National Council Licensure Examination for Registered Nurses (NCLEX-RN) Psychosocial Integrity Syllabus

What distinguishes major depressive disorder from a normal grief reaction?

Grief is tied to a specific loss with preserved self-esteem and waves of sadness; major depression involves pervasive low mood, worthlessness/guilt, anhedonia, and often suicidal ideation lasting 2+ weeks.

What are the diagnostic criteria highlights for a manic episode in bipolar disorder?

A distinct period (1+ week) of abnormally elevated/irritable mood plus increased energy, with symptoms like grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, and risky behavior.

What is the priority nursing concern for a client in an acute manic episode, and a key dietary intervention?

Risk for injury/exhaustion and inadequate nutrition; provide high-calorie finger foods that can be eaten on the go since the client cannot sit still to eat.

What is the difference between generalized anxiety disorder and panic disorder?

GAD: chronic, excessive worry about multiple things for 6+ months. Panic disorder: recurrent, sudden discrete panic attacks with intense physical symptoms (palpitations, chest pain, fear of dying) peaking within minutes.

What is the most therapeutic nursing intervention for a client experiencing a panic attack?

Stay with the client, remain calm, use short simple directions, decrease stimuli (quiet environment), and help with slow deep breathing. Do not leave the client alone.

Define obsessions vs. compulsions in OCD.

Obsessions are recurrent, intrusive, unwanted thoughts causing anxiety; compulsions are repetitive behaviors or mental acts performed to reduce that anxiety.

What is the appropriate nursing approach to a client's compulsive ritual?

Allow time for the ritual initially (do not abruptly stop it, as this increases anxiety); set reasonable limits gradually and reduce anxiety-provoking situations as treatment progresses.

Differentiate positive and negative symptoms of schizophrenia.

Positive symptoms are added/distorted functions: hallucinations, delusions, disorganized speech. Negative symptoms are losses: flat affect, alogia (poverty of speech), avolition, anhedonia, and social withdrawal.

What is the difference between a hallucination, an illusion, and a delusion?

Hallucination: false sensory perception with no external stimulus (e.g., hearing voices). Illusion: misinterpretation of a real stimulus. Delusion: a fixed, false belief not based in reality.

What is the priority nursing response to a client reporting command hallucinations?

Assess for content/safety - ask what the voices are saying to determine risk of harm to self or others; ensure safety. Acknowledge the experience is real to the client without reinforcing the hallucination.

How should a nurse respond to a client expressing a delusion?

Do not argue with or reinforce the delusion; acknowledge the feeling ('You seem frightened'), present reality matter-of-factly, and focus on real-world topics/feelings.

What is the difference between delirium and dementia?

Delirium: acute, sudden onset, fluctuating, often reversible, with impaired attention and altered consciousness (often from infection, drugs, metabolic causes). Dementia: gradual, progressive, usually irreversible decline in memory/cognition with clear consciousness.

What are key nursing interventions for a client with Alzheimer's/dementia to maintain safety and orientation?

Provide a consistent routine and caregivers, reorient frequently, use simple clear communication, remove hazards, label rooms, use familiar objects, and avoid overstimulation.

What communication technique works best when a dementia client is confused or agitated (validation therapy)?

Acknowledge and validate the client's feelings and reality rather than correcting them; redirect and avoid confrontation.

What characterizes borderline personality disorder, and what is a key nursing strategy?

Unstable relationships, impulsivity, fear of abandonment, identity disturbance, self-harm, and splitting (all-good/all-bad thinking). Key strategy: set clear, consistent limits and maintain consistent staff approach to prevent manipulation/splitting.

What is 'splitting' as seen in borderline personality disorder?

A defense mechanism of viewing people or situations as entirely good or entirely bad, unable to integrate positive and negative qualities; staff must communicate and maintain consistency to counter it.

Differentiate antisocial personality disorder from narcissistic personality disorder.

Antisocial: disregard for and violation of others' rights, deceit, lack of remorse, manipulation. Narcissistic: grandiosity, need for admiration, sense of entitlement, and lack of empathy.

Differentiate anorexia nervosa from bulimia nervosa.

Anorexia: restriction leading to significantly low body weight, intense fear of weight gain, distorted body image. Bulimia: recurrent binge eating followed by compensatory behaviors (vomiting, laxatives), usually with normal or near-normal weight.

What is refeeding syndrome and why is it a priority concern in anorexia treatment?

A potentially fatal fluid/electrolyte shift (notably hypophosphatemia, hypokalemia, hypomagnesemia) when nutrition is reintroduced too quickly; can cause cardiac failure. Refeed slowly and monitor electrolytes.

List four key therapeutic communication techniques.

Active listening, using open-ended questions, reflecting/restating, clarifying, focusing, using silence, and offering self/general leads. (Examples of facilitating dialogue without judgment.)

Name common nontherapeutic (blocking) communication techniques to avoid.

Giving advice, false reassurance ('Everything will be fine'), asking 'why' questions, changing the subject, minimizing feelings, giving approval/disapproval, and asking closed-ended questions.

What is milieu therapy?

A planned, structured therapeutic environment where all interactions and activities are used therapeutically to promote safety, learning, and social skills - the unit/community itself is the treatment tool.

What is the CIWA scale used for, and name key alcohol withdrawal symptoms it monitors.

The Clinical Institute Withdrawal Assessment for Alcohol assesses withdrawal severity. Symptoms: tremors, anxiety, agitation, sweating, nausea, tachycardia, hypertension, and (severe) seizures and hallucinations.

What is delirium tremens (DTs), its onset, and its danger?

The most severe form of alcohol withdrawal occurring ~48-72 hours after the last drink; features severe confusion, agitation, hallucinations, autonomic instability, and seizures. It is a medical emergency and can be fatal.

Which medications are commonly used to manage alcohol withdrawal, and which vitamin prevents Wernicke's encephalopathy?

Benzodiazepines (e.g., lorazepam, chlordiazepoxide) for withdrawal; thiamine (vitamin B1) is given to prevent Wernicke's encephalopathy.

What does the CAGE questionnaire screen for?

Alcohol use problems - Cut down, Annoyed by criticism, Guilty about drinking, Eye-opener (drinking first thing in the morning). Two or more 'yes' answers suggest a problem.

What are signs of opioid overdose and its reversal agent?

Respiratory depression, pinpoint (miotic) pupils, sedation/coma, and hypotension. Reversal agent: naloxone (Narcan).

What is the priority and recommended approach for de-escalating an agitated, potentially violent client?

Ensure safety (yours, others', client's) first. Remain calm, maintain a safe distance and clear exit, use a low calm voice, set limits, offer choices, and reduce stimulation. Use restraints/seclusion only as a last resort.

What are the legal/safety requirements when restraints or seclusion are used?

Require a provider order (time-limited), use least restrictive method, continuous/frequent monitoring, regular assessment of circulation/needs (food, toileting, hydration), and documentation; never use for staff convenience or punishment.

What is the nurse's legal duty regarding suspected abuse, neglect, or violence?

Nurses are mandated reporters - they must report suspected child or vulnerable-adult abuse to authorities, ensure the victim's immediate safety, document objectively, and preserve evidence.

What is the most important nursing consideration when caring for clients of differing cultural, spiritual, or religious backgrounds?

Provide culturally competent, individualized care - assess the client's specific beliefs/practices without stereotyping, respect dietary/religious/health practices, use interpreters as needed, and avoid imposing personal values.