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NCLEX PART 3

CH 10. Psychiatric & Final Review

Congratulations! You have reached the final chapter.

Psychiatric Nursing is about Safety and Communication.
Never ask "Why?" and never say "Don't worry."

We also included the "Must-Know Lab Values" at the end.
Good luck, future RN!

1. Therapeutic Communication

The NCLEX wants you to be empathetic but professional. Avoid "Non-therapeutic" blocks.

Technique Example & Rationale
Do NOT ask "Why?" Wrong: "Why are you so angry?"
Right: "I see you are upset. Tell me more."
("Why" makes the patient defensive.)
Do NOT give False Reassurance Wrong: "Don't worry, everything will be fine."
Right: "We are here to help you."
(False hope destroys trust.)
Use "Open-Ended" Questions Right: "How are you feeling today?"
(Avoid Yes/No questions unless assessing suicide risk.)
Silence Right: Sitting quietly with a grieving client.
(Silence is powerful. Don't rush to fill the void.)

2. Psych Pharmacology (Danger Zones)

Psych meds have serious side effects. Know these three.

  • Lithium (Bipolar):
    - Therapeutic Level: 0.6 - 1.2 mEq/L.
    - Toxicity (>1.5): Tremors, N/V, Confusion.
    - Diet: Do NOT restrict Sodium (Low Na = High Lithium Toxicity). Drink 2-3L water.
  • Clozapine (Schizophrenia):
    - Risk: Agranulocytosis (Severe drop in WBCs).
    - Action: Report sore throat or fever immediately!
    - Weekly WBC monitoring required.
  • MAOIs (Antidepressants):
    - (e.g., Phenelzine, Tranylcypromine)
    - Diet: NO Tyramine (Aged cheese, wine, cured meats).
    - Risk: Hypertensive Crisis.

3. Defense Mechanisms

How do people cope with stress? You need to identify the behavior.

  • Projection:
    Attributing one's own unacceptable feelings to someone else.
    (e.g., A cheating husband accuses his wife of cheating.)
  • Displacement:
    Transferring anger to a "safer" target.
    (e.g., Kicking the dog after a bad day at work.)
  • Rationalization:
    Making excuses to justify behavior.
    (e.g., "I failed because the teacher hates me," not because I didn't study.)

4. FINAL REVIEW: Lab Values

Memorize these numbers. Write them down on your whiteboard when the exam starts.

Test Normal Range Significance
Potassium (K+) 3.5 - 5.0 mEq/L < 3.5 or > 5.0 affects the HEART.
Sodium (Na+) 135 - 145 mEq/L Changes affect the BRAIN (LOC).
Calcium (Ca++) 8.5 - 10.5 mg/dL Muscles. Low = Tetany.
Magnesium (Mg) 1.5 - 2.5 mEq/L "Mellows" muscles. Low = Wild (Torsades).
Creatinine 0.6 - 1.2 mg/dL Best indicator of Kidney function.
WBC 5,000 - 10,000 High = Infection. Low = Neutropenia.
Platelets 150,000 - 400,000 < 100k = Bleeding risk.

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