NCLEX-RN Mental Health Conditions and Substance Use Summary

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.

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.

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.

People with dementia have trouble remembering and following several steps. Giving one short, simple instruction at a time ("Put your arm in this sleeve") lowers frustration and helps the client stay as independent as possible.

Wrong choices

• "Explain all the steps at once" is too much information; the client will likely forget and become upset.
• "Choose from many outfits" can overwhelm the client. Offering two choices works better.
• "Correct the client firmly" can cause anxiety and agitation. Gentle guidance is better.

During a panic attack, the client cannot focus or learn. The nurse should stay with the client, speak calmly in short, simple sentences, and help the client slow down breathing. The nurse's presence helps the client feel safe.

Wrong choices

• "Leave the client alone" can make the fear worse. A client in panic should not be left alone.
• "Teach a detailed relaxation program" does not work during panic. Teaching is done after the anxiety goes down.
• "Ask what caused the attack" is too hard to answer during panic. This can be explored later.

The nurse should not pretend to hear the voices, but should also not argue. The best response gently states reality ("I don't hear any voices") and responds to the client's feelings. This builds trust and keeps the client connected to what is real.

Wrong choices

• "Yes, I hear them too" supports the hallucination and is dishonest.
• "Just ignore them. They are not real" dismisses the client. To the client, the voices feel very real.
• "Don't worry. The voices will go away soon" is false reassurance and ignores the client's feelings.

Clients taking MAOIs must avoid foods high in tyramine. Tyramine with an MAOI can cause a sudden, dangerous rise in blood pressure (hypertensive crisis). Signs include a severe headache in the back of the head, stiff neck, and a pounding heart. Aged cheeses, cured or smoked meats, tap beer, and fermented foods such as sauerkraut are high in tyramine. Fresh foods are generally safe.

Wrong choices

• "Fresh baked chicken" is fresh meat, which is low in tyramine. Aged, cured, or spoiled meats should be avoided.
• "Steamed white rice" is low in tyramine.
• "A fresh apple" is low in tyramine. Overripe or spoiled fruits should be avoided.