NCLEX-PN Mental Health Disorders — Recognition and LPN Care Responsibilities

THERAPEUTIC RESPONSE to expressions of hopelessness acknowledges the feeling, validates it, and opens exploration without false reassurance. The best response: (1) REFLECTS THE EMOTION — 'It sounds like you're feeling hopeless' names what the client communicated; (2) INVITES ELABORATION — the open-ended question 'What's been happening...' allows the client to explore the source without directing them to a specific answer; (3) DOES NOT MINIMIZE — it takes the statement seriously. FALSE REASSURANCE ('Things will definitely improve') is non-therapeutic because: it dismisses the client's current experience; it makes a promise you cannot keep; it communicates that their feelings are wrong; it often ends the conversation. CHANGING THE SUBJECT ('talk about something uplifting') is avoidance — it communicates that you are uncomfortable with their distress. 'GRATITUDE' RESPONSES (you have so much to be grateful for) are invalidating — they compare the client's suffering to others' blessings and imply they should feel differently. PN CLINICAL NOTE: A client expressing hopelessness should also be assessed for suicidal ideation — hopelessness is one of the strongest predictors of suicide risk; after therapeutic exploration of the feeling, directly ask about safety.

OCD (Obsessive-Compulsive Disorder) is defined by two core features: OBSESSIONS — persistent, intrusive, unwanted thoughts, urges, or images that cause marked anxiety or distress; common themes: contamination (fear of germs), harm (fear of hurting others accidentally), symmetry (things must be 'just right'), forbidden thoughts; the person recognizes the thoughts as excessive or irrational (INSIGHT — distinguishes OCD from psychotic disorders); COMPULSIONS — repetitive behaviors or mental acts the person feels driven to perform in response to the obsession; temporary anxiety relief is the reinforcer that maintains the cycle; behaviors: handwashing, checking, counting, ordering/arranging, repeating; mental acts: praying, counting mentally, replacing a bad thought with a 'good' one; CYCLE: Obsessive thought → anxiety → compulsion → temporary relief → obsession returns → cycle repeats. IMPAIRMENT: OCD must cause significant distress or functional impairment; mild orderliness or preferences for cleanliness are NOT OCD; OCD symptoms are egodystonic (the person finds them distressing and unwanted, unlike obsessive-compulsive PERSONALITY traits which are ego-syntonic). TREATMENT: Cognitive-behavioral therapy with ERP (Exposure and Response Prevention) is the gold standard; SSRIs (fluoxetine, fluvoxamine, sertraline, paroxetine) are first-line medication; combination of CBT+SSRI is most effective.

COCAINE INTOXICATION produces classic CNS STIMULANT effects because cocaine blocks the reuptake of dopamine, norepinephrine, and serotonin — flooding the reward pathway and activating the sympathetic nervous system. CLINICAL PRESENTATION: NEUROLOGICAL/BEHAVIORAL: Euphoria (intense but brief — 15-30 minutes for intranasal; seconds to minutes for smoked 'crack'); agitation, grandiosity, talkativeness; impaired judgment; potential paranoia or psychosis with heavy use; CARDIOVASCULAR (most dangerous): Tachycardia; hypertension; cardiac dysrhythmias; coronary artery vasospasm (can cause MI even in young people with no underlying heart disease); cocaine-induced chest pain must be evaluated seriously; SYMPATHOMIMETIC: Mydriasis (dilated pupils); diaphoresis; hyperthermia; tremors; APPETITE SUPPRESSION; RESPIRATORY: Nasal septum damage with intranasal use; pulmonary edema with 'crack lung'; CRASH (post-intoxication): As cocaine wears off: profound fatigue, depression, hypersomnia, intense drug craving. NURSING CARE: Cardiac monitoring (MI risk); vital signs; benzodiazepines for agitation, hypertension, seizures (NOT beta-blockers — unopposed alpha stimulation can worsen hypertension); cool environment for hyperthermia; watch for cocaine-associated chest pain; CONTRAST WITH OPIOID INTOXICATION (often confused on tests): Opioids produce sedation, respiratory depression, MIOSIS (pinpoint pupils) — opposite of cocaine.

BARGAINING is the third stage in Kübler-Ross's model, characterized by attempts to negotiate for more time, better outcomes, or a specific delay to the inevitable. The structure is typically 'if-then': 'If I can just see my daughter get married, then I'll accept this.' 'If I follow every treatment protocol, maybe the doctors can give me more time.' THERAPEUTIC APPROACH: Validate the wish and the meaning behind it (the wedding, the relationship); do not dismiss as denial or irrational; it often reflects what the client values and what gives life meaning; help the client plan for the event if medically feasible; gently explore what 'being at peace' means to them — this opens conversation about advance care planning and legacy; THE STAGES ARE NOT LINEAR: People move among stages, skip stages, and return to earlier stages; some people never reach acceptance; this model is a framework for understanding, not a prescription. BARGAINING IN FAMILIES: Family members also bargain — 'if we try one more treatment'; this can sometimes delay comfort care unnecessarily; the palliative care team can help families balance hope with realistic planning. PN ROLE: Meet the client where they are emotionally; support the meaning behind their request; coordinate with the care team about feasibility; document emotional state and coping.

INTELLECTUALIZATION is a defense mechanism in which a person manages anxiety by focusing on the intellectual, analytical, or factual aspects of a situation, thereby avoiding or delaying the emotional processing of it. DISTINGUISHING FEATURES: The person engages with the reality of the situation (unlike DENIAL, which refuses to accept reality); they focus on facts, data, statistics, treatment options, research; emotional response is minimized or absent in the moment; the energy that would go into grief, fear, or anger goes into analysis instead. IS IT ADAPTIVE?: In the short term, intellectualization can be adaptive — it can help a person take action (research treatment options, find specialists) when they might otherwise be paralyzed by emotion; long-term exclusive intellectualization can delay necessary emotional processing. NURSING APPROACH: Do not abruptly try to redirect the person to emotions they're avoiding; meet them where they are; ask questions that bridge the intellectual and emotional: 'You've done a lot of research — how have you been feeling as you've been reading all of this?'; this respects their coping while gently opening emotional space. CONTRAST: RATIONALIZATION creates logical-sounding excuses to justify behavior; PROJECTION attributes own feelings to others; SUBLIMATION channels impulses into socially constructive activity; INTELLECTUALIZATION specifically uses abstract thinking to avoid the emotional component of a situation.