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07/24/15 April 15, 2019 3:10 PM rm_rn_2019_mh_FRONT-MATTER

RN Mental Health Nursing

REVIEW MODULE EDITION 11.0

Contributors
Honey C. Holman, MSN, RN

Debborah Williams, MSN, RN Consultants

Sheryl Sommer, PhD, RN, CNE Susan Adcock, RN, MS

Janean Johnson, MSN, RN, CNE Lisa Kongable, MA, ARNP, PMHCNS, CNE

Brenda S. Ball, MEd, BSN, RN Gail Raasakka, MSN, RN, CNE

Mendy G. McMichael, DNP, RN Melanie P. Schrader, PhD, RN

INTELLECTUAL PROPERTY NOTICE

ATI Nursing is a division of Assessment Technologies Institute®, LLC.

Copyright © 2019 Assessment Technologies Institute, LLC. All rights reserved.

The reproduction of this work in any electronic, mechanical or other means, now known or hereafter
invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. All of the
content in this publication, including, for example, the cover, all of the page headers, images, illustrations,
graphics, and text, are subject to trademark, service mark, trade dress, copyright, and/or other intellectual
property rights or licenses held by Assessment Technologies Institute, LLC, one of its affiliates, or by
third parties who have licensed their materials to Assessment Technologies Institute, LLC.

RN MENTAL HEALTH NURSING I

07/24/15 April 15, 2019 3:10 PM rm_rn_2019_mh_FRONT-MATTER 07/24

Director of content review: Kristen Lawler

Director of development: Derek Prater

Project management: Tiffany Pavlik, Shannon Tierney

Coordination of content review: Honey C. Holman, Debborah Williams

Copy editing: Kelly Von Lunen, Bethany Phillips, Kya Rodgers, Joshua Hoeven

Layout: Spring Lenox, Maureen Bradshaw, Bethany Phillips

Illustrations: Randi Hardy

Online media: Brant Stacy, Ron Hanson, Britney Fuller, Barry Wilson

Cover design: Jason Buck

Interior book design: Spring Lenox

IMPORTANT NOTICE TO THE READER

Assessment Technologies Institute, LLC, is the publisher of this publication. The content of this publication is for
informational and educational purposes only and may be modified or updated by the publisher at any time. This
publication is not providing medical advice and is not intended to be a substitute for professional medical advice,
diagnosis, or treatment. The publisher has designed this publication to provide accurate information regarding the
subject matter covered; however, the publisher is not responsible for errors, omissions, or for any outcomes related to
the use of the contents of this book and makes no guarantee and assumes no responsibility or liability for the use of the
products and procedures described or the correctness, sufficiency, or completeness of stated information, opinions, or
recommendations. The publisher does not recommend or endorse any specific tests, providers, products, procedures,
processes, opinions, or other information that may be mentioned in this publication. Treatments and side effects described
in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect
that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by
the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice,
and government regulations often change the accepted standard in this field. When consideration is being given to use
of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the
drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations
on dose, precautions, and contraindications and determining the appropriate usage for the product. Any references
in this book to procedures to be employed when rendering emergency care to the sick and injured are provided solely
as a general guide. Other or additional safety measures may be required under particular circumstances. This book
is not intended as a statement of the standards of care required in any particular situation, because circumstances
and a patient’s physical condition can vary widely from one emergency to another. Nor is it intended that this book
shall in any way advise personnel concerning legal authority to perform the activities or procedures discussed. Such
specific determination should be made only with the aid of legal counsel. Some images in this book feature models.
These models do not necessarily endorse, represent, or participate in the activities represented in the images. THE
PUBLISHER MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, WITH
RESPECT TO THE CONTENT HEREIN. THIS PUBLICATION IS PROVIDED AS-IS, AND THE PUBLISHER AND ITS AFFILIATES
SHALL NOT BE LIABLE FOR ANY ACTUAL, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY
DAMAGES RESULTING, IN WHOLE OR IN PART, FROM THE READER’S USE OF, OR RELIANCE UPON, SUCH CONTENT.

II CONTENT MASTERY SERIES

07/24/15 April 15, 2019 3:10 PM rm_rn_2019_mh_FRONT-MATTER

User’s Guide
Welcome to the Assessment Technologies Institute® ACTIVE LEARNING SCENARIOS
RN Mental Health Nursing Review Module Edition 11.0. AND APPLICATION EXERCISES
The mission of ATI’s Content Mastery Series® Review
Each chapter includes opportunities for you to test your
Modules is to provide user-friendly compendiums of
knowledge and to practice applying that knowledge. Active
nursing knowledge that will:
Learning Scenario exercises pose a nursing scenario
● Help you locate important information quickly.
and then direct you to use an ATI Active Learning
● Assist in your learning efforts.

Template (included at the back of this book) to record

● Provide exercises for applying your nursing knowledge.
the important knowledge a nurse should apply to the
● Facilitate your entry into the nursing profession as a
scenario. An example is then provided to which you can
newly licensed nurse.
compare your completed Active Learning Template. The
This newest edition of the Review Modules has been Application Exercises include NCLEX-style questions, such
redesigned to optimize your learning experience. We’ve as multiple-choice and multiple-select items, providing
fit more content into less space and have done so in a you with opportunities to practice answering the kinds of
way that will make it even easier for you to find and questions you might expect to see on ATI assessments or
understand the information you need. the NCLEX. After the Application Exercises, an answer key
is provided, along with rationales.

ORGANIZATION
This Review Module is organized into units covering
NCLEX® CONNECTIONS
foundations for mental health nursing, traditional To prepare for the NCLEX-RN, it is important to
nonpharmacological therapies, psychobiologic disorders, understand how the content in this Review Module
psychopharmacological therapies, specific populations, and is connected to the NCLEX-RN test plan. You can find
psychiatric emergencies. Chapters within these units conform information on the detailed test plan at the National
to one of four organizing principles for presenting the content. Council of State Boards of Nursing’s website, www.ncsbn.
● Nursing concepts org. When reviewing content in this Review Module,
● Procedures regularly ask yourself, “How does this content fit into
● Disorders the test plan, and what types of questions related to this
● Medications content should I expect?”

Nursing concepts chapters begin with an overview To help you in this process, we’ve included NCLEX
describing the central concept and its relevance to nursing. Connections at the beginning of each unit and with each
Subordinate themes are covered in outline form to question in the Application Exercises Answer Keys. The
demonstrate relationships and present the information in a NCLEX Connections at the beginning of each unit point
clear, succinct manner. out areas of the detailed test plan that relate to the content
within that unit. The NCLEX Connections attached to the
Procedures chapters include an overview describing the
Application Exercises Answer Keys demonstrate how each
procedure(s) covered in the chapter. These chapters provide
exercise fits within the detailed content outline.
nursing knowledge relevant to each procedure, including
These NCLEX Connections will help you understand how
indications, nursing considerations, and complications.
the detailed content outline is organized, starting with
Disorders chapters include an overview describing the major client needs categories and subcategories and
disorder. These chapters cover assessments, including risk followed by related content areas and tasks. The major
factors and expected findings, and patient-centered care, client needs categories are:
including nursing care, medications, therapeutic procedures, ● Safe and Effective Care Environment
and interprofessional care. ◯ Management of Care

◯ Safety and Infection Control

Medications chapters include an overview describing a ● Health Promotion and Maintenance

disorder or group of disorders. Medications used to treat ● Psychosocial Integrity
these disorders are grouped according to classification. ● Physiological Integrity
A specific medication can be selected as a prototype or ◯ Basic Care and Comfort

example of the characteristics of medications in this ◯ Pharmacological and Parenteral Therapies

classification. These sections include information about ◯ Reduction of Risk Potential

how the medication works and its therapeutic uses. ◯ Physiological Adaptation

Next, you will find information about complications,

contraindications/precautions, and interactions, as well as An NCLEX Connection might, for example, alert you that
nursing interventions and client education to help prevent content within a unit is related to:
and/or manage these issues. Finally, the chapter includes ● Psychosocial Integrity
information on nursing administration of the medication and ◯ Behavioral Interventions

evaluation of the medication’s effectiveness. ■ Incorporate behavioral management techniques

when caring for a client.

RN MENTAL HEALTH NURSING USER’S GUIDE III

07/24/15 April 15, 2019 3:10 PM rm_rn_2019_mh_FRONT-MATTER

QSEN COMPETENCIES ICONS

As you use the Review Modules, you will note the Icons are used throughout the Review Module to draw
integration of the Quality and Safety Education for your attention to particular areas. Keep an eye out for
Nurses (QSEN) competencies throughout the chapters. these icons.
These competencies are integral components of the
curriculum of many nursing programs in the United States This icon is used for NCLEX Connections.
and prepare you to provide safe, high-quality care as a
newly licensed nurse. Icons appear to draw your attention This icon indicates gerontological considerations,
to the six QSEN competencies. or knowledge specific to the care of older
adult clients.
Safety: The minimization of risk factors that could
cause injury or harm while promoting quality care This icon is used for content related to safety
and maintaining a secure environment for clients, self, and is a QSEN competency. When you see this
and others. icon, take note of safety concerns or steps that
nurses can take to ensure client safety and a
Patient-Centered Care: The provision of caring and
safe environment.
compassionate, culturally sensitive care that addresses
clients’ physiological, psychological, sociological, spiritual, This icon is a QSEN competency that indicates
and cultural needs, preferences, and values. the importance of a holistic approach to
providing care.
Evidence-Based Practice: The use of current knowledge
from research and other credible sources, on which to base This icon, a QSEN competency, points out the
clinical judgment and client care. integration of research into clinical practice.

Informatics: The use of information technology as a This icon is a QSEN competency and highlights
communication and information-gathering tool that the use of information technology to support
supports clinical decision-making and scientifically based nursing practice.
nursing practice.
This icon is used to focus on the QSEN
Quality Improvement: Care related and organizational competency of integrating planning processes to
processes that involve the development and meet clients’ needs.
implementation of a plan to improve health care services
This icon highlights the QSEN competency of care
and better meet clients’ needs.
delivery using an interprofessional approach.
Teamwork and Collaboration: The delivery of client care
This icon appears at the top-right of pages
in partnership with multidisciplinary members of the
and indicates availability of an online media
health care team to achieve continuity of care and positive
supplement, such as a graphic, animation, or
client outcomes.
video. If you have an electronic copy of the
Review Module, this icon will appear alongside
clickable links to media supplements. If you have
a hard copy version of the Review Module, visit
www.atitesting.com for details on how to access
these features.

FEEDBACK
ATI welcomes feedback regarding this Review Module.
Please provide comments to [email protected].

As needed updates to the Review Modules are identified,

changes to the text are made for subsequent printings
of the book and for subsequent releases of the electronic
version. For the printed books, print runs are based
on when existing stock is depleted. For the electronic
versions, a number of factors influence the update
schedule. As such, ATI encourages faculty and students to
refer to the Review Module addendums for information on
what updates have been made. These addendums, which
are available in the Help/FAQs on the student site and the
Resources/eBooks & Active Learning on the faculty site,
are updated regularly and always include the most current
information on updates to the Review Modules.

IV USER’S GUIDE CONTENT MASTERY SERIES

07/24/15 April 15, 2019 3:08 PM rm_rn_2019_MH_TOC

Table of Contents

NCLEX® Connections 1

UNIT 1 Foundations for Mental Health Nursing 3

CHAPTER 1 Basic Mental Health Nursing Concepts 3

CHAPTER 2 Legal and Ethical Issues 9

CHAPTER 3 Effective Communication 15

CHAPTER 4 Stress and Defense Mechanisms 19

CHAPTER 5 Creating and Maintaining a Therapeutic and Safe Environment 25

CHAPTER 6 Diverse Practice Settings 31

NCLEX® Connections 35

UNIT 2 Traditional Nonpharmacological

Therapies 37
CHAPTER 7 Psychoanalysis, Psychotherapy, and Behavioral Therapies 37

CHAPTER 8 Group and Family Therapy 41

CHAPTER 9 Stress Management 47

CHAPTER 10 Brain Stimulation Therapies 51

RN MENTAL HEALTH NURSING TABLE OF CONTENTS V

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NCLEX® Connections 55

UNIT 3 Psychobiologic Disorders 57

CHAPTER 11 Anxiety Disorders 57

CHAPTER 12 Trauma- and Stressor-Related Disorders 61

CHAPTER 13 Depressive Disorders 67

CHAPTER 14 Bipolar Disorders 73

CHAPTER 15 Psychotic Disorders 77

CHAPTER 16 Personality Disorders 83

CHAPTER 17 Neurocognitive Disorders 87

CHAPTER 18 Substance Use and Addictive Disorders 93

CHAPTER 19 Eating Disorders 99

CHAPTER 20 Somatic Symptom and Related Disorders 105

NCLEX® Connections 111

UNIT 4 Psychopharmacological Therapies 113

CHAPTER 21 Medications for Anxiety and Trauma- and Stressor-Related Disorders 113

CHAPTER 22 Medications for Depressive Disorders 121

CHAPTER 23 Medications for Bipolar Disorders 129

CHAPTER 24 Medications for Psychotic Disorders 135

CHAPTER 25 Medications for Children and Adolescents Who Have Mental Health Issues 143

CHAPTER 26 Medications for Substance Use Disorders 153

VI TABLE OF CONTENTS CONTENT MASTERY SERIES

07/24/15 April 15, 2019 3:08 PM rm_rn_2019_MH_TOC

NCLEX® Connections 159

UNIT 5 Specific Populations 161

CHAPTER 27 Care of Clients Who are Dying and/or Grieving 161

CHAPTER 28 Mental Health Issues of Children and Adolescents 165

NCLEX® Connections 171

UNIT 6 Psychiatric Emergencies 173

CHAPTER 29 Crisis Management 173

CHAPTER 30 Suicide 177

CHAPTER 31 Anger Management 181

CHAPTER 32 Family and Community Violence 185

CHAPTER 33 Sexual Assault 189

References 193

Active Learning Templates A1

Basic Concept A1

Diagnostic Procedure A3

Growth and Development A5

Medication A7

Nursing Skill A9

System Disorder A11

Therapeutic Procedure A13

Concept Analysis A15

RN MENTAL HEALTH NURSING TABLE OF CONTENTS VII

07/24/15 April 15, 2019 3:08 PM rm_rn_2019_MH_TOC

VIII TABLE OF CONTENTS CONTENT MASTERY SERIES

07/24/15 April 15, 2019 11:54 AM rm_rn_2019_mh_unit1

NCLEX® Connections
When reviewing the following chapters, keep in mind the
relevant topics and tasks of the NCLEX outline, in particular:

Management of Care
CLIENT RIGHTS: Advocate for client rights and needs.

CONFIDENTIALITY/INFORMATION SECURITY:
Maintain client confidentiality and privacy.

ESTABLISHING PRIORITIES: Apply knowledge of pathophysiology

when establishing priorities for interventions with multiple clients.

ETHICAL PRACTICE: Practice in a manner consistent

with a code of ethics for registered nurses.

LEGAL RIGHTS AND RESPONSIBILITIES

Report client conditions as required by law.
Identify legal issues affecting the client.

REFERRALS: Identify community resources for the client.

Safety and Infection Control

ACCIDENT/ERROR/INJURY PREVENTION: Identify
factors that influence accident/injury prevention.

USE OF RESTRAINTS/SAFETY DEVICES: Monitor/evaluate

the client’s response to restraints/safety device.

RN MENTAL HEALTH NURSING NCLEX® CONNECTIONS 1

07/24/15 April 15, 2019 11:54 AM rm_rn_2019_mh_unit1

Psychosocial Integrity
COPING MECHANISMS: Assess client’s ability to
adapt to temporary/permanent role changes.

CRISIS INTERVENTION: Assess potential for

violence and use safety precautions.

MENTAL HEALTH CONCEPTS

Recognize client use of defense mechanisms.
Assess client for alterations in mood, judgment, and, cognition.

THERAPEUTIC COMMUNICATION
Assess verbal and nonverbal client communication needs.
Evaluate the effectiveness of communications with the client.
Use therapeutic communication techniques.

THERAPEUTIC ENVIRONMENT: Promote a therapeutic environment.

2 NCLEX® CONNECTIONS CONTENT MASTERY SERIES

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