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

A patient with borderline personality disorder praises one nurse as "the only one who understands me" and calls the others useless. What is the best team response?

  1. AAvoid the patient
  2. BAgree on consistent rules and responses across the whole team
  3. CTell the patient that the other nurses are also useless
  4. DLet the favoured nurse make all decisions for this patient
2.Mental health nursingHard

A patient being treated for opioid dependence is about to receive his first dose of buprenorphine. He last used heroin 2 hours ago. What is the risk?

  1. ABuprenorphine will add to the heroin and cause a dangerous opioid overdose with respiratory depression
  2. BThere is no risk; it should be given at once
  3. CBuprenorphine can cause precipitated withdrawal if given while full agonists are still active
  4. DBuprenorphine will have no effect at all
3.Clinical psychologyMedium

Rosenhan's study "On being sane in insane places" raised concerns about:

  1. AThe safety of antidepressants
  2. BThe ethics of animal research
  3. CThe validity of psychiatric diagnosis
  4. DThe effectiveness of CBT
4.Clinical psychologyHard

A man who hears the word "thud" is admitted to hospital, then behaves normally. Staff record his note-taking as "engages in writing behaviour". In Rosenhan's study, what does this illustrate?

  1. AOnce a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
  2. BStaff deliberately falsified records
  3. CPseudopatients developed real symptoms in hospital
  4. DNote-taking is a recognised symptom of schizophrenia, so the staff were right to record it as such
5.PharmacologyMedium

Which drug is the antidote for an opioid overdose?

  1. AAcetylcysteine
  2. BFlumazenil
  3. CNaloxone
  4. DAtropine
6.PharmacologyHard

A patient has received a sodium nitroprusside infusion for several days. He becomes confused and develops a metabolic acidosis. What should be suspected?

  1. ACyanide toxicity from nitroprusside breakdown
  2. BAn allergic reaction to the plastic of the infusion bag
  3. CHypoglycaemia from nitroprusside
  4. DHyperkalaemia from the infusion

3Solutions

1.Mental health nursing

Answer: B · Agree on consistent rules and responses across the whole team

Why this is the answer

Splitting divides staff into "all good" and "all bad". A consistent team approach, clear boundaries and good communication between staff prevent manipulation of the team and help the patient.

Answer

B · Agree on consistent rules and responses across the whole team
2.Mental health nursing

Answer: C · Buprenorphine can cause precipitated withdrawal if given while full agonists are still active

Why this is the answer

Buprenorphine displaces full agonists from opioid receptors but activates them less, causing sudden withdrawal. It is usually started when the patient already shows signs of withdrawal, assessed for example with a withdrawal scale.

Answer

C · Buprenorphine can cause precipitated withdrawal if given while full agonists are still active
3.Clinical psychology

Answer: C · The validity of psychiatric diagnosis

Why this is the answer

Pseudopatients who reported hearing a single word were admitted and kept for weeks, suggesting diagnosis was influenced by context. The study's methods have been questioned since.

Answer

C · The validity of psychiatric diagnosis
4.Clinical psychology

Answer: A · Once a label is applied, normal behaviour tends to be interpreted as a sign of the disorder

Why this is the answer

Rosenhan argued that the label "schizophrenic" made staff see ordinary behaviour as pathological. Critics such as Spitzer argued the study did not prove diagnosis was invalid.

Answer

A · Once a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
5.Pharmacology

Answer: C · Naloxone

Why this is the answer

Naloxone reverses opioid-induced respiratory depression. Flumazenil reverses benzodiazepines, acetylcysteine treats paracetamol overdose and atropine treats bradycardia or organophosphate poisoning.

Answer

C · Naloxone
6.Pharmacology

Answer: A · Cyanide toxicity from nitroprusside breakdown

Why this is the answer

Nitroprusside releases cyanide, which is normally converted to thiocyanate. With high doses, long infusions or poor organ function, cyanide and thiocyanate can accumulate; the infusion is also protected from light.

Answer

A · Cyanide toxicity from nitroprusside breakdown

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