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

Which serum lithium range is commonly quoted as the maintenance therapeutic range?

  1. AAbout 0.6 to 1.2 mmol/L (target ranges vary between guidelines)
  2. BAbout 0.01 to 0.05 mmol/L
  3. CAbout 2.0 to 3.0 mmol/L (higher levels are needed for acute mania)
  4. DAbout 3.5 to 5.0 mmol/L
2.Mental health nursingHard

A patient with dementia repeatedly walks towards the ward exit, saying he must go to work. What is the most appropriate action?

  1. AWalk with him, acknowledge his concern and gently redirect him to an activity
  2. BLock him in his room so that he cannot leave
  3. CTell him firmly that he has been retired for 20 years
  4. DUse a physical restraint in a chair for the rest of the day so that he stays safe and cannot reach the exit
3.Clinical psychologyMedium

Selective serotonin reuptake inhibitors (SSRIs) increase serotonin in the synapse by:

  1. ASpeeding up the breakdown of serotonin by monoamine oxidase enzymes
  2. BBlocking dopamine release
  3. CBlocking the reuptake of serotonin into the presynaptic neuron
  4. DDestroying serotonin receptors
4.Clinical psychologyHard

A student believes "If I'm not perfect, I'm worthless." In Beck's model, this belief is best classed as:

  1. AA negative symptom of schizophrenia
  2. BA hallucination that requires antipsychotics
  3. CA dysfunctional assumption or core belief that makes the person vulnerable
  4. DA defence mechanism called sublimation, which channels distress into socially valued work
5.PharmacologyMedium

A patient takes theophylline for COPD. Which advice is most important?

  1. AAvoid potassium-rich foods such as bananas
  2. BLimit coffee, tea and cola, because caffeine adds to the side effects
  3. CTake extra doses when short of breath
  4. DDrink plenty of grapefruit juice each morning to improve absorption
6.PharmacologyHard

A drug has a half-life of 6 hours. Its plasma level is 80 mg/L. Assuming first-order elimination and no further doses, what is the level after 18 hours?

  1. A20 mg/L
  2. B26.7 mg/L
  3. C10 mg/L
  4. D40 mg/L

3Solutions

1.Mental health nursing

Answer: A · About 0.6 to 1.2 mmol/L (target ranges vary between guidelines)

Why this is the answer

Many textbooks quote 0.6–1.2 mmol/L (mEq/L) for maintenance, and some guidelines recommend lower targets such as 0.6–0.8. Levels above about 1.5 are associated with toxicity. Follow the local laboratory and prescriber.

Answer

A · About 0.6 to 1.2 mmol/L (target ranges vary between guidelines)
2.Mental health nursing

Answer: A · Walk with him, acknowledge his concern and gently redirect him to an activity

Why this is the answer

Wandering often has a reason, such as a past routine, boredom or a physical need. Redirection, meaningful activity and a safe environment are preferred over restraint, which increases agitation and the risk of injury.

Answer

A · Walk with him, acknowledge his concern and gently redirect him to an activity
3.Clinical psychology

Answer: C · Blocking the reuptake of serotonin into the presynaptic neuron

Why this is the answer

SSRIs block the serotonin transporter, so serotonin stays longer in the synaptic cleft. Clinical effects usually take several weeks.

Answer

C · Blocking the reuptake of serotonin into the presynaptic neuron
4.Clinical psychology

Answer: C · A dysfunctional assumption or core belief that makes the person vulnerable

Why this is the answer

Beck distinguished surface negative automatic thoughts from deeper schemas and conditional assumptions. Such beliefs remain dormant until activated by a matching stressor, such as failure.

Answer

C · A dysfunctional assumption or core belief that makes the person vulnerable
5.Pharmacology

Answer: B · Limit coffee, tea and cola, because caffeine adds to the side effects

Why this is the answer

Theophylline has a narrow therapeutic range, and caffeine adds stimulant effects such as tachycardia, restlessness and insomnia. Toxicity can cause arrhythmias and seizures, so blood levels may be monitored.

Answer

B · Limit coffee, tea and cola, because caffeine adds to the side effects
6.Pharmacology

Answer: C · 10 mg/L

Why this is the answer

18 hours is three half-lives. The level halves three times: 80 → 40 → 20 → 10 mg/L.

Answer

C · 10 mg/L

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