Nursing study guide
Psychology + mental health
Use safety, therapeutic communication, observation, and person-centered care—not labels or assumptions.
Start with safety
Assess immediate risk to self or others, medical instability, intoxication or withdrawal, and ability to meet basic needs.
Describe objectively
Document words, behavior, appearance, function, and change from baseline rather than judgmental conclusions.
Preserve dignity
Use trauma-informed, culturally responsive language and the least restrictive safe approach.
Therapeutic communication
Listen for meaning before solving
Calm, concrete, respectful communication improves assessment.
Open
Use broad invitations, reflection, clarification, silence, and focused follow-up.
Validate emotion
Acknowledge fear, grief, anger, or distress without affirming a delusion or inaccurate belief.
Avoid
Do not argue, interrogate, minimize, give false reassurance, make promises, or offer advice beyond role.
Set limits
State expected behavior, available choices, and consequences calmly and consistently.
Assessment
Build a mental status picture
One conversation is a snapshot; collateral information and trends matter.
| Domain | Observe or ask | Examples |
|---|---|---|
| Appearance + behavior | Grooming, eye contact, psychomotor activity, cooperation | Agitation, slowing, withdrawal, unusual movements. |
| Speech + mood | Rate, volume, fluency; stated mood and observed affect | Pressured speech, latency, flat or labile affect. |
| Thought | Process, content, perception | Organization, delusions, obsessions, hallucinations, suicidal or homicidal thoughts. |
| Cognition | Alertness, orientation, attention, memory | Consider delirium, substances, medication, neurologic or metabolic causes. |
| Insight + judgment | Understanding and decision-making | Connect findings to safety and function. |
Common patterns
Symptoms cross diagnostic boundaries
Duration, severity, impairment, substances, medical causes, and history guide diagnosis.
Depression
Low mood or loss of interest may accompany sleep, appetite, energy, concentration, guilt, psychomotor, or suicide-risk changes.
Anxiety + trauma
Fear, avoidance, hyperarousal, intrusive experiences, panic, or somatic symptoms may impair function.
Mania
Elevated or irritable mood with reduced need for sleep, increased energy, rapid speech, impulsivity, or grandiosity can create high risk.
Psychosis
Hallucinations, delusions, and disorganization require safety assessment and evaluation for psychiatric, substance, and medical causes.
Substance-related
Intoxication and withdrawal can alter mood, cognition, perception, vital signs, and seizure risk.
Suicide safety
Ask directly and act on the answer
Direct questions do not create suicidal thoughts.
Ask
Assess thoughts of death or suicide, intent, plan, access to lethal means, preparatory behavior, prior attempts, current stressors, and protective factors.
Do not leave alone
Follow emergency and observation policy when imminent risk is suspected; remove hazards within role and escalate immediately.
Crisis support
In the United States, call or text 988 for crisis support; call 911 for life-threatening danger.
De-escalation
Reduce stimulation and preserve choices
The goal is safety, not winning an argument.
Approach
Use one calm communicator, personal space, nonthreatening posture, simple language, and a quieter environment.
Assess needs
Pain, fear, hunger, sleep loss, withdrawal, delirium, sensory overload, and misunderstanding can drive behavior.
Escalate early
Call trained support when risk rises; follow policy for emergency medication or restrictive intervention.
After
Reassess physical and emotional status, document antecedents and response, and debrief when appropriate.
Medication safety
Monitor the target symptom and the whole patient
Psychiatric medications require class- and drug-specific assessment.
Antidepressants
Monitor activation, worsening mood or suicidality, serotonin toxicity, discontinuation effects, and delayed benefit.
Antipsychotics
Monitor movement effects, metabolic changes, orthostasis, sedation, QT risk, and urgent fever-rigidity-mental-status patterns.
Mood stabilizers
Verify drug-specific levels or organ monitoring, pregnancy risk, hydration, sodium, interactions, and toxicity teaching.
Sedatives
Assess respiratory and CNS depression, falls, misuse, tolerance, withdrawal, and combination with alcohol or opioids.
Recovery + rights
Function, connection, and choice are clinical outcomes
Care plans should reflect the person’s goals and strengths.
Plan
Include sleep, nutrition, activity, coping, therapy, medication, substance-use support, relationships, housing, work or school, and follow-up.
Teach
Review early warning signs, crisis contacts, medication safety, appointments, and barriers to access.
Rights
Explain care, privacy, consent, confidentiality limits, and the least restrictive available safe option.
Sources
Reference notes
Use current law, facility policy, and trained emergency procedures.