' alert range (1,000–1,499) for clozapine monitoring. The nurse must withhold the dose and notify the prescriber immediately so the prescriber can determine whether to suspend therapy and arrange daily CBCs. Protective isolation is not yet warranted (that threshold is <500), and continuing the medication while the ANC is declining places the client at serious risk of life-threatening agranulocytosis.

During a therapeutic group session on an inpatient psychiatric unit, one client begins criticizing another client's disclosed trauma, saying, 'You brought it on yourself.' The nurse co-facilitating the group should respond first by:

Answer: Redirecting the group by saying 'In this group we have an agreement to maintain respect — let's pause and revisit our group norms together'

The nurse's first priority is to immediately reinforce the group's safety contract and therapeutic boundaries without singling out either client in a way that escalates conflict or re-traumatizes the disclosing client. Asking the trauma survivor to respond before the nurse intervenes prolongs their exposure to a harmful comment. Immediate removal of the criticizing client is premature and bypasses therapeutic opportunity. Exploring the criticizing client's trauma in the moment shifts focus and could derail the session.

A nurse is assessing a 78-year-old client admitted from a long-term care facility with new-onset confusion, agitation, and visual hallucinations that began 18 hours ago. The client has a documented history of major depressive disorder managed with an SSRI. Which assessment finding would most strongly suggest delirium rather than a psychiatric exacerbation?

Answer: Fluctuating level of consciousness with periods of lucidity throughout the shift

Fluctuating consciousness — waxing and waning across the course of hours — is the hallmark distinguishing feature of delirium from a primary psychiatric disorder. Psychiatric disorders such as depression or psychosis do not cause this rapid fluctuation in alertness and orientation. Visual hallucinations can occur in both delirium and psychosis but are more characteristic of delirium in elderly patients. Prior psychiatric history and refusal to engage are non-specific and do not differentiate the two.

A nurse is preparing to administer lorazepam 2 mg IV to a client experiencing acute alcohol withdrawal. The client's current CIWA-Ar score is 18. Which finding would require the nurse to withhold the medication and reassess before administering?

Answer: Respiratory rate of 10 breaths per minute

A respiratory rate of 10 breaths/min indicates early respiratory depression and is a contraindication to further benzodiazepine administration. Benzodiazepines depress the CNS, and administering IV lorazepam to a client with a respiratory rate ≤10 risks respiratory arrest. Elevated blood pressure, tachycardia, diaphoresis, and tremor are expected autonomic features of alcohol withdrawal at a CIWA-Ar score of 18 and are actually indicators supporting benzodiazepine treatment, not contraindications.

A practical nurse working in a community mental health outreach program visits a client with treatment-resistant bipolar I disorder who has recently been prescribed lithium. The client reports eating a low-sodium diet to manage newly diagnosed hypertension and has started a fitness regimen involving daily hot yoga. The nurse's priority teaching should address:

Answer: The risk that sodium restriction and heavy sweating can increase lithium reabsorption, raising serum levels toward toxicity

Lithium is reabsorbed in the proximal renal tubule in competition with sodium. When sodium intake is restricted or sodium is lost through heavy sweating (as in hot yoga), the kidneys compensate by reabsorbing more sodium — and lithium is reabsorbed alongside it, causing serum lithium levels to rise toward the toxic range (>1.5 mEq/L). This combination of sodium restriction plus profuse diaphoresis is a clinically significant and underrecognized cause of lithium toxicity. The other options address real but lower-priority concerns in this scenario.

A nurse on a psychiatric inpatient unit is reviewing the chart of a client admitted involuntarily under provincial mental health legislation. The client is now calm, oriented, and is requesting to speak with a lawyer. Which action by the nurse is most consistent with the client's legal rights?

Answer: Facilitate the client's access to a telephone and legal counsel without delay, as this right is preserved under involuntary admission

In all Canadian provinces and territories, involuntary psychiatric detention does not extinguish a patient's right to retain and instruct legal counsel. This right is constitutionally protected under the Canadian Charter of Rights and Freedoms (s. 10(b)) and is explicitly preserved within provincial mental health acts. The nurse must facilitate this access promptly. Requiring psychiatrist approval, delaying until a team meeting, or advising the client to wait until a review period is complete are all violations of the client's retained legal rights.