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 on a mental health ward insists that he is a famous inventor whose ideas were stolen by the government. Which type of delusion is the main one here?

  1. AGrandiose
  2. BSomatic
  3. CErotomanic
  4. DNihilistic
2.Mental health nursingHard

A nurse is teaching a patient who has started haloperidol for schizophrenia. Which statement shows a need for further teaching?

  1. A"I can stop taking it as soon as the voices go away."
  2. B"I should tell the nurse if my neck or jaw muscles feel stiff."
  3. C"I'll avoid alcohol while I'm taking this medicine."
  4. D"I should get up slowly if I feel dizzy."
3.Clinical psychologyMedium

According to the duty established in the Tarasoff case in California, a therapist may need to:

  1. ATake steps to protect an identifiable person whom a client seriously threatens
  2. BKeep all information confidential under every circumstance, whatever the risk to others
  3. CReport every client who expresses anger
  4. DRefuse to treat clients with a history of violence
4.Clinical psychologyHard

In Clark and Wells' cognitive model of social anxiety, which factor maintains the anxiety?

  1. ASelf-focused attention and safety behaviours that prevent disconfirmation of fears
  2. BRepressed sexual impulses from childhood
  3. CPositive reinforcement from being praised in public, which rewards the anxious behaviour
  4. DLow levels of dopamine in the frontal lobe
5.PharmacologyMedium

A patient takes isoniazid. Which advice is most important?

  1. AExpect the urine to turn orange
  2. BAvoid alcohol and report jaundice, dark urine or poor appetite
  3. CStop the drug when the cough improves
  4. DTake it with antacids to protect the stomach from irritation
6.PharmacologyHard

A woman has received a high-dose oxytocin infusion with large volumes of hypotonic fluid for many hours. She now has a headache, confusion and a low serum sodium. What is the most likely cause?

  1. AWater intoxication from the antidiuretic effect of oxytocin
  2. BAn allergic reaction to oxytocin causing brain swelling
  3. CNormal tiredness after a long labour
  4. DExcessive salt in the infusion fluid

3Solutions

1.Mental health nursing

Answer: A · Grandiose

Why this is the answer

Grandiose delusions are false beliefs about one's own importance, power or identity. They may combine with persecutory themes, as here, but the central belief is about being exceptional.

Answer

A · Grandiose
2.Mental health nursing

Answer: A · "I can stop taking it as soon as the voices go away."

Why this is the answer

Antipsychotics are continued after symptoms improve, because stopping them early is a major cause of relapse. Any change should be discussed with the prescriber.

Answer

A · "I can stop taking it as soon as the voices go away."
3.Clinical psychology

Answer: A · Take steps to protect an identifiable person whom a client seriously threatens

Why this is the answer

The Tarasoff rulings held that when a client poses a serious danger of violence to an identifiable victim, the therapist has a duty to take reasonable steps to protect that person.

Answer

A · Take steps to protect an identifiable person whom a client seriously threatens
4.Clinical psychology

Answer: A · Self-focused attention and safety behaviours that prevent disconfirmation of fears

Why this is the answer

Socially anxious people focus on an internal, negative image of themselves and use safety behaviours. These behaviours make them seem odd and stop them learning that feared outcomes rarely happen.

Answer

A · Self-focused attention and safety behaviours that prevent disconfirmation of fears
5.Pharmacology

Answer: B · Avoid alcohol and report jaundice, dark urine or poor appetite

Why this is the answer

Isoniazid can cause hepatitis, and alcohol increases the risk. Signs of liver injury are reported at once, and liver tests may be checked.

Answer

B · Avoid alcohol and report jaundice, dark urine or poor appetite
6.Pharmacology

Answer: A · Water intoxication from the antidiuretic effect of oxytocin

Why this is the answer

Oxytocin has antidiuretic activity at high doses. With large volumes of fluid this can cause water retention and dilutional hyponatraemia, so fluid balance and sodium are monitored.

Answer

A · Water intoxication from the antidiuretic effect of oxytocin

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