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

An 84-year-old asks for an over-the-counter sleep aid containing diphenhydramine. What is the main concern?

  1. AIt raises blood pressure to dangerous levels in older adults
  2. BIt is a strong opioid that causes severe dependence
  3. CIt has no effects at all in people over 80, so it will not help her sleep
  4. DIts anticholinergic effects can cause confusion, urine retention and falls
2.Mental health nursingHard

A patient asks the nurse to pray with her before her ECT. The nurse does not share her religion. What is the most appropriate response?

  1. ARespect the request, join in if comfortable, and offer to call the chaplain
  2. BIgnore the request politely and change the subject to the procedure itself
  3. CTell her that religion has no place in hospital care
  4. DTry to persuade her to adopt the nurse's own beliefs
3.Clinical psychologyMedium

In the two-factor model of phobias (Mowrer), how is a phobia maintained?

  1. AAvoidance reduces anxiety, which negatively reinforces the avoidance
  2. BPunishment of approach behaviour by others, which strengthens the fear itself
  3. CThe fear is learned by watching others only
  4. DPositive reinforcement of fear by rewards
4.Clinical psychologyHard

An older patient becomes confused over two days after starting a new medication, with attention that varies through the day. Her daughter says her memory was normal last week. What is the most appropriate interpretation?

  1. ANormal ageing
  2. BLate-onset schizophrenia
  3. CDelirium, which needs a search for a physical or drug cause
  4. DEarly Alzheimer's disease, which needs a referral to a memory clinic
5.PharmacologyMedium

Which signs suggest early lithium toxicity?

  1. APinpoint pupils and slow breathing
  2. BVery high blood pressure and a severe headache
  3. CHair loss and dark urine only
  4. DDiarrhoea, vomiting, coarse tremor and drowsiness
6.PharmacologyHard

A patient on disulfiram becomes flushed, nauseated and has palpitations after using a mouthwash. What is the most likely cause?

  1. ALow blood glucose from skipping breakfast
  2. BDisulfiram toxicity from taking too many tablets by mistake
  3. CAlcohol in the mouthwash caused a disulfiram–alcohol reaction
  4. DAn allergy to mint flavouring in the mouthwash

3Solutions

1.Mental health nursing

Answer: D · Its anticholinergic effects can cause confusion, urine retention and falls

Why this is the answer

Diphenhydramine is strongly anticholinergic and sedating. In older adults, it can cause delirium, constipation, urinary retention and falls, and is generally avoided.

Answer

D · Its anticholinergic effects can cause confusion, urine retention and falls
2.Mental health nursing

Answer: A · Respect the request, join in if comfortable, and offer to call the chaplain

Why this is the answer

Supporting spiritual needs can reduce distress. The nurse can respond with respect within her own comfort, and refer to chaplaincy or faith leaders, without imposing her own beliefs.

Answer

A · Respect the request, join in if comfortable, and offer to call the chaplain
3.Clinical psychology

Answer: A · Avoidance reduces anxiety, which negatively reinforces the avoidance

Why this is the answer

Fear is acquired through classical conditioning and maintained because avoiding the feared object reduces anxiety, negatively reinforcing avoidance.

Answer

A · Avoidance reduces anxiety, which negatively reinforces the avoidance
4.Clinical psychology

Answer: C · Delirium, which needs a search for a physical or drug cause

Why this is the answer

Acute onset with fluctuating attention suggests delirium, a medical emergency with causes such as drugs, infection or dehydration. Dementia develops gradually over months to years.

Answer

C · Delirium, which needs a search for a physical or drug cause
5.Pharmacology

Answer: D · Diarrhoea, vomiting, coarse tremor and drowsiness

Why this is the answer

Early lithium toxicity causes GI upset, a coarse tremor, sluggishness and unsteadiness. Higher levels cause confusion, seizures and arrhythmias, so the drug is held and the level checked.

Answer

D · Diarrhoea, vomiting, coarse tremor and drowsiness
6.Pharmacology

Answer: C · Alcohol in the mouthwash caused a disulfiram–alcohol reaction

Why this is the answer

Disulfiram reactions can occur with small amounts of alcohol in mouthwash, cough syrups, sauces or aftershave. Patients are taught to check labels and avoid all alcohol-containing products.

Answer

C · Alcohol in the mouthwash caused a disulfiram–alcohol reaction

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