🧠 Comprehensive Psychiatric Nursing Final Exam Study Guide
🚩 I. Priority Frameworks & Test Strategies
1. The "Deep Dive" Topics
Focus 80% of your study time on these three major areas, as they often make up the bulk of the exam:
1. Schizophrenia (Symptoms, Meds, Communication).
2. Depression & Suicide Risk (Meds, Safety).
3. Anxiety Disorders (Levels of anxiety, PTSD, Panic).
2. Prioritization Hierarchies
When answering questions, use these frameworks to choose the "best" action:
Safety First (The Psych Priority): Unlike medical-surgical nursing (Airway-Breathing-Circulation), in
psych, Safety/Circulation is often the top priority due to risk of suicide or violence.
o Exception: Opioid overdose or severe sedation (Airway/Breathing becomes #1).
Most Concerning: Is the patient at risk of harming others or themselves?
o Know priority diagnoses you would consider when someone presents with confusion, paranoia,
suspiciousness, etc.
Maslow’s Hierarchy:
Physiological needs (food, sleep) Safety Love/Belonging Esteem
Assessment First: Unless the patient is in immediate danger, assess before intervening.
3. Nursing Process
ADPIE Breakdown for Mental Health Crisis
ASSESSMENT – Assess for hallucinations, delusions, suicidal/homicidal ideations, substance use,
insight, behavior
DIAGNOSIS – Risk for violence, Disturbed thought process, Risk for injury, Risk for suicide
PLANNING – Ensure safety: initiate 1:1, remove hazards, meds ordered
INTERVENTION – Therapeutic communication, administer antipsychotics, involve mental health team,
calm environment
EVALUATION – Monitor for reduction in agitation, increased orientation, improved thought process
, 💊 II. Psychopharmacology (Drug Classes)
Includes generic/brand names, mechanisms, and critical nursing considerations.
1. Antipsychotics (Neuroleptics)
Used for Schizophrenia, Mania, and acute agitation.
Examples
Type (Generic/Brand) MOA & Use Critical Side Effects & Nursing Care
Haloperidol (Haldol) High EPS Risk! (Dystonia, Akathisia, Parkinsonism)
Chlorpromazine NMS (neuroleptic malignant syndrome) Risk:
(Thorazine) (Fever, Rigidity, Altered mental status
1st Gen Fluphenazine Blocks Dopamine. Treats positive "ENRAGED": EPS, NMS, Anticholinergic,
(Typical) (Prolixin) symptoms (hallucinations). Gynecomastia
Metabolic Syndrome: Weight gain,
Risperidone
hyperglycemia, high cholesterol
(Risperdal)
Sexual dysfunction, sedation, orthostatic
Olanzapine (Zyprexa)
hypotension, anticholinergic effects
Clozapine (Clozaril)
Clozapine: Risk of Agranulocytosis (Monitor WBC
Quetiapine (Seroquel) weekly!)
2nd Gen Blocks Dopamine & Serotonin. Treats
(Atypical) Ziprasidone (Geodon) positive & negative symptoms. Geodon: Monitor QT interval
2. Medications for Side Effects (EPS)
Benztropine (Cogentin):
o Class: Anticholinergic / Antiparkinsonian.
o Use: Treats Extrapyramidal Symptoms (EPS) caused by antipsychotics (e.g., stiffness, shuffling
gait, tremors). Also used to treat movements caused by Parkinson’s disease.
o Note: Not used for Tardive Dyskinesia.
o Action: Restores the balance between the Dopamine and Acetylcholine in the parts of the brain
that control the action of the muscles. Antipsychotics lower dopamine levels, Benztropine
blocks acetylcholine to balance it out.
o NCLEX tip: If a question shows a patient on Haldol suddenly tilting their head, eyes rolling back,
or neck twisting – benztropine IM is the immediate intervention
3. Mood Stabilizers (Bipolar Disorder)
Lithium (Lithobid/Eskalith):
o Therapeutic Range: 0.6 – 1.2 mEq/L.
🚩 I. Priority Frameworks & Test Strategies
1. The "Deep Dive" Topics
Focus 80% of your study time on these three major areas, as they often make up the bulk of the exam:
1. Schizophrenia (Symptoms, Meds, Communication).
2. Depression & Suicide Risk (Meds, Safety).
3. Anxiety Disorders (Levels of anxiety, PTSD, Panic).
2. Prioritization Hierarchies
When answering questions, use these frameworks to choose the "best" action:
Safety First (The Psych Priority): Unlike medical-surgical nursing (Airway-Breathing-Circulation), in
psych, Safety/Circulation is often the top priority due to risk of suicide or violence.
o Exception: Opioid overdose or severe sedation (Airway/Breathing becomes #1).
Most Concerning: Is the patient at risk of harming others or themselves?
o Know priority diagnoses you would consider when someone presents with confusion, paranoia,
suspiciousness, etc.
Maslow’s Hierarchy:
Physiological needs (food, sleep) Safety Love/Belonging Esteem
Assessment First: Unless the patient is in immediate danger, assess before intervening.
3. Nursing Process
ADPIE Breakdown for Mental Health Crisis
ASSESSMENT – Assess for hallucinations, delusions, suicidal/homicidal ideations, substance use,
insight, behavior
DIAGNOSIS – Risk for violence, Disturbed thought process, Risk for injury, Risk for suicide
PLANNING – Ensure safety: initiate 1:1, remove hazards, meds ordered
INTERVENTION – Therapeutic communication, administer antipsychotics, involve mental health team,
calm environment
EVALUATION – Monitor for reduction in agitation, increased orientation, improved thought process
, 💊 II. Psychopharmacology (Drug Classes)
Includes generic/brand names, mechanisms, and critical nursing considerations.
1. Antipsychotics (Neuroleptics)
Used for Schizophrenia, Mania, and acute agitation.
Examples
Type (Generic/Brand) MOA & Use Critical Side Effects & Nursing Care
Haloperidol (Haldol) High EPS Risk! (Dystonia, Akathisia, Parkinsonism)
Chlorpromazine NMS (neuroleptic malignant syndrome) Risk:
(Thorazine) (Fever, Rigidity, Altered mental status
1st Gen Fluphenazine Blocks Dopamine. Treats positive "ENRAGED": EPS, NMS, Anticholinergic,
(Typical) (Prolixin) symptoms (hallucinations). Gynecomastia
Metabolic Syndrome: Weight gain,
Risperidone
hyperglycemia, high cholesterol
(Risperdal)
Sexual dysfunction, sedation, orthostatic
Olanzapine (Zyprexa)
hypotension, anticholinergic effects
Clozapine (Clozaril)
Clozapine: Risk of Agranulocytosis (Monitor WBC
Quetiapine (Seroquel) weekly!)
2nd Gen Blocks Dopamine & Serotonin. Treats
(Atypical) Ziprasidone (Geodon) positive & negative symptoms. Geodon: Monitor QT interval
2. Medications for Side Effects (EPS)
Benztropine (Cogentin):
o Class: Anticholinergic / Antiparkinsonian.
o Use: Treats Extrapyramidal Symptoms (EPS) caused by antipsychotics (e.g., stiffness, shuffling
gait, tremors). Also used to treat movements caused by Parkinson’s disease.
o Note: Not used for Tardive Dyskinesia.
o Action: Restores the balance between the Dopamine and Acetylcholine in the parts of the brain
that control the action of the muscles. Antipsychotics lower dopamine levels, Benztropine
blocks acetylcholine to balance it out.
o NCLEX tip: If a question shows a patient on Haldol suddenly tilting their head, eyes rolling back,
or neck twisting – benztropine IM is the immediate intervention
3. Mood Stabilizers (Bipolar Disorder)
Lithium (Lithobid/Eskalith):
o Therapeutic Range: 0.6 – 1.2 mEq/L.
