NCLEX Review Guide: Mental Health & Neurocognitive Disorders

Therapeutic Communication

• Active listening involves maintaining eye contact, using open-ended questions, and reflecting patient feelings back to them. This builds trust and encourages patient expression of concerns.
• Therapeutic silence allows patients time to process thoughts and feelings without pressure to respond immediately. Use 3-5 second pauses strategically during conversations.
• Avoid non-therapeutic responses such as giving advice, false reassurance ("everything will be fine"), or asking "why" questions that can make patients defensive.

Crisis Intervention

1. Assess for immediate safety risks and suicidal/homicidal ideation
2. Establish rapport and actively listen to patient concerns
3. Help patient identify coping mechanisms and support systems
4. Develop concrete action plan with patient input
5. Arrange appropriate follow-up care and resources

Depression & Bipolar Disorder

Anxiety Disorders

• Generalized Anxiety Disorder (GAD) involves excessive worry about multiple life areas for 6+ months, causing significant impairment in daily functioning.
• Panic Disorder features recurrent panic attacks with physical symptoms like chest pain, shortness of breath, and fear of dying or losing control.
• Nursing interventions include teaching deep breathing techniques, progressive muscle relaxation, and identifying anxiety triggers.

Dementia vs. Delirium

• Sundowning refers to increased confusion and agitation in dementia patients during evening hours, often requiring environmental modifications and consistent routines.
• Use validation therapy rather than reality orientation for dementia patients - acknowledge their feelings without correcting their perception of reality.

Alzheimer's Disease Stages

1. Mild: Memory lapses, difficulty with complex tasks, mood changes
2. Moderate: Increased confusion, assistance needed with ADLs, behavioral changes
3. Severe: Loss of communication, total dependence, difficulty swallowing

Key Distinctions

Essential Nursing Interventions

• Never leave suicidal patients alone - maintain constant observation
• Don't argue with delusions - acknowledge feelings instead
• Avoid restraints in delirium unless absolutely necessary for safety
• Remember: therapeutic communication focuses on feelings, not facts