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 man with few physical symptoms is convinced he has cancer, checks his body many times a day and is not reassured by normal test results. According to DSM-5, which disorder does this suggest?

  1. AFactitious disorder
  2. BSomatic symptom disorder
  3. CConversion disorder
  4. DIllness anxiety disorder
2.Mental health nursingHard

A patient who took a high-dose benzodiazepine daily for a year tells you she stopped it suddenly 2 days ago. What is the main risk?

  1. AWeight gain
  2. BHypoglycaemia
  3. CHair loss
  4. DWithdrawal seizures
3.Clinical psychologyMedium

Benzodiazepines reduce anxiety mainly by:

  1. ABlocking dopamine D2 receptors
  2. BInhibiting monoamine oxidase
  3. CBlocking serotonin reuptake into presynaptic neurons
  4. DEnhancing the effect of GABA at GABA-A receptors
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. AStaff deliberately falsified records
  2. BNote-taking is a recognised symptom of schizophrenia, so the staff were right to record it as such
  3. COnce a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
  4. DPseudopatients developed real symptoms in hospital
5.PharmacologyMedium

A patient is starting doxazosin, an alpha-1 blocker. What should the nurse advise about the first dose?

  1. ATake it at bedtime, because it can cause dizziness and fainting
  2. BTake it only if the urine is darker than usual
  3. CExpect a short rise in blood pressure after the dose
  4. DTake it in the morning with a cup of strong coffee to stay alert
6.PharmacologyHard

A patient with severe chronic hyponatraemia receives hypertonic saline. Why is the rate of correction strictly limited?

  1. ARaising sodium too fast causes severe hypokalaemia and cardiac arrest
  2. BFast correction causes immediate kidney failure
  3. CHypertonic saline is toxic to the liver at high rates
  4. DRaising sodium too fast can cause osmotic demyelination in the brain

3Solutions

1.Mental health nursing

Answer: D · Illness anxiety disorder

Why this is the answer

In illness anxiety disorder, the person is preoccupied with having or getting a serious illness, with no or only mild symptoms. In somatic symptom disorder, the distressing physical symptoms themselves are prominent. ICD-11 calls this condition hypochondriasis.

Answer

D · Illness anxiety disorder
2.Mental health nursing

Answer: D · Withdrawal seizures

Why this is the answer

Abrupt withdrawal after long-term high-dose use can cause severe anxiety, tremor, perceptual disturbances and seizures. The prescriber should be informed and a supervised taper considered.

Answer

D · Withdrawal seizures
3.Clinical psychology

Answer: D · Enhancing the effect of GABA at GABA-A receptors

Why this is the answer

Benzodiazepines increase GABA-A receptor activity, producing rapid calming effects. Because of tolerance and dependence, they are usually recommended only for short-term use.

Answer

D · Enhancing the effect of GABA at GABA-A receptors
4.Clinical psychology

Answer: C · 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

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

Answer: A · Take it at bedtime, because it can cause dizziness and fainting

Why this is the answer

Alpha-1 blockers dilate blood vessels and can cause marked orthostatic hypotension after the first dose. Taking it at bedtime and rising slowly reduces the risk of falls.

Answer

A · Take it at bedtime, because it can cause dizziness and fainting
6.Pharmacology

Answer: D · Raising sodium too fast can cause osmotic demyelination in the brain

Why this is the answer

In chronic hyponatraemia the brain adapts to low osmolality. Correcting sodium too rapidly shrinks brain cells and can cause osmotic demyelination (central pontine myelinolysis), so sodium is checked often.

Answer

D · Raising sodium too fast can cause osmotic demyelination in the brain

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