Mental Wellness & Coping
A client going through a divorce joins a support group, takes up running, and continues performing well at work despite the life change.
What is adaptive coping (the healthy end of the mental health continuum)?
A client with major depressive disorder shows anhedonia, slowed movement, and poor concentration; the nurse understands these symptoms relate to reduced activity of these two neurotransmitters.
What are serotonin and norepinephrine?
A client who has seemed withdrawn for weeks begins writing letters to each of their siblings and asks a friend to take in their dog.
What is a suicide warning sign?
Two days into an inpatient alcohol withdrawal protocol, a client becomes tachycardic, diaphoretic, and insists that small animals are darting across the floor of the room.
What is delirium tremens (DTs)?
A client stable on lithium for months suddenly develops blurred vision, ataxia, and slurred speech during a routine follow-up call.
What is a sign of lithium toxicity requiring the provider to be notified immediately?
A client in a substance use recovery program reaches a 30-day sobriety milestone, and the nurse acknowledges the achievement in front of the peer group to encourage continued progress.
What is positive reinforcement?
A client who is frustrated after being reprimanded by a supervisor says nothing at work, then comes home and yells at their teenager for leaving dishes in the sink.
What is displacement?
While shopping, a client suddenly feels a wave of intense fear, tingling in the hands, and a sense of losing control, though nothing dangerous is happening.
What is a panic attack?
During a home visit, a client having a hard time coping after a job loss mentions that there is a loaded firearm in the nightstand “just in case things get bad.”
What is the nurse’s priority action — address safe storage/removal of the firearm and initiate suicide precautions?
A client with a long history of heavy alcohol use cannot recall recent events and instead fills in the gaps with fabricated stories they believe are true.
What is thiamine (B1) deficiency — Wernicke-Korsakoff syndrome?
A nurse teaching a client about an MAOI explains that combining the medication with aged cheeses, cured meats, and red wine can trigger this dangerous reaction.
What is a hypertensive crisis (from tyramine interaction)?
A client repeatedly trades cafeteria snacks for cigarettes with peers and ignores the unit's no-trading policy when reminded.
What is the nurse's most effective approach — consistently enforcing rules and applying stated consequences?
A client scheduled for a cardiac catheterization makes light-hearted remarks about “getting a tune-up” to ease their own tension while talking with the nurse.
What is humor (as a mature defense mechanism)?
During an intake interview, a client jumps quickly from discussing their job to their car to their weekend plans — each topic loosely connected to the last, but delivered at a rapid pace.
What is flight of ideas?
An older adult client flinches when their caregiver reaches toward them, and the caregiver answers every question directed at the client before they can respond themselves.
What is a red flag for elder abuse prompting the nurse to speak with the client privately and report suspected abuse?
A long-term care resident with dementia is calm most of the day but becomes agitated and starts searching for “car keys to get to work” every afternoon, right around dinnertime.
What is sundowning?
Before a scheduled ECT session, the nurse confirms NPO status, IV access, and signed consent, and anticipates giving a medication specifically to limit oral secretions before anesthesia induction.
What is atropine?
A client refuses a prescribed mood stabilizer, citing concerns about weight gain, and asks to just stop taking it.
What is the PN's appropriate action — reinforce teaching about the medication's purpose/risks and report the refusal to the RN?
A client passed over for a promotion tells a coworker, “I didn’t really want the extra hours anyway,” despite having pursued the position for months.
What is rationalization?
A client responds to a question with, “I feel great, don’t be late, open the gate!” — words chosen for their rhyme rather than their meaning.
What is a clang association?
A survivor pulled from a car accident is shaking, unable to answer basic orientation questions, and repeating the same phrase over and over at the scene.
What is the nurse’s first crisis intervention — stay with the client and give calm, simple directions?
Three days after surgery, a client’s level of consciousness fluctuates — alert and conversational one hour, then drowsy and disoriented the next — with a sudden onset that wasn’t present preoperatively.
What is delirium (as distinct from dementia)?
Immediately following an ECT session, a client's confusion begins to clear, but they remain drowsy with a somewhat sluggish swallow reflex; the nurse's priority is this ongoing assessment.
What is monitoring the airway, gag reflex, and vital signs closely during recovery?
A client in an acute manic episode refuses to sit down for meals but is willing to eat if food can be handed to them while they continue pacing the hallway.
What is offering portable, high-calorie finger foods and fluids that the client can consume on the move?
A client newly diagnosed with a chronic illness reports trouble sleeping and snapping at family members; the nurse teaches guided imagery and a structured problem-solving approach to daily stressors.
What is a therapeutic stress-management teaching/coping skills intervention?
A client washes their hands upward of 40 times a day due to an overwhelming fear of contamination, even though they recognize the fear is excessive, and it is now interfering with their job.
What is obsessive-compulsive disorder?
A school nurse notices a child with unexplained burns in a patterned shape and a caregiver who becomes irritable when asked about it. Legally, the nurse must take this action regardless of certainty.
What is immediately reporting suspected abuse to the proper authorities (mandatory reporting)?
A client with moderate dementia repeatedly asks when a family member is visiting, unaware that the visit already happened an hour ago; the nurse’s best approach is to provide this kind of low-stimulation reminder.
What is a written daily schedule / simple reorientation aid?
A client taking an SSRI is started on tramadol for pain and, within a day, develops agitation, muscle rigidity, high fever, and tremor.
What is serotonin syndrome?
A client insists on being allowed to use the unit phone ahead of other clients because “my time is more valuable than theirs.” The nurse's most therapeutic response reinforces this principle.
What is all clients are treated equally and follow the same unit rules?