Psychiatric and Mental Health Nursing Reviewer for NLE Philippines 2026

Psychiatric and Mental Health Nursing is Part 2C of the PNLE and is one of the subjects that catches many examinees off guard. The content feels different from the rest of clinical nursing because it is less about physical assessments and procedures and more about communication, therapeutic relationships, and understanding how mental illness presents and is treated.

The good news is that psychiatric nursing questions in the NLE follow predictable patterns. If you master therapeutic communication techniques and the major psychiatric disorder profiles, you can answer a large portion of this section confidently.

Therapeutic Communication: The Foundation of Psychiatric Nursing

Therapeutic communication is the single most tested concept in NLE psychiatric nursing. It appears in scenario questions asking what the nurse should say or do in response to a patient's statement or behavior.

How to Answer Therapeutic Communication Questions

When an NLE question asks what the nurse should say, eliminate any option that:

• Gives direct advice
• Uses false reassurance like "everything will be okay"
• Asks "why" questions
• Judges, moralizes, or defends
• Closes off the conversation

The correct answer almost always keeps the conversation open, reflects the patient's feelings, or encourages them to share more.

Major Psychiatric Disorders

Schizophrenia

Schizophrenia is a chronic psychotic disorder characterized by disturbances in thought, perception, affect, and behavior.

Positive symptoms are symptoms added to normal functioning: hallucinations, delusions, disorganized speech, and disorganized behavior. These respond better to antipsychotic medications.

Negative symptoms are symptoms that represent a loss of normal functioning: flat affect, alogia (poverty of speech), avolition (lack of motivation), anhedonia (inability to feel pleasure), and social withdrawal. These respond less well to medication.

Hallucinations are sensory perceptions without external stimuli. Auditory hallucinations (hearing voices) are most common in schizophrenia. The nurse should acknowledge the patient's experience without reinforcing the hallucination.

Correct response: "I know the voices seem real to you, but I don't hear them. Let's focus on what we can do right now."

Delusions are fixed false beliefs not consistent with cultural norms. Do not argue with or reinforce delusions. Redirect to reality without direct confrontation.

Nursing priority: Safety. A patient experiencing command hallucinations telling them to harm themselves or others requires immediate safety measures.

Mood Disorders

Major Depressive Disorder:

Key signs: persistent depressed mood, loss of interest (anhedonia), sleep disturbances (usually insomnia but can be hypersomnia), appetite changes, fatigue, feelings of worthlessness, difficulty concentrating, and suicidal ideation.

Priority nursing assessment: Assess for suicidal ideation directly. Ask "Are you thinking about hurting yourself or ending your life?" Directly asking about suicide does not plant the idea and is essential for safety planning.

Nursing interventions: Establish therapeutic relationship. Stay with the patient. Remove harmful objects from the environment. Administer antidepressants as ordered. Monitor for side effects especially in the first 2 weeks when energy returns before mood improves (this is when suicide risk is highest).

Bipolar Disorder:

Characterized by cycles of depression and mania or hypomania.

Manic episode key signs: Elevated or expansive mood, decreased need for sleep, pressured speech, grandiosity, increased goal-directed activity, poor judgment, and impulsive behavior.

Nursing priority during mania: Safety and meeting basic needs. Manic patients often forget to eat, sleep, or maintain hygiene. Provide high-calorie finger foods they can eat on the move. Reduce environmental stimulation. Set firm consistent limits on unsafe behavior.

Anxiety Disorders

Generalized Anxiety Disorder (GAD): Excessive worry about multiple areas of life for at least 6 months. Physical symptoms: muscle tension, restlessness, fatigue, difficulty concentrating, sleep disturbances.

Panic Disorder: Recurrent unexpected panic attacks with fear of future attacks. During a panic attack: stay with the patient, speak calmly in short sentences, assist with controlled breathing, provide a calm quiet environment. Do not leave the patient alone.

Levels of anxiety:

Mild anxiety enhances learning and performance.

Moderate anxiety narrows the perceptual field but the patient can still function with direction.

Severe anxiety greatly reduces the perceptual field. The patient focuses only on immediate concerns.

Panic level anxiety disorganizes the individual completely.

Personality Disorders

Borderline Personality Disorder (BPD): Characterized by instability in relationships, self-image, and emotions. Key behaviors: splitting (seeing people as all-good or all-bad), self-harm, impulsivity, intense fear of abandonment, and identity disturbance.

Nursing approach: Consistent, firm, and non-rejecting. Maintain consistent limits. Avoid power struggles. Do not allow manipulation of staff through splitting.

Antisocial Personality Disorder: Persistent disregard for and violation of rights of others. Manipulative behavior, lack of remorse. Set clear consistent limits. Do not moralize or lecture.

Psychopharmacology for Psychiatric Nursing

Extrapyramidal Side Effects (EPS)

EPS are movement-related side effects from typical antipsychotic medications. These are frequently tested in NLE psychiatric nursing.

Acute Dystonia: Sudden, painful muscle spasms, usually of the neck, face, or back. Appears within hours to days of starting medication. Treatment: diphenhydramine (Benadryl) or benztropine (Cogentin) IM.

Akathisia: Subjective feeling of restlessness and need to move constantly. Patient appears agitated and cannot sit still. Often mistaken for worsening psychosis. Treatment: reduce dose or switch medication. Beta-blockers may help.

Pseudoparkinsonism: Drug-induced Parkinson-like symptoms: tremor, rigidity, bradykinesia, shuffling gait. Treatment: anticholinergic agents like benztropine.

Tardive Dyskinesia: Late-onset involuntary repetitive movements, especially of the mouth, tongue, and face (lip smacking, tongue protrusion, grimacing). May be irreversible. Prevention is key: use lowest effective dose, monitor regularly.

Neuroleptic Malignant Syndrome (NMS)

NMS is a rare but potentially fatal reaction to antipsychotic medications. The NLE tests recognition of this emergency.

Key signs (think FEVER): Fever (high), Encephalopathy (altered consciousness), Vitals unstable (autonomic instability: tachycardia, hypertension), Elevated enzymes (elevated CPK), Rigidity (severe muscle rigidity).

Nursing action: Discontinue the antipsychotic immediately. Notify the physician. Supportive care. This is a medical emergency.

Crisis Intervention

A psychiatric crisis occurs when a person's usual coping mechanisms fail in response to a stressful event, resulting in acute psychological distress and inability to function.

Principles of crisis intervention:

Time-limited: Crisis intervention is focused on the immediate problem, not long-term therapy.

Focus on the precipitating event: What happened to trigger this crisis?

Strengthen coping: Help the person identify and use their existing strengths and support systems.

Levels of intervention:

Environmental manipulation: Change the situation causing the crisis.

General support: Provide emotional support and validation.

Generic approach: Use techniques effective for most crisis situations.

Individual approach: Tailor intervention to the specific person and crisis.

Suicidal Ideation Assessment:

Always assess suicidal ideation directly. Asking does not increase risk. Key factors that increase suicide risk: previous attempts (strongest predictor), specific plan, access to means, hopelessness, substance abuse, social isolation, recent loss.

Suicide precautions: One-to-one observation, remove harmful objects, check environment for potential ligature points, document assessment findings.

The Therapeutic Milieu

The therapeutic milieu is the total environment of a psychiatric unit, designed to promote healing and reduce maladaptive behaviors. NLE questions test the principles that guide milieu management.

Key principles: Safety must be maintained at all times. Patients participate in their own care and governance. Clear consistent structure and limits reduce anxiety. Community meetings allow patients to address unit concerns.

Seclusion and restraint are last resort interventions when a patient poses an imminent danger to self or others. They require a physician order, continuous monitoring, and documentation. The nurse must assess circulation, sensation, and movement at regular intervals.

Practice What You Just Learned

Psychiatric nursing questions in the NLE are scenario-based. The best preparation is answering questions that require you to choose the correct therapeutic response or identify the appropriate nursing priority.

Head to LisensyaPrep and practice now. No account needed.

Practice Psychiatric Nursing Questions at LisensyaPrep