Mental Health and Psychosocial Nursing – LPN Flashcards

Flashcards for Mental Health and Psychosocial Nursing at NCLEX-PN depth. The emphasis is basic therapeutic communication, observing and describing behavior, working within the established plan of care, reinforcing teaching, and reporting changes to the supervising registered nurse. Cover the answer, recall it, then check.

Therapeutic Communication Basics

Give three therapeutic techniques with an example of each

Open-ended question ("Tell me what has been happening at home"), reflecting ("You feel angry when your family visits"), and making observations ("You are pacing and clenching your fists"). Silence and offering self ("I will sit with you for a while") also count.

Name four responses that block communication

False reassurance ("Everything will be fine"), giving advice ("If I were you..."), asking "why" (it demands justification), and changing the subject or minimizing ("Other people have it worse"). Approval, disapproval, and defending the staff also block communication.

Can the LPN share client information with a visitor who says she is a close friend?

No. Client information, including whether the person is a client at all, is confidential and is not released without the client's authorization. Decline politely and refer the visitor to the client or the registered nurse.

Observing and Reporting

What is the LPN's central role in mental health nursing?

Collect data, observe and accurately describe behavior, reinforce teaching, implement the established plan of care, and report changes promptly to the supervising registered nurse, who performs the initial assessment and revises the plan.

How should behavior be documented?

Objectively and specifically, describing what was seen and heard rather than interpreting it. Write "Client paced the hallway for 20 minutes, clenched fists, and stated 'I can't take this'" rather than "Client was agitated and hostile."

A withdrawn, depressed client suddenly becomes cheerful and energetic. What does this mean and what does the LPN do?

A sudden unexplained lift in mood in a previously despondent client may mean the client has decided on suicide and feels relief. Report it to the registered nurse immediately and maintain the current level of observation. Do not treat it as simple improvement.

Name four warning signs of suicide the LPN reports immediately

Statements about wanting to die or being a burden, giving away prized possessions, saying goodbye or settling affairs, and any request for potentially harmful items such as shoelaces, belts, cords, razors, or glass. Cheeking or hoarding medication is another.

What does the LPN do first when a client states an intention to kill himself tonight?

Stay with the client and use the call system or another staff member to alert the registered nurse. Never leave a client with suicidal intent alone, and never delay for documentation.

What is medication "cheeking," and why does it matter?

Cheeking is holding a pill in the mouth and later spitting it out to avoid taking it or to hoard it. It matters because the client is untreated and may be saving doses for an overdose. Watch the client swallow, check the mouth, and report it.

Which safety items are removed from a client at risk for suicide?

Belts, shoelaces, cords and charger cables, plastic bags, sharps and razors, glass, lighters, and any medication brought from home. Search belongings according to facility policy.

Recognizing and Responding to Symptoms

How should the nurse respond to a delusion?

Do not agree with it and do not argue against it. Respond to the underlying feeling: "It must be frightening to feel that you are being watched." Arguing with logic increases defensiveness and damages trust.

How should the nurse respond to a hallucination?

Present reality once without arguing and validate the client's experience: "I do not hear a voice, but I understand that you do." Then ask what the voices are saying, because voices commanding harm to self or others are an emergency to report at once.

A client is trembling, breathing rapidly, and says "I can't breathe, I am dying," and cannot follow directions. What does the LPN do?

Stay with the client, use a calm voice with short simple repeated sentences, and move to a quiet low-stimulation area. Never leave a panicked client alone and do not ask for decisions or explanations. Report to the registered nurse, who evaluates the need for a PRN medication.

A client with obsessive-compulsive disorder must complete a handwashing ritual before meals. What does the LPN do?

Allow extra time for the ritual early in treatment. Abruptly stopping it causes a sharp rise in anxiety. Limits are reduced gradually as part of the plan of care. Also check the hands for skin breakdown.

What is sundowning, and what helps?

Increased confusion, restlessness, and agitation in the late afternoon and evening in clients with dementia. Increase lighting, reduce noise and clutter, keep a predictable routine, and redirect with a calm familiar activity such as walking and talking about family. Avoid arguing or correcting in advanced dementia, and never lie by promising that someone is coming to take the client home.

What are the early signs of escalation and the basic de-escalation steps?

Early signs: louder voice, pacing, clenched fists or jaw, invading others' space, staring, and refusing redirection. Speak calmly and quietly, keep at least two arm-lengths of space, do not block the exit or corner the client, avoid sustained direct eye contact and touch, remove other clients, offer simple choices, state a clear limit, and summon additional staff before force is needed.

Medications and Physical Safety

Which findings in a client taking lithium must be reported immediately?

Coarse hand tremor, vomiting, diarrhea, drowsiness, muscle weakness, confusion, unsteady gait, or slurred speech. These suggest toxicity. Mild thirst, increased urination, a fine tremor, and modest weight gain are common expected effects.

What fluid and diet teaching is reinforced for a client on lithium?

Drink about 2 to 3 liters of water daily and keep salt intake about the same each day. Report vomiting, diarrhea, fever, or heavy sweating, because fluid and sodium loss raises the lithium level. Do not take NSAIDs such as ibuprofen without provider approval.

A client on haloperidol develops a twisted rigid neck with the eyes rolled upward. What is this and what does the LPN do?

Acute dystonia, an extrapyramidal reaction that can progress to laryngospasm and airway compromise. Stay with the client and notify the registered nurse immediately; treatment is intramuscular diphenhydramine or benztropine.

Which signs in a client on an antipsychotic suggest neuroleptic malignant syndrome?

High fever, severe muscle rigidity, unstable blood pressure and heart rate, profuse sweating, and decreased level of consciousness. This is life-threatening. Withhold the drug, stay with the client, and get emergency help at once.

What is tardive dyskinesia?

Involuntary repetitive movements such as lip smacking, tongue protrusion, chewing motions, and grimacing that develop after months to years of antipsychotic use and may be permanent. Report new movements promptly so treatment can be changed early.

What teaching is reinforced for a client starting an SSRI such as sertraline?

Full benefit takes about 4 to 6 weeks, so do not stop early. Do not stop the drug abruptly; it must be tapered. Report all other medicines and herbal products, including St. John's wort. Take as prescribed and report worsening mood or thoughts of self-harm right away.

What signs of alcohol withdrawal does the LPN watch for and report?

Rising heart rate and blood pressure, tremor, sweating, nausea, anxiety, agitation, hallucinations, and any seizure activity. Withdrawal can begin 6 to 12 hours after the last drink and can become life-threatening, so changes go to the registered nurse promptly.

What is the LPN's responsibility when a client is in restraints?

Check circulation, sensation, and skin under each restraint at the intervals set by policy; observe at least every 15 minutes or as specified; offer fluids and toileting regularly; release one limb at a time for range of motion; and document behavior and the less restrictive measures tried. Secure restraints to the movable bed frame, never to side rails. Restraint always requires a provider order, is never ordered PRN, is never used for staff convenience or punishment, and is removed as soon as the client is safe.

Coping, Grief, and Development

What is a defense mechanism, and name four common ones

An unconscious way of reducing anxiety. Denial (refusing a painful reality), regression (returning to earlier behavior, such as a toilet-trained child wetting the bed during hospitalization), projection (attributing one's own feelings to someone else), and displacement (shifting anger to a safer target).

What is a crisis, and how long does it usually last?

A crisis occurs when a person's usual coping fails against a perceived threat. It is time-limited, generally resolving within about 4 to 6 weeks, and help focuses on the immediate problem and practical short-term steps.

What should the nurse avoid saying to a grieving client?

Clichés such as "at least he is no longer suffering," "everything happens for a reason," and "I know exactly how you feel." Instead, be present, use silence, use the deceased person's name, and allow the full range of feelings including anger and relief.

How do children commonly show emotional distress?

Through the body and behavior rather than words: stomachaches, headaches, sleep problems, school refusal, irritability, clinginess, and regression such as bedwetting or thumb sucking. Play and drawing help them express feelings.

What should the LPN watch for in an older adult who has recently moved into long-term care?

Relocation stress syndrome: withdrawal, sadness, confusion, sleep disturbance, and poor appetite. Provide familiar personal items, a consistent routine, choices where possible, frequent orientation, and report significant changes to the registered nurse.

Why is it important to screen older adults for depression?

Depression in older adults often looks like physical complaints, irritability, or memory problems rather than reported sadness, and older adults have high rates of completed suicide. Report any statement about wanting to die, however casual it sounds.

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