Psychiatric and Mental Health Nursing Flashcards

A patient with major depressive disorder is started on fluoxetine. What must the nurse monitor for in the first 2 weeks?

Answer: Increased risk of suicidal ideation, especially in patients under 25

SSRIs, including fluoxetine, carry a black-box warning for increased suicidal thoughts particularly in children, adolescents, and young adults (under 25) during the first few weeks of treatment. Close monitoring for mood changes and emergent suicidality is essential.

A patient with schizophrenia on haloperidol develops sudden severe muscle rigidity, hyperthermia, and altered consciousness. The nurse should suspect:

Answer: Neuroleptic malignant syndrome (NMS)

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening reaction to antipsychotics, presenting with hyperthermia, severe muscle rigidity, altered consciousness, and autonomic instability. It requires immediate discontinuation of the antipsychotic and supportive care.

The nurse is using therapeutic communication with a patient who says, 'I feel like no one cares about me.' Which response is most therapeutic?

Answer: 'It sounds like you're feeling very alone right now. Tell me more about that.'

Reflective listening and open-ended exploration validate the patient's feelings and encourage further communication. Reassuring, minimizing, or asking 'why' questions can make patients feel dismissed or put on the defensive.

A patient with alcohol use disorder is admitted. Which withdrawal symptom requires the most urgent intervention?

Answer: Delirium tremens (DTs) with seizures and autonomic instability

Delirium tremens (DTs) typically occur 48–72 hours after last drink and represent the most severe form of alcohol withdrawal with a mortality rate of up to 15% if untreated. Features include severe agitation, confusion, seizures, tachycardia, hypertension, and hyperthermia.

The nurse is caring for a patient with anorexia nervosa. Which physical complication is most life-threatening?

Answer: Cardiac arrhythmias from electrolyte imbalances

Hypokalemia and other electrolyte imbalances from starvation and purging can cause fatal cardiac arrhythmias in anorexia nervosa. Malnutrition also causes cardiomyopathy. Cardiac complications are the leading cause of death in anorexia nervosa.

The nurse is assessing a patient for lithium toxicity. Which early sign should be monitored?

Answer: Coarse tremor, nausea, diarrhea, and confusion at levels >1.5 mEq/L

Lithium toxicity occurs when levels exceed 1.5 mEq/L. Early signs include coarse tremors (vs. fine tremors at therapeutic levels), GI upset, drowsiness, and confusion. Levels >2.5 mEq/L cause seizures, cardiac arrhythmias, and coma. Therapeutic range is 0.6–1.2 mEq/L.