11/13/23, 1:00 AM ATI Mental Health - Tips for NCLEX help such as tips, acronyms, common …
ATI Capstone Content
Review: Mental Health
Mental Health tips:
All clients should have a Mental Status Exam, which includes:
Level of consciousness
Physical appearance
Behavior
Cognitive and intellectual abilities
The nurse conducts the MSE as part of his or her routine and ongoing
assessment of the client. Changes in Mental Status should be investigated
further and the provider notified.
There are two types of mental health hospitalizations: Voluntary commitment
and involuntary or civil commitment. Involuntary commitment is against the
client’s will. Despite that, unless proven otherwise, clients are still considered
competent and have the right to refuse treatment.
Use the following communication tips when answering questions on
NCLEX:
* If the client is anxious or depressed – use open-ended, supportive
statements
* If the client is suicidal – use direct, yes or no questions to assess suicide
risk
* If the client is panicked – use gentle guidance and direction
* If the client is confused – provide reality orientation
* If the client has delusions / hallucinations / paranoia – acknowledge these,
but don’t reinforce
* If the client has obsessive / compulsive behavior – communicate AFTER the
compulsive behavior
* If the client has a personality or cognitive disorder – be calm and matter-of-
fact
Treatment for mental health illnesses and disorders can include medications,
talk and behavior therapy, and / or brain stimulation. Clients undergoing
care for mental health disorders may feel pressure to deny behavior or issues
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to appear ‘normal’. The nurse should always carefully assess each individual
to ensure optimal response to therapies.
The most common type of brain stimulation therapy is electroconvulsive
therapy or ECT. ECT is generally performed for major depressive disorders,
schizophrenia, or acute manic disorders. Most clients receive therapy three
times a week for two to three weeks. Prior to ECT, carefully screen the client
for any home medication use. Lithium, MAOIs, and all seizure threshold
medications should be discontinued two weeks prior to ECT. After therapy,
reorient the client as short-term memory loss is common.
Anxiety disorders are common mental health disorders. Generalized Anxiety
Disorder, Panic Disorder, Phobias, Obsessive Compulsive Disorder, and
Posttraumatic stress disorder (PTSD) are all considered types of anxiety
disorders. Assess the client for risk factors, triggers, and responses.
A classic symptom of depression is change in sleep patterns, indecisiveness,
decreased concentration, or change in body weight. Any client who shows
these signs or symptoms should be asked if they have suicidal ideation.
Teach clients to never discontinue antidepressants suddenly.
Bipolar disorders are mood disorders with periods of depression and mania.
Clients have a high risk for injury during the manic phase related to
decreased sleep, feelings of grandiosity, and impulsivity. Hospitalization is
often required and nurses should provide for client safety.
There are several different types of abuse, including physical, sexual, or
emotional. Abuse tends to be cyclic, following a pattern of tension building,
battering, and honeymoon phase. When test questions appear related to
abuse, look for the phase to determine the correct response.
For the aggressive or violent client, setting boundaries and limits on behavior
is important. The nurse should maintain a calm approach and use short,
simple sentences.
More drug tips!
Common Psychiatric Medications
SSRIs: Selective Serotonin Reuptake Inhibitors. These medications
include Citalopram (Celexa), Fluoxetine (Prozac), or Sertraline (Zoloft). The
client should avoid using St. John’s Wort with these medications, and should
eat a healthy diet while on these medications.
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TCAs: Tricyclic Antidepressants. Amitriptyline (Elavil) is an example.
Anticholinergic effects and orthostatic hypotension may occur.
MAOIs: Monoamine Oxidase Inhibitors. Phenelzine (Nardil) is an
example. Hypertensive crisis may occur with tyramine food ingestion, so
care must be taken to avoid these substances. Educate the client to avoid
all medications until discussed with provider.
Atypical antidepressants. Bupropion (Wellbutrin) is the most common
example. Appetite suppression is a common side-effect. Headache and dry
mouth may be severe and client should notify the provider if this occurs.
Atypical antidepressants should not be used with clients with seizure
disorders.
Serotonin Norepinephrine Reuptake Inhibitors. Common SNRIs include
Venlafaxine (Effexor) and Duloxetine (Cymbalta). Adverse effects may
include nausea, weight gain, and sexual dysfunction.
Antagonists
In order to understand how antagonist drugs work, you need to understand
how agonist drugs produce therapeutic effects. Agonists are simply drugs
that allow the body’s neurotransmitters, hormones, and other regulators to
perform the jobs they are supposed to perform. Morphine sulfate, codeine,
and meperidine (Demerol) are opioid agonists that act on the mu receptors
to produce analgesia, respiratory depression, euphoria, and sedation. These
drugs also work on kappa receptors, resulting in pain control, sedation, and
decreased GI motility. Antagonists, on the other hand, are drugs that
prevent the body from performing a function that it would normally
perform. To quote William Shakespeare & the US Army, these drug
classes allow the body’s functions “to be or not to be…all that they
can be.”
Common uses of antagonists:
· Treatment of opioids overdose, reversal of effects of opioids, or reversal of
respiratory depression in an infant
· Example: a postoperative client receiving morphine sulfate for pain control
experiences respiratory depression and is treated with naloxone (Narcan)
Nursing Interventions for antagonists:
· Monitor for side/adverse effects
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· Tachycardia and tachypnea
· Abstinence syndrome in clients who are physically dependent on opioid
agonists
· Monitor for symptoms to include cramping, hypertension, and vomiting
· Administer naloxone by IV, IM, or subcutaneous routes, not orally
· Be prepared to address client’s pain because naloxone will immediately
stop the analgesia effect of the opioid the client had taken
· When used for respiratory depression, monitor for return to normal
respiratory rate (16-20/min for adults; 40-60/min for newborns)
Antidotes
Antidotes are agents given to counteract the effects of poisoning related to
toxicity of certain drugs or substances. Antidotes are extremely valuable,
however most drugs do not have a specific antidote.
Antidote Drug/Substance Treated
Muscarinic agonists, cholinesterase inhibitors
Atropine · Bethanechol (Urecholine)
· Neostigmine (Prostigmin)
Anticholinergic drugs
Physostigmine (Antilirium)
· Atropine
Digoxin immune Fab (Digibind) Digoxin, digitoxin
Vitamin K Warfarin (Coumadin)
Protamine sulfate Heparin
Glucagon Insulin-induced hypoglycemia
Acetylcysteine (Mucomyst) Acetaminophen (Tylenol)
Bronchodilators
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