A.L.L.
coyura Academy
NCLEX-RN
PSYCHOSOCIAL
INTEGRITY
Study Guide + Practice Questions
Complete coverage of therapeutic communication, mental health disorders, grief,
crisis intervention, coping, abuse, and cultural care — ~6-12% of the NCLEX-RN.
— What's Inside: — — You Will Master: —
• Therapeutic communication techniques • Use the right response in any scenario
• Non-therapeutic responses to avoid • Recognise what NOT to say on NCLEX
• Mental health disorders & key features • Identify disorders by their defining features
• Grief, loss & end-of-life care • Apply Kubler-Ross and nursing interventions
• Crisis intervention & suicide assessment • Assess suicide risk and respond appropriately
• Coping mechanisms & defence mechanisms • Distinguish adaptive vs. maladaptive coping
• Abuse, neglect & trauma-informed care • Identify abuse and apply mandatory reporting
• Cultural & spiritual considerations • Provide culturally competent, person-centred care
Psychosocial Integrity is where nursing becomes human — meeting clients where they are, emotionally and spiritually.
Therapeutic Mental Health Crisis, Grief
Communication Disorders & Coping
Created by ALLcoyura Academy
,A.L.L.
coyura Academy
THERAPEUTIC COMMUNICATION
The most-tested Psychosocial Integrity topic — know which response IS and IS NOT therapeutic.
THERAPEUTIC TECHNIQUES — What to DO
Technique Definition & NCLEX Application
Active Listening Give full attention; use silence; nod; maintain eye contact. Shows the client they are heard and valued.
Open-ended Invite elaboration: 'Tell me more about that.' 'What has that been like for you?' Avoids yes/no responses.
Questions
Reflection Restating the client's feelings or words: 'It sounds like you are feeling overwhelmed.' Validates and clarifies.
Clarification 'I'm not sure I understand — can you say more about that?' Prevents misunderstanding.
Focusing 'Let's go back to what you said about your fear.' Keeps conversation on meaningful topics.
Silence Intentional pause that allows the client to think, feel, and continue at their own pace. Powerful but under-used.
Summarising Reviewing key points at the end: 'So what I hear you saying is...' Confirms understanding.
Offering Self 'I'm here and I have time to listen.' Physical and emotional presence — non-verbal support.
General Leads 'Go on.' 'And then?' 'I see.' Encourages continuation without directing the client.
Accepting 'I hear that this is very difficult.' Non-judgmental acknowledgement of the client's experience.
Sharing 'I notice you seem tense today.' Describes what the nurse sees without interpreting or judging.
Observations
Voicing the Implied 'It sounds like you might be feeling hopeless about the future.' Puts into words what the client hints at.
NON-THERAPEUTIC RESPONSES — What to AVOID
Non-Therapeutic Response Why It Is Harmful — NCLEX Explanation
False reassurance 'Everything will be fine.' 'Don't worry.' Dismisses the client's real feelings. NEVER therapeutic.
Giving advice 'If I were you, I would...' 'You should...' Undermines autonomy and shifts responsibility to the nurse.
Changing the subject Redirecting away from distressing topics to avoid discomfort. Invalidates the client's experience.
Closed-ended 'Are you feeling better?' Forces yes/no — blocks deeper exploration.
questions
Why questions 'Why did you do that?' Implies judgment and puts the client on the defensive.
Agreeing/Disagreeing Taking a personal stance on the client's beliefs, plans, or values. Not the nurse's role.
Minimising 'Lots of people go through this.' 'At least you still have...' Invalidates and dismisses feelings.
Cliches 'I know how you feel.' 'Everything happens for a reason.' Hollow phrases that feel dismissive.
Probing/Prying Persistent questioning beyond what the client is ready to share. Violates boundaries.
Defending 'The doctor is excellent — I'm sure they know best.' Blocks the client's ability to express concerns.
Created by ALLcoyura Academy Page 2
,A.L.L.
coyura Academy
MENTAL HEALTH DISORDERS — KEY FEATURES & NURSING CARE
Know the defining features of each disorder and the priority nursing intervention for each.
MOOD DISORDERS & ANXIETY
Disorder Key Features & Priority Nursing Concern
Major Depressive Depressed mood, anhedonia, sleep/appetite changes, fatigue, worthlessness, poor concentration, suicidal ideation. Duration:
Disorder 2+ weeks. Priority: safety assessment.
Bipolar I Disorder Episodes of mania (elevated/irritable mood, grandiosity, decreased sleep, racing thoughts, impulsivity, risky behaviour) AND
depression. Mania: 7+ days. Priority: safety, limit-setting.
Bipolar II Hypomania (less severe, no psychosis) AND major depression. Hypomania: 4+ days.
Generalised Anxiety Excessive, uncontrollable worry about multiple areas for 6+ months. Restlessness, fatigue, muscle tension, poor sleep,
irritability.
Panic Disorder Recurrent unexpected panic attacks with physical symptoms (palpitations, chest pain, dizziness, paraesthesia, choking).
Fear of future attacks. Duration: minutes to an hour.
PTSD Following a traumatic event: intrusive memories/flashbacks, avoidance, negative cognitions, hyperarousal. Duration: 1+
month. Triggers re-experiencing.
Obsessive-Compulsive Obsessions (intrusive, unwanted thoughts) drive compulsions (repetitive behaviours to reduce anxiety). Ego-dystonic —
client recognises thoughts as irrational.
PSYCHOTIC & PERSONALITY DISORDERS: SUBSTANCE USE & EATING DISORDERS:
Disorder Key Features & Nursing Approach Disorder Key Features & Nursing Approach
Schizophrenia Positive symptoms: hallucinations (auditory Alcohol Use Disorder Withdrawal timeline: 6-12 hr: tremors,
most common), delusions, disorganised anxiety, diaphoresis. 12-24 hr: seizures.
speech/behaviour. Negative symptoms: flat 48-72 hr: delirium tremens (DTs). Treatment:
affect, alogia, avolition, anhedonia. Duration: benzodiazepines (lorazepam/diazepam),
6+ months. Priority: safety, reality orientation. CIWA-Ar scale.
Hallucinations False sensory perceptions with no external Opioid Withdrawal NOT life-threatening (unlike alcohol/benzos).
stimulus. DO NOT argue; acknowledge the Symptoms: anxiety, muscle aches, nausea,
client's distress; focus on feelings; ensure diarrhoea, piloerection, yawning. Treatment:
safety. methadone, buprenorphine, comfort care.
Delusions Fixed false beliefs not amenable to logical Anorexia Nervosa Restriction of food, intense fear of weight
argument. DO NOT reinforce or argue; gain, distorted body image. BMI <17.5.
redirect; maintain therapeutic relationship. Life-threatening. Priority: refeeding syndrome
prevention, cardiac monitoring.
Borderline PD Unstable relationships, identity, and mood;
fear of abandonment; self-harm; impulsivity. Bulimia Nervosa Binge-purge cycles. Normal or near-normal
Consistent limit-setting; structured weight. Complications: electrolyte imbalances
environment; avoid splitting. (hypokalaemia), dental erosion, parotid gland
swelling, oesophageal tears.
Antisocial PD Disregard for others' rights; deceit; lack of
remorse; may manipulate staff. Consistent Wernicke-Korsakoff Thiamine (B1) deficiency from chronic alcohol
boundaries; firm, non-punitive limit-setting. use. Wernicke: confusion, ataxia,
ophthalmoplegia. Korsakoff: confabulation,
severe memory impairment. Give IV thiamine
BEFORE glucose.
Created by ALLcoyura Academy Page 3
, A.L.L.
coyura Academy
GRIEF, LOSS, CRISIS INTERVENTION & SUICIDE
Grief, suicidality, and crisis response are consistently tested — know the frameworks and interventions cold.
GRIEF & LOSS — Kubler-Ross Stages & Nursing Care
Kubler-Ross Five Stages of Grief: Types of Grief & Nursing Responses:
Stage Description & Nursing Response Type/Concept Definition & Nursing Response
Denial 'This can't be happening to me.' Protective Normal/Uncomplicated Grief that follows loss and gradually resolves
mechanism — do NOT force acceptance. Allow over time. Intensity decreases. Person
time; provide presence. re-engages with life.
Anger 'Why me? It's not fair!' May be directed at staff, Anticipatory Grief Grieving before an expected loss — common
God, family. Do NOT take personally; for families of dying clients. Allow expression;
acknowledge feelings; set limits on harmful support the person.
behaviour.
Complicated/ProlongedGrief that does not diminish over time;
Bargaining 'If only I had... Maybe if I promise...' 'What if' intense, disabling symptoms persisting >12
thinking. Therapeutic listening; do NOT dismiss months. Requires professional intervention.
the bargaining.
Disenfranchised Grief for losses society does not fully
Depression Profound sadness, withdrawal, crying, Grief acknowledge (miscarriage, pet, ex-partner,
hopelessness. Not clinical MDD — it is friend). Validate and support without
appropriate grief. Provide presence; do not force minimising.
cheerfulness.
Palliative Care Goals Comfort over cure. Pain management,
Acceptance 'I'm ready.' Peace with the reality. Not everyone dignity, spiritual care, family support, advance
reaches this stage. Support without pushing. directives. Hospice = comfort only when
Facilitate relationships and comfort. prognosis <6 months.
Death Physician determines death; nurse may
Pronouncement document time; provide post-mortem care
with dignity; support the family.
SUICIDE ASSESSMENT & CRISIS INTERVENTION
Suicide Risk Assessment: Crisis Intervention & Nursing Priorities:
Topic Key Nursing Knowledge Topic Key Nursing Knowledge
Ask directly 'Are you thinking about suicide?' Direct Crisis definition A temporary state of disequilibrium when
questioning does NOT increase risk — it usual coping mechanisms are overwhelmed.
decreases it by opening dialogue. Person is open to change — crisis =
opportunity.
Risk factors Male sex (more lethal methods), previous
attempt (STRONGEST predictor), Types of crisis Maturational (developmental transitions),
depression, hopelessness, substance use, Situational (unexpected events), Adventitious
social isolation, access to means, recent loss. (disasters, community-wide events).
Protective factors Social support, religious beliefs, children at Crisis intervention Return the client to pre-crisis level of
home, engagement with treatment, reasons goal functioning — or HIGHER. Goal is
for living, future orientation. stabilisation, not therapy.
Lethality assessment Assess: ideation (passive vs. active), plan Priority intervention Safety FIRST. Establish therapeutic alliance.
(specific vs. vague), means (access to Assess current coping. Mobilise support.
method), intent (determined vs. ambivalent). Problem-solve collaboratively.
Highest risk Specific plan + lethal means + strong intent + Active listening The nurse's most powerful crisis tool.
social isolation = highest immediate risk. Validate feelings without minimising. Avoid
Remove means immediately. Created by ALLcoyura Academy advice-giving in acute crisis. Page 4
Means restriction Remove/secure firearms, medications, sharp Psychiatric hold Involuntary hospitalisation when client is an
objects. Ask family to remove guns from imminent danger to self or others — legal
coyura Academy
NCLEX-RN
PSYCHOSOCIAL
INTEGRITY
Study Guide + Practice Questions
Complete coverage of therapeutic communication, mental health disorders, grief,
crisis intervention, coping, abuse, and cultural care — ~6-12% of the NCLEX-RN.
— What's Inside: — — You Will Master: —
• Therapeutic communication techniques • Use the right response in any scenario
• Non-therapeutic responses to avoid • Recognise what NOT to say on NCLEX
• Mental health disorders & key features • Identify disorders by their defining features
• Grief, loss & end-of-life care • Apply Kubler-Ross and nursing interventions
• Crisis intervention & suicide assessment • Assess suicide risk and respond appropriately
• Coping mechanisms & defence mechanisms • Distinguish adaptive vs. maladaptive coping
• Abuse, neglect & trauma-informed care • Identify abuse and apply mandatory reporting
• Cultural & spiritual considerations • Provide culturally competent, person-centred care
Psychosocial Integrity is where nursing becomes human — meeting clients where they are, emotionally and spiritually.
Therapeutic Mental Health Crisis, Grief
Communication Disorders & Coping
Created by ALLcoyura Academy
,A.L.L.
coyura Academy
THERAPEUTIC COMMUNICATION
The most-tested Psychosocial Integrity topic — know which response IS and IS NOT therapeutic.
THERAPEUTIC TECHNIQUES — What to DO
Technique Definition & NCLEX Application
Active Listening Give full attention; use silence; nod; maintain eye contact. Shows the client they are heard and valued.
Open-ended Invite elaboration: 'Tell me more about that.' 'What has that been like for you?' Avoids yes/no responses.
Questions
Reflection Restating the client's feelings or words: 'It sounds like you are feeling overwhelmed.' Validates and clarifies.
Clarification 'I'm not sure I understand — can you say more about that?' Prevents misunderstanding.
Focusing 'Let's go back to what you said about your fear.' Keeps conversation on meaningful topics.
Silence Intentional pause that allows the client to think, feel, and continue at their own pace. Powerful but under-used.
Summarising Reviewing key points at the end: 'So what I hear you saying is...' Confirms understanding.
Offering Self 'I'm here and I have time to listen.' Physical and emotional presence — non-verbal support.
General Leads 'Go on.' 'And then?' 'I see.' Encourages continuation without directing the client.
Accepting 'I hear that this is very difficult.' Non-judgmental acknowledgement of the client's experience.
Sharing 'I notice you seem tense today.' Describes what the nurse sees without interpreting or judging.
Observations
Voicing the Implied 'It sounds like you might be feeling hopeless about the future.' Puts into words what the client hints at.
NON-THERAPEUTIC RESPONSES — What to AVOID
Non-Therapeutic Response Why It Is Harmful — NCLEX Explanation
False reassurance 'Everything will be fine.' 'Don't worry.' Dismisses the client's real feelings. NEVER therapeutic.
Giving advice 'If I were you, I would...' 'You should...' Undermines autonomy and shifts responsibility to the nurse.
Changing the subject Redirecting away from distressing topics to avoid discomfort. Invalidates the client's experience.
Closed-ended 'Are you feeling better?' Forces yes/no — blocks deeper exploration.
questions
Why questions 'Why did you do that?' Implies judgment and puts the client on the defensive.
Agreeing/Disagreeing Taking a personal stance on the client's beliefs, plans, or values. Not the nurse's role.
Minimising 'Lots of people go through this.' 'At least you still have...' Invalidates and dismisses feelings.
Cliches 'I know how you feel.' 'Everything happens for a reason.' Hollow phrases that feel dismissive.
Probing/Prying Persistent questioning beyond what the client is ready to share. Violates boundaries.
Defending 'The doctor is excellent — I'm sure they know best.' Blocks the client's ability to express concerns.
Created by ALLcoyura Academy Page 2
,A.L.L.
coyura Academy
MENTAL HEALTH DISORDERS — KEY FEATURES & NURSING CARE
Know the defining features of each disorder and the priority nursing intervention for each.
MOOD DISORDERS & ANXIETY
Disorder Key Features & Priority Nursing Concern
Major Depressive Depressed mood, anhedonia, sleep/appetite changes, fatigue, worthlessness, poor concentration, suicidal ideation. Duration:
Disorder 2+ weeks. Priority: safety assessment.
Bipolar I Disorder Episodes of mania (elevated/irritable mood, grandiosity, decreased sleep, racing thoughts, impulsivity, risky behaviour) AND
depression. Mania: 7+ days. Priority: safety, limit-setting.
Bipolar II Hypomania (less severe, no psychosis) AND major depression. Hypomania: 4+ days.
Generalised Anxiety Excessive, uncontrollable worry about multiple areas for 6+ months. Restlessness, fatigue, muscle tension, poor sleep,
irritability.
Panic Disorder Recurrent unexpected panic attacks with physical symptoms (palpitations, chest pain, dizziness, paraesthesia, choking).
Fear of future attacks. Duration: minutes to an hour.
PTSD Following a traumatic event: intrusive memories/flashbacks, avoidance, negative cognitions, hyperarousal. Duration: 1+
month. Triggers re-experiencing.
Obsessive-Compulsive Obsessions (intrusive, unwanted thoughts) drive compulsions (repetitive behaviours to reduce anxiety). Ego-dystonic —
client recognises thoughts as irrational.
PSYCHOTIC & PERSONALITY DISORDERS: SUBSTANCE USE & EATING DISORDERS:
Disorder Key Features & Nursing Approach Disorder Key Features & Nursing Approach
Schizophrenia Positive symptoms: hallucinations (auditory Alcohol Use Disorder Withdrawal timeline: 6-12 hr: tremors,
most common), delusions, disorganised anxiety, diaphoresis. 12-24 hr: seizures.
speech/behaviour. Negative symptoms: flat 48-72 hr: delirium tremens (DTs). Treatment:
affect, alogia, avolition, anhedonia. Duration: benzodiazepines (lorazepam/diazepam),
6+ months. Priority: safety, reality orientation. CIWA-Ar scale.
Hallucinations False sensory perceptions with no external Opioid Withdrawal NOT life-threatening (unlike alcohol/benzos).
stimulus. DO NOT argue; acknowledge the Symptoms: anxiety, muscle aches, nausea,
client's distress; focus on feelings; ensure diarrhoea, piloerection, yawning. Treatment:
safety. methadone, buprenorphine, comfort care.
Delusions Fixed false beliefs not amenable to logical Anorexia Nervosa Restriction of food, intense fear of weight
argument. DO NOT reinforce or argue; gain, distorted body image. BMI <17.5.
redirect; maintain therapeutic relationship. Life-threatening. Priority: refeeding syndrome
prevention, cardiac monitoring.
Borderline PD Unstable relationships, identity, and mood;
fear of abandonment; self-harm; impulsivity. Bulimia Nervosa Binge-purge cycles. Normal or near-normal
Consistent limit-setting; structured weight. Complications: electrolyte imbalances
environment; avoid splitting. (hypokalaemia), dental erosion, parotid gland
swelling, oesophageal tears.
Antisocial PD Disregard for others' rights; deceit; lack of
remorse; may manipulate staff. Consistent Wernicke-Korsakoff Thiamine (B1) deficiency from chronic alcohol
boundaries; firm, non-punitive limit-setting. use. Wernicke: confusion, ataxia,
ophthalmoplegia. Korsakoff: confabulation,
severe memory impairment. Give IV thiamine
BEFORE glucose.
Created by ALLcoyura Academy Page 3
, A.L.L.
coyura Academy
GRIEF, LOSS, CRISIS INTERVENTION & SUICIDE
Grief, suicidality, and crisis response are consistently tested — know the frameworks and interventions cold.
GRIEF & LOSS — Kubler-Ross Stages & Nursing Care
Kubler-Ross Five Stages of Grief: Types of Grief & Nursing Responses:
Stage Description & Nursing Response Type/Concept Definition & Nursing Response
Denial 'This can't be happening to me.' Protective Normal/Uncomplicated Grief that follows loss and gradually resolves
mechanism — do NOT force acceptance. Allow over time. Intensity decreases. Person
time; provide presence. re-engages with life.
Anger 'Why me? It's not fair!' May be directed at staff, Anticipatory Grief Grieving before an expected loss — common
God, family. Do NOT take personally; for families of dying clients. Allow expression;
acknowledge feelings; set limits on harmful support the person.
behaviour.
Complicated/ProlongedGrief that does not diminish over time;
Bargaining 'If only I had... Maybe if I promise...' 'What if' intense, disabling symptoms persisting >12
thinking. Therapeutic listening; do NOT dismiss months. Requires professional intervention.
the bargaining.
Disenfranchised Grief for losses society does not fully
Depression Profound sadness, withdrawal, crying, Grief acknowledge (miscarriage, pet, ex-partner,
hopelessness. Not clinical MDD — it is friend). Validate and support without
appropriate grief. Provide presence; do not force minimising.
cheerfulness.
Palliative Care Goals Comfort over cure. Pain management,
Acceptance 'I'm ready.' Peace with the reality. Not everyone dignity, spiritual care, family support, advance
reaches this stage. Support without pushing. directives. Hospice = comfort only when
Facilitate relationships and comfort. prognosis <6 months.
Death Physician determines death; nurse may
Pronouncement document time; provide post-mortem care
with dignity; support the family.
SUICIDE ASSESSMENT & CRISIS INTERVENTION
Suicide Risk Assessment: Crisis Intervention & Nursing Priorities:
Topic Key Nursing Knowledge Topic Key Nursing Knowledge
Ask directly 'Are you thinking about suicide?' Direct Crisis definition A temporary state of disequilibrium when
questioning does NOT increase risk — it usual coping mechanisms are overwhelmed.
decreases it by opening dialogue. Person is open to change — crisis =
opportunity.
Risk factors Male sex (more lethal methods), previous
attempt (STRONGEST predictor), Types of crisis Maturational (developmental transitions),
depression, hopelessness, substance use, Situational (unexpected events), Adventitious
social isolation, access to means, recent loss. (disasters, community-wide events).
Protective factors Social support, religious beliefs, children at Crisis intervention Return the client to pre-crisis level of
home, engagement with treatment, reasons goal functioning — or HIGHER. Goal is
for living, future orientation. stabilisation, not therapy.
Lethality assessment Assess: ideation (passive vs. active), plan Priority intervention Safety FIRST. Establish therapeutic alliance.
(specific vs. vague), means (access to Assess current coping. Mobilise support.
method), intent (determined vs. ambivalent). Problem-solve collaboratively.
Highest risk Specific plan + lethal means + strong intent + Active listening The nurse's most powerful crisis tool.
social isolation = highest immediate risk. Validate feelings without minimising. Avoid
Remove means immediately. Created by ALLcoyura Academy advice-giving in acute crisis. Page 4
Means restriction Remove/secure firearms, medications, sharp Psychiatric hold Involuntary hospitalisation when client is an
objects. Ask family to remove guns from imminent danger to self or others — legal
