Study topic
Mental health conditions
NCLEX mental health chapter: mania and psychosis responses, suicide risk ranking, lithium toxicity, NMS, acute dystonia, and MAOI crisis.
Mental health items on the NCLEX turn on safety first: feed and protect the manic client, answer psychosis without feeding the delusion, rank suicide risk honestly, and catch the drug emergencies that kill.
Mood and psychotic disorders
| Picture | Nursing move |
|---|---|
| Mania: not eating/sleeping, constant motion | Safety, reduce stimulation, finger foods/fluids, sleep measures |
| Voices saying the client is in danger | Acknowledge fear; do not validate the voice content; stay with safety |
| Fixed delusion (chip in arm, etc.) | Do not argue or agree; focus on feelings and present reality tasks |
| Major depression cluster | Low mood, anhedonia, sleep/appetite change, guilt, energy loss, concentration, suicidality |
Suicide risk
- Ask directly about thoughts of suicide, plan, means, and intent.
- Remove means and increase observation for high-risk clients.
- Do not leave a high-risk client alone while you “go check something.”
- Document and communicate the risk level to the team.
- Warning signs: hopelessness, giving away possessions, sudden calm after severe depression, talking about death, rehearsing a plan.
- Highest immediate risk: specific plan with accessible means and clear intent, or active attempt preparation.
Safety
A client who says life is not worth living needs a direct suicide assessment now. Cheerful distraction is not the priority action.
Psychiatric medication emergencies
| Drug issue | Cues | Action |
|---|---|---|
| Lithium toxicity | Nausea/vomiting, coarse tremor, ataxia; level above therapeutic | Hold lithium, notify, support; review fluid/sodium and interacting drugs |
| NMS | High fever, severe rigidity, altered LOC, unstable BP/HR | Stop antipsychotic; emergency cooling/support |
| Acute dystonia | Twisted neck, oculogyric crisis soon after dose | Give ordered IM/IV anticholinergic promptly |
| MAOI crisis | Severe headache, palpitations, extreme hypertension after tyramine | Emergency BP treatment pathway; never mix with contraindicated drugs/foods |
Lithium teaching that prevents the crisis
- Take as prescribed; monitor levels as ordered.
- Keep salt and fluid intake steady. Dehydration and low sodium raise levels.
- Report vomiting, diarrhea, coarse tremor, or unsteady gait immediately.
Priority map
| Picture | First move |
|---|---|
| Manic, not eating | Finger foods + safety/sleep plan |
| Voices / delusion | Acknowledge feeling; do not argue content |
| Specific suicide plan + means | Immediate safety measures |
| Lithium 1.8 + ataxia | Hold drug; notify |
| Fever + rigidity on antipsychotic | NMS emergency |
Must know
- 1Mania priorities: safety, sleep, nutrition. Offer high-calorie finger foods and fluids when the client cannot sit for meals.
- 2Hallucinations/delusions: acknowledge feelings, do not argue or agree with the false content, redirect to reality/safety.
- 3Suicide: ask directly about ideation, plan, means, and intent. Highest risk includes specific plan + means + intent, recent attempt, or sudden brightening after deep depression.
- 4Hopeless “I can’t go on” statements require immediate safety assessment, not vague reassurance alone.
- 5Lithium: steady salt and fluid intake; toxicity cues include nausea/vomiting, coarse tremor, ataxia; hold and notify. Dehydration, low sodium, and NSAIDs raise toxicity risk.
- 6NMS: high fever, lead-pipe rigidity, altered LOC, unstable vitals after antipsychotics → stop drug, cool, escalate as emergency.
- 7Acute dystonia (torticolis, oculogyric crisis) soon after antipsychotic: give ordered anticholinergic (e.g., benztropine/diphenhydramine) promptly.
- 8MAOI + tyramine (aged cheese, cured meats, red wine, etc.): hypertensive crisis. Severe headache + extreme BP → emergency.
Memory hooks
Finger foods for flight
Manic clients who cannot sit still still need calories. Portable high-calorie foods beat empty meal trays.
Plan + means = highest risk
Ideation with a concrete plan and access to means outranks vague passive wishes for priority safety action.
Hot, stiff, out of it = NMS
Fever, rigidity, and falling LOC on an antipsychotic is neuroleptic malignant syndrome until proven otherwise.
How it's tested
Stems ask the best response to voices, who is highest suicide risk, what to do with lithium 1.8 and ataxia, or how to treat a twisted neck after a first antipsychotic dose. Distractors argue with delusions, leave a planned suicide client alone “to rest,” or treat NMS like mild EPS.