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

In the mental status examination, what is assessed under "insight"?

  1. AThe speed of the patient's speech
  2. BWhether the patient understands that they have a mental health problem and needs help
  3. CWhether the patient can make safe everyday decisions about money, meals and self-care
  4. DThe patient's orientation to time and place
2.Mental health nursingHard

A patient with schizophrenia refuses his antipsychotic, saying it makes him feel slow. What is the best initial response?

  1. AExplore his reasons and side effects, and inform the team so the treatment can be reviewed
  2. BTell him he will be restrained and given an injection if he does not take the tablets by mouth
  3. CHide the medication in his food
  4. DRecord "refused" and never discuss it again
3.Clinical psychologyMedium

Which personality disorder is marked by instability in relationships, self-image and emotions, together with marked impulsivity?

  1. ANarcissistic personality disorder
  2. BAvoidant personality disorder
  3. CBorderline personality disorder
  4. DSchizoid personality disorder
4.Clinical psychologyHard

A clinician considers whether a categorical or dimensional approach to personality disorders is better. Which point favours a dimensional approach?

  1. ACategories have been shown to give perfect inter-rater reliability
  2. BTraits vary continuously, and categories overlap with arbitrary cut-offs
  3. CPersonality traits are either fully present or fully absent in any one person
  4. DDimensional models cannot be measured with questionnaires or interviews
5.PharmacologyMedium

A nurse has a needlestick injury from a patient with HIV. When should post-exposure prophylaxis start?

  1. AAs soon as possible, and within 72 hours at the latest
  2. BOnly after the nurse's HIV test turns positive
  3. CAfter one week, when the risk of infection is clearer
  4. DOnly if the patient's viral load is above a set level
6.PharmacologyHard

A patient with severe liver cirrhosis takes oral propranolol, a drug with a high first-pass metabolism. What effect is expected?

  1. AMore drug reaches the circulation, so a lower dose may be needed
  2. BThe drug is excreted faster by the kidney, so it works for a shorter time
  3. CThe first-pass effect increases, so the drug becomes inactive
  4. DLess drug is absorbed from the gut, so a higher dose is needed

3Solutions

1.Mental health nursing

Answer: B · Whether the patient understands that they have a mental health problem and needs help

Why this is the answer

Insight is the patient's awareness of their illness and its effects. Judgement is the ability to make sound decisions, for example what to do if they found a lost wallet.

Answer

B · Whether the patient understands that they have a mental health problem and needs help
2.Mental health nursing

Answer: A · Explore his reasons and side effects, and inform the team so the treatment can be reviewed

Why this is the answer

Patients have a right to be heard and, in most situations, to refuse treatment. Exploring the reasons and side effects helps the team review the treatment. Covert medication is only allowed under specific legal and policy conditions.

Answer

A · Explore his reasons and side effects, and inform the team so the treatment can be reviewed
3.Clinical psychology

Answer: C · Borderline personality disorder

Why this is the answer

Borderline personality disorder involves unstable relationships and identity, affective instability, fear of abandonment, impulsivity and recurrent self-harm. DBT is a well-supported treatment.

Answer

C · Borderline personality disorder
4.Clinical psychology

Answer: B · Traits vary continuously, and categories overlap with arbitrary cut-offs

Why this is the answer

Categorical diagnoses overlap heavily and treat a continuum as present/absent. DSM-5 Section III and ICD-11 therefore offer trait-based dimensional models of personality disorder.

Answer

B · Traits vary continuously, and categories overlap with arbitrary cut-offs
5.Pharmacology

Answer: A · As soon as possible, and within 72 hours at the latest

Why this is the answer

Post-exposure prophylaxis aims to stop infection becoming established. It works best when started within hours, is not started after 72 hours, and is usually taken for 28 days.

Answer

A · As soon as possible, and within 72 hours at the latest
6.Pharmacology

Answer: A · More drug reaches the circulation, so a lower dose may be needed

Why this is the answer

In cirrhosis, less of the oral dose is removed by the liver on its first pass, partly because blood bypasses the liver through shunts. Bioavailability and plasma levels rise, so doses of such drugs often need to be reduced.

Answer

A · More drug reaches the circulation, so a lower dose may be needed

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