NCLEX-RN · Psychosocial Integrity
NCLEX-RN: Mental Health Conditions and Substance Use Concepts
Importance ★★★★☆ · 50% (estimate)
Written by AI. Only units that passed a separate AI check (re-reading facts and numbers) are published. Tell us if you find a mistake.
Overview
This chapter covers caring for clients with anxiety, mood disorders, psychosis, confusion and substance use. Safety is the main theme: protecting clients from harming themselves or others while treating them with respect.
Ask about suicide directly and clearly. A client with a plan and a way to carry it out is at high risk, and a sudden calm after deep depression can be a warning sign. Keep the area free of harmful objects. Delirium starts suddenly and often has a physical cause, while dementia develops slowly over time.
Alcohol withdrawal can begin within hours of the last drink and can become life-threatening, with tremors, sweating, fast heart rate and seizures; it is treated with benzodiazepines and thiamine. Some psychiatric drugs need close watching: lithium needs steady fluid and salt intake and blood levels, MAO inhibitors require avoiding foods high in tyramine, and clozapine can lower white blood cells.
Key concepts
Suicide risk assessment
Ask directly: 'Are you thinking about killing yourself?' Then ask about a plan, the means and timing. Asking does not put the idea in the client's head.
Memory tipA sudden calm or giving away belongings after depression can mean the client has decided on a plan.
Delirium
A sudden change in attention and thinking, often over hours or days, caused by a physical problem such as infection, drugs or low oxygen. It usually improves when the cause is treated.
Memory tipSudden confusion in an older adult: look for infection, drugs or low oxygen first.
Alcohol withdrawal
Symptoms such as shaking, sweating, anxiety, fast heart rate and high blood pressure can begin within hours of the last drink. Severe cases cause seizures and delirium tremens. Benzodiazepines are the main treatment.
Memory tipGive thiamine as ordered to prevent brain damage (Wernicke's), and keep seizure precautions.
Lithium safety
Lithium treats bipolar disorder but has a narrow safe range. Dehydration and low salt intake raise the level and can cause toxicity, with vomiting, diarrhea, coarse tremor and confusion.
Memory tipTeach steady fluids and steady salt, and keep regular blood level checks.
MAO inhibitors and tyramine
MAO inhibitors are antidepressants. Eating foods high in tyramine, such as aged cheese, cured meats and draft beer, can cause a dangerous rise in blood pressure.
Memory tipSevere headache in a client on an MAO inhibitor: think high blood pressure crisis.
Neuroleptic malignant syndrome
A rare, life-threatening reaction to antipsychotic drugs with high fever, very stiff muscles, confusion and unstable vital signs.
Memory tipHigh fever plus rigid muscles after an antipsychotic: stop the drug and call the provider right away.
Therapeutic milieu
A safe, structured unit setting that supports healing. It includes removing harmful objects, clear rules, a calm space and consistent staff responses.
Memory tipStart with the least restrictive step, such as talking calmly, before seclusion or restraints.
Often tested
- Ask about suicide directly and check for a plan and means.
- A sudden calm or giving things away after depression may signal suicide risk.
- Delirium is sudden and often reversible; dementia is gradual.
- Alcohol withdrawal can cause seizures; benzodiazepines and thiamine are key.
- Teach steady fluid and salt intake for lithium and tyramine limits for MAO inhibitors.
- Clozapine needs white blood cell monitoring; report fever or sore throat.
Easy to confuse: Delirium and dementia
| Feature | Delirium | Dementia |
|---|---|---|
| Onset | Sudden, hours to days | Slow, months to years |
| Attention | Poor, comes and goes | Usually normal early |
| Cause | Often a physical problem | Brain disease |
| Course | Often reversible | Usually progressive |
3 sample questions
Verified practice questions from this unit.
Question 1. A client takes lithium for bipolar disorder. Which finding should the nurse report as a possible early sign of lithium toxicity?
- ① Mild thirst when starting the medicine
- ② Increased appetite
- ③ Feeling calmer than last week
- ④ Vomiting and diarrhea
▼ Show answer and explanation▲ Hide answer and explanation
Answer: ④ Vomiting and diarrhea
Key point: Vomiting, diarrhea, and a worsening tremor can signal lithium toxicity
Lithium has a narrow safe range in the blood. Early signs of toxicity include nausea, vomiting, diarrhea, and a worsening hand tremor. Vomiting and diarrhea also cause fluid and sodium loss, which can raise the lithium level even more. The nurse should hold the dose and report the finding so the level can be checked.
Wrong choices
- "Feeling calmer than last week" is the expected effect of treatment.
- "Mild thirst when starting the medicine" is a common side effect, not a sign of toxicity on its own.
- "Increased appetite" can occur with lithium and is not a sign of toxicity.
Question 2. The nurse is caring for a client with major depression who has been on the unit for 5 days. Which finding requires the nurse's immediate follow-up?
- ① The client went to group therapy and spoke briefly
- ② The client ate half of lunch
- ③ The client slept 6 hours last night
- ④ The client gave away a favorite watch and photos to other clients today
▼ Show answer and explanation▲ Hide answer and explanation
Answer: ④ The client gave away a favorite watch and photos to other clients today
Key point: Giving away belongings may signal a suicide plan
Giving away important belongings can mean the client is preparing to die by suicide. The nurse should ask the client directly about suicidal thoughts and plans, keep the client safe, and report the finding. A sudden calm or cheerful mood after deep depression is another warning sign.
Wrong choices
- "Ate half of lunch" is common with depression and should be watched, but it is not urgent.
- "Slept 6 hours last night" is not an urgent finding.
- "Went to group therapy and spoke briefly" is a positive sign of taking part in treatment.
Question 3. The nurse is assigned to four clients on a mental health unit. Which client should the nurse see first?
- ① A client on day 2 of alcohol withdrawal who has shaking hands, a heart rate of 122/min, and says there are bugs on the wall
- ② A client with depression who is asking for something to help her sleep tonight
- ③ A client with schizophrenia who is pacing in the hallway and talking quietly to himself, as usual
- ④ A client with bipolar disorder in a manic phase who did not finish dinner
▼ Show answer and explanation▲ Hide answer and explanation
Answer: ① A client on day 2 of alcohol withdrawal who has shaking hands, a heart rate of 122/min, and says there are bugs on the wall
Key point: Alcohol withdrawal with hallucinations and fast pulse is urgent
Alcohol withdrawal can become life-threatening. Tremors, a fast heart rate, and new hallucinations on day 2 suggest worsening withdrawal that can lead to seizures or delirium tremens (severe withdrawal with confusion and unstable vital signs). This client needs assessment and treatment first.
Wrong choices
- "Schizophrenia ... as usual" describes the client's usual behavior, so it is not urgent.
- "Depression ... asking for something to help her sleep" is a comfort request that can wait.
- "Bipolar disorder ... did not finish dinner" is a nutrition concern that matters, but it is not life-threatening right now.