Clinical study guides / Mental health assessment and safe treatmentMental health assessment and safe treatment Connect therapeutic communication and safety assessment with medication monitoring, substance-use care and timely referral.
Practice this collection Ask about suicide directly Does asking someone directly about suicide increase their risk?
A client seems hopeless, and the nurse is unsure whether to bring up suicide.
Response and reasoning No. Asking directly does not increase suicidal thoughts or behavior, and it opens the door to help.
Asking directly is recommended and does not increase risk.
Ask clearly; vague questions get vague answers.
NIMH · 5 action steps to help someone having thoughts of suicide · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Reduce access to lethal means Why is limiting access to highly lethal items part of suicide prevention?
A client with suicidal thoughts is going home to live with family.
Response and reasoning Reducing access to highly lethal items or places can help prevent suicide.
Reducing access to highly lethal means helps prevent suicide.
Safety planning includes the home environment.
NIMH · 5 action steps to help someone having thoughts of suicide · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Recognize suicide warning signs Which behaviors are warning signs of suicide?
A family member describes recent changes in a loved one.
Response and reasoning Talking about wanting to die or being a burden, researching ways to die, withdrawing or saying goodbye, giving away important items, and increased substance use.
Increased alcohol or drug use is a warning sign. Giving away important items is a listed warning sign. Talking about being a burden is a warning sign.
New or increasing warning signs mean get help now, including 988.
NIMH · Warning signs of suicide · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Connect to the 988 Lifeline What crisis resource can someone with suicidal thoughts call or text in the United States?
A friend texts late at night about wanting to die.
Response and reasoning The 988 Suicide & Crisis Lifeline (call or text 988, or chat online); call 911 if life is in immediate danger.
988 connects people in crisis with support at any hour.
988 for crisis support; 911 for immediate danger.
NIMH · 5 action steps to help someone having thoughts of suicide · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Early antidepressant monitoring When is the risk of new suicidal thoughts highest on an antidepressant such as sertraline in young people?
A 19-year-old has just started sertraline.
Response and reasoning During the first few months of treatment and whenever the dose is changed, up or down.
The sertraline label stresses the first few months and dose changes, either increases or decreases.
Watch closely early in treatment and after any dose change.
MedlinePlus · Sertraline · DailyMed · Sertraline hydrochloride tablets label · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Give the antidepressant time How soon does sertraline usually reach its full benefit, and can it be stopped once mood improves?
A client feels no change after one week of treatment.
Response and reasoning Full benefit may take a few weeks or longer; do not stop without the prescriber because withdrawal symptoms can occur.
Full benefit takes weeks, and stopping needs the prescriber.
Keep taking it as prescribed and talk before stopping.
MedlinePlus · Sertraline · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Recognize serotonin syndrome What can happen when two serotonin-affecting medicines are combined?
A client taking an SSRI recently started a second serotonergic medicine.
Response and reasoning Serotonin syndrome: agitation, fast heartbeat, high temperature, sweating, twitching or overactive reflexes, and diarrhea, often within hours.
A new serotonergic combination with these findings fits serotonin syndrome.
New serotonergic combinations plus agitation and twitching need urgent attention.
MedlinePlus · Serotonin syndrome · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Tyramine on an MAOI Which foods need restriction with phenelzine?
A client starting an MAOI antidepressant is reviewing their diet.
Response and reasoning Foods on the phenelzine label's avoid list, such as aged cheeses, dry sausage like salami, yogurt, sauerkraut, beer and wine, and spoiled or improperly stored protein foods.
The label lists most cheeses and dry sausage such as Genoa salami among foods to avoid.
Severe headache, pounding heartbeat or stiff neck on an MAOI needs immediate contact.
DailyMed · Phenelzine sulfate tablets label · MedlinePlus · Phenelzine · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Check pain relievers with lithium Why check before taking ibuprofen or naproxen with lithium?
A client taking lithium wants an over-the-counter pain reliever for back pain.
Response and reasoning NSAIDs are among the medicines the lithium labeling flags; the prescriber should review them first.
NSAIDs such as ibuprofen are interactions the labeling asks clients to discuss.
Ask before adding any new medicine to lithium.
MedlinePlus · Lithium · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Infection signs on clozapine Why are fever and sore throat urgent on clozapine?
Clozapine can cause a severe drop in white blood cells.
Response and reasoning Fever, sore throat or chills on clozapine need immediate reporting; the prescriber evaluates for infection and orders an ANC, because a total white count alone does not diagnose neutropenia.
Fever and sore throat on clozapine need urgent evaluation, including an ANC as ordered; the total white count trend alone does not diagnose neutropenia.
Lab monitoring and prompt symptom reporting go together.
MedlinePlus · Clozapine · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Report involuntary face movements What do new rhythmic face, mouth or tongue movements on an antipsychotic suggest?
A client has taken haloperidol for several months.
Response and reasoning Possible tardive dyskinesia; report the movements to the prescriber right away and do not stop the medicine suddenly.
These involuntary movements should be reported right away.
Watch the mouth and tongue during long-term antipsychotic use.
MedlinePlus · Haloperidol · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Fever and rigidity on an antipsychotic What do fever, stiff muscles, sweating and confusion on an antipsychotic signal?
A client recently had a haloperidol dose increase.
Response and reasoning A possible serious reaction (neuroleptic malignant syndrome) needing immediate medical attention.
Fever, rigidity, sweating, confusion and irregular heartbeat need immediate attention.
Fever plus rigidity on an antipsychotic is an emergency signal.
MedlinePlus · Haloperidol · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Watch glucose on olanzapine Which metabolic effects can olanzapine cause?
A client without diabetes started olanzapine several months ago.
Response and reasoning High blood sugar, weight gain and higher blood fats; report thirst, frequent urination, hunger or blurred vision.
Olanzapine can cause hyperglycemia; these symptoms and values need follow-up.
Antipsychotic care includes metabolic follow-up.
MedlinePlus · Olanzapine · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Time alcohol withdrawal risk When do alcohol withdrawal symptoms usually start and peak?
A client was admitted after surgery and last drank heavily the evening before.
Response and reasoning They usually start within 8 hours of the last drink and peak at 24–72 hours; seizures, hallucinations or severe confusion are emergencies.
Rising heart rate, tremor and new hallucinations in the peak window signal severe withdrawal.
Know the time of the last drink.
MedlinePlus · Alcohol withdrawal · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Thiamine and Wernicke encephalopathy What causes Wernicke encephalopathy, and how is it treated?
A client with long-term heavy alcohol use is newly confused.
Response and reasoning Lack of vitamin B1 (thiamine); suspected Wernicke encephalopathy is treated with prescribed thiamine by injection as soon as possible.
The source states vitamin B1 by injection as soon as possible for Wernicke encephalopathy.
Confusion, abnormal eye movements and unsteady gait in alcohol use suggest thiamine deficiency.
MedlinePlus · Wernicke-Korsakoff syndrome · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Benzodiazepine plus opioid cough medicine Why is combining lorazepam with a cough or pain medicine risky?
A client on lorazepam has an old bottle of codeine cough syrup at home.
Response and reasoning The combination can cause serious or life-threatening breathing problems, sedation or coma.
Lorazepam with certain cough or pain medicines can cause life-threatening breathing problems.
Check every sedating medicine before combining.
MedlinePlus · Lorazepam · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Take sublingual buprenorphine correctly How is a sublingual buprenorphine tablet taken?
A client is starting treatment for opioid use disorder.
Response and reasoning Under the tongue until fully dissolved, without chewing or swallowing it, and without eating, drinking or talking meanwhile.
Sublingual tablets are left under the tongue until completely dissolved.
Let it dissolve, then rinse; store it out of reach of children.
MedlinePlus · Buprenorphine sublingual and buccal · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Be opioid-free before naltrexone Why must recent opioid use be disclosed before starting naltrexone?
A client wants to start naltrexone for opioid use disorder.
Response and reasoning Naltrexone can cause sudden withdrawal; opioid use in the last 7–10 days must be disclosed, and it is not started after recent use.
Naltrexone is not given after recent opioid use because it can trigger withdrawal.
Timing the first dose prevents precipitated withdrawal.
MedlinePlus · Naltrexone · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Hidden alcohol on disulfiram Which products can trigger a disulfiram reaction?
A client is starting disulfiram.
Response and reasoning Foods and drinks containing alcohol, including some sauces and vinegars, and medicines such as alcohol-containing cough syrup; skin products like aftershave need caution.
Alcohol-containing medicines such as cough syrup should be avoided. Sauces containing alcohol should be avoided. The labeling advises avoiding vinegars.
A reaction can occur up to 2 weeks after stopping disulfiram.
MedlinePlus · Disulfiram · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Panic symptoms can mimic a heart attack Why are chest pain and a racing heart evaluated even when panic is suspected?
A client with known panic attacks reports chest pain.
Response and reasoning Panic attacks can feel like a heart attack, but chest pain can have other causes, so a provider evaluates physical causes.
Chest pain can have other causes and needs provider evaluation.
Do not assume chest pain is panic.
NIMH · Panic disorder: when fear overwhelms · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Screening needs follow-up What should happen after an adult screens positive for depression?
Depression screening is recommended for adults.
Response and reasoning Further evaluation for diagnosis and, if appropriate, evidence-based care or referral.
Positive screens are evaluated further and linked to evidence-based care.
A screen without follow-up does not help; ask about safety as appropriate during evaluation.
USPSTF · Depression and suicide risk in adults: screening (2023) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept When grief needs more help Which grief experiences suggest a need for professional help?
A client's spouse died four months ago.
Response and reasoning Being unable to cope, deep or long-lasting depression that interferes with daily life, heavy alcohol or drug use, or suicidal thoughts.
Using alcohol heavily to cope is a reason to seek help.
Grief is healthy; some patterns need support.
MedlinePlus · Grief · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Stimulant monitoring in children What should families monitor when a child takes methylphenidate?
A school-age child has started methylphenidate for ADHD.
Response and reasoning Appetite, weight and height (growth can slow), and the medicine itself: store it securely, track doses and never share it.
Growth can slow, and the drug is habit-forming, so secure storage and counts matter.
Monitor growth and treat the medicine as habit-forming.
MedlinePlus · Methylphenidate · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Recognize an emerging manic episode Which changes can signal a manic episode?
A client with bipolar disorder is being followed at home.
Response and reasoning Decreased need for sleep, racing thoughts, fast talking and high activity can signal emerging manic or hypomanic symptoms that need prompt assessment; a log alone is not a diagnosis.
Decreased need for sleep, fast talking and high activity are manic-spectrum symptoms; diagnosis needs clinical assessment.
A sharp drop in sleep with high energy is a warning pattern.
NIMH · Bipolar disorder (publication) · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept What to expect after ECT What are common short-term effects after electroconvulsive therapy?
A client with severe depression is scheduled for ECT under general anesthesia.
Response and reasoning Headache, muscle soreness and confusion are common; memory gaps for events around treatment usually improve over days to weeks, though some may persist. An adult must drive the client home.
Confusion and memory loss around treatment are common and usually improve; some gaps may persist.
Memory effects are common and usually improve; lasting loss beyond the treatment period is uncommon.
NIMH · Brain stimulation therapies · MedlinePlus · Electroconvulsive therapy · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Early warning signs of psychosis Which changes can come before psychosis develops?
A college student's family notices gradual changes.
Response and reasoning Suspiciousness, trouble thinking clearly, social withdrawal, unusual or absent feelings, declining self-care, and a sudden drop in grades or work.
A sudden drop in school performance is a listed warning sign. Social withdrawal and declining self-care are warning signs. Suspiciousness and paranoid ideas are early warning signs.
Early treatment often means better recovery.
NIMH · Understanding psychosis · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Overdose risk after opioid treatment Why is opioid overdose risk higher after naltrexone treatment ends?
A client has finished a course of naltrexone.
Response and reasoning After treatment, a person may be more sensitive to opioids, so a previously used amount can cause overdose.
After treatment, people may be more sensitive to opioids.
Lower tolerance after treatment means higher overdose risk; keep naloxone available.
MedlinePlus · Naltrexone · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Korsakoff memory loss Does memory loss from Korsakoff syndrome usually improve with thiamine?
A client with long-term alcohol use received thiamine for Wernicke encephalopathy.
Response and reasoning Often not; thiamine may improve confusion and coordination, but Korsakoff memory loss often persists.
This is why early recognition and prompt thiamine matter, along with stopping alcohol to prevent further damage.
Treat early; memory damage may be lasting.
MedlinePlus · Wernicke-Korsakoff syndrome · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Dispose of unused methylphenidate tablets safely How should unneeded oral methylphenidate tablets be disposed of?
A family has leftover tablets after a dose change.
Response and reasoning Preferably through a medicine take-back program, following pharmacist or product instructions; do not flush. Meanwhile keep them secured and counted.
Methylphenidate can be habit-forming, so leftover tablets are a misuse risk.
Secure, count, and return unused stimulants.
MedlinePlus · Methylphenidate · Source accessed 2026-10-19 · Concept version 1
Save and practice this concept Sources Use these notes to study clinical concepts. In patient care, follow the setting's emergency response and treatment protocols.