Mental Health Nursing: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

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1Formulas and methods

Mental health nursing

Method

  1. Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
  2. Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
  3. Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
  4. Respect rights: the least restrictive option, consent and confidentiality with its limits.

2Practice problems

1.Mental health nursingMedium

What should a patient starting zolpidem for insomnia be taught to report?

  1. AFeeling slightly more rested and alert the next morning than before starting the medicine
  2. BDoing things while not fully awake, such as sleepwalking or driving, with no memory of it
  3. CSleeping through the night without waking up
  4. DFeeling sleepy about 30 minutes after taking it at bedtime
2.Mental health nursingHard

An 83-year-old becomes confused and constipated and cannot pass urine. She takes amitriptyline, oxybutynin and an over-the-counter sleep aid with diphenhydramine. What is the most likely cause?

  1. AThe combined anticholinergic effects of her medicines
  2. BA sign that she needs a higher dose of amitriptyline
  3. CSudden-onset Alzheimer's disease
  4. DThe normal effects of ageing
3.Clinical psychologyMedium

Which statement about the monoamine hypothesis of depression is most accurate?

  1. AIt proves that depression is caused only by low dopamine in the frontal lobe
  2. BIt has been fully confirmed by direct measurements of serotonin levels in the brains of living patients
  3. CIt links depression to low monoamine activity but struggles to explain the delayed drug response
  4. DIt predicts that antidepressants improve mood within a few hours of a dose
4.Clinical psychologyHard

A therapist asks a client to rate the evidence for and against the thought "I always fail". Which technique is this?

  1. ACognitive restructuring
  2. BToken economy
  3. CSystematic desensitisation
  4. DFree association
5.PharmacologyMedium

Why is testing for HLA-B*15:02 recommended before carbamazepine in people of some Asian ancestries?

  1. AThis gene variant causes carbamazepine to raise blood glucose
  2. BThis gene variant speeds up the kidney excretion of carbamazepine
  3. CThis gene variant makes carbamazepine ineffective
  4. DIt greatly raises the risk of Stevens–Johnson syndrome
6.PharmacologyHard

A patient on digoxin is started on amiodarone. What change should the nurse expect?

  1. ADigoxin levels rise, so the digoxin dose is often reduced
  2. BNo interaction is expected
  3. CDigoxin levels fall sharply, so the digoxin dose is doubled
  4. DAmiodarone levels fall to zero

3Solutions

1.Mental health nursing

Answer: B · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it

Why this is the answer

Zolpidem and similar "Z-drugs" can cause complex sleep behaviours, such as sleep-walking, sleep-driving or cooking while not fully awake, which can cause serious injury. These must be reported and the drug stopped.

Answer

B · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it
2.Mental health nursing

Answer: A · The combined anticholinergic effects of her medicines

Why this is the answer

Several drugs with anticholinergic effects add up, increasing the risk of delirium, constipation and urinary retention in older adults. A medicine review aims to reduce the total anticholinergic burden.

Answer

A · The combined anticholinergic effects of her medicines
3.Clinical psychology

Answer: C · It links depression to low monoamine activity but struggles to explain the delayed drug response

Why this is the answer

The hypothesis grew from the effects of drugs on monoamines. The delay of several weeks before benefit suggests that downstream changes, such as receptor adaptation, matter too.

Answer

C · It links depression to low monoamine activity but struggles to explain the delayed drug response
4.Clinical psychology

Answer: A · Cognitive restructuring

Why this is the answer

Cognitive restructuring identifies automatic thoughts, examines evidence and replaces distortions such as overgeneralisation with balanced thoughts.

Answer

A · Cognitive restructuring
5.Pharmacology

Answer: D · It greatly raises the risk of Stevens–Johnson syndrome

Why this is the answer

The HLA-B*15:02 allele, common in parts of South-East Asia, is strongly linked to carbamazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis. Carriers are given a different drug.

Answer

D · It greatly raises the risk of Stevens–Johnson syndrome
6.Pharmacology

Answer: A · Digoxin levels rise, so the digoxin dose is often reduced

Why this is the answer

Amiodarone inhibits P-glycoprotein and reduces digoxin clearance, so digoxin levels rise. The digoxin dose is often reduced, and the patient is monitored for bradycardia and toxicity; amiodarone also raises warfarin levels.

Answer

A · Digoxin levels rise, so the digoxin dose is often reduced

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