Mental Health and Safety — NCLEX-PN

Anger is an emotional response to threat, loss, or frustration that the nurse must respond to calmly and safely. Stay calm, do not argue, keep an exit route and adequate personal space, and set firm, clear limits on unacceptable behavior. Acknowledge the feeling without endorsing the behavior — “You sound very angry” — which often de-escalates the situation.

Depression is a mood disorder marked by persistent sadness, anhedonia (loss of pleasure), and impaired functioning. A sudden mood improvement in a severely depressed client can be a warning sign that they have settled on a suicide plan and gained the energy to act, so assess suicide risk directly. Screening tools such as the PHQ-9 help identify it, and SSRIs typically take 2–6 weeks for full effect, so safety must be maintained in the meantime.

Dementia is a chronic, progressive decline in cognition that gradually interferes with daily life. Communicate with short sentences and one instruction at a time, keep a consistent routine and familiar surroundings, and redirect rather than argue or reason with the client. The key contrast for the exam: dementia is gradual and irreversible, whereas delirium is acute and reversible — never confuse the two.

Delirium is an acute, fluctuating disturbance of consciousness and attention, commonly triggered by infection, hypoxia, dehydration, or medication. New confusion in an older adult is treated as a urinary tract infection until proven otherwise, so check vital signs, oxygen saturation, glucose, and the medication list. Because delirium is reversible, treat the underlying cause and minimize sedating medications rather than assuming permanent decline.

Abuse is physical, sexual, emotional, or financial harm inflicted by another person, and it crosses all ages and settings. Interview the suspected victim alone, since an abuser often answers for them or stays close; nurses are mandatory reporters for suspected child and elder abuse. Document findings objectively using the client’s own words and notify the appropriate agency per state law.

Suicide is deliberate self-inflicted death, and risk must be assessed directly and without euphemism. A client who has a specific plan, the means to carry it out, and the intent to do so is at highest risk and requires one-to-one continuous observation and a safe environment. Asking about suicide does not plant the idea — it opens a life-saving conversation and lets the client know help is available.

Addiction is a compulsive pattern of substance use that continues despite harmful consequences. Know the withdrawal patterns, because alcohol and benzodiazepine withdrawal can be life-threatening (delirium tremens, seizures), while opioid withdrawal is miserable but rarely fatal. Use nonjudgmental, person-first language such as “a person with a substance-use disorder” to preserve dignity and engagement.