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

During a session, a patient says he intends to seriously harm a named neighbour. What is the correct general principle?

  1. AThe threat should be ignored because patients often say things they don't mean
  2. BThe risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy
  3. CConfidentiality means nothing can be shared
  4. DThe nurse should personally go and warn the neighbour without telling the team
3.Clinical psychologyMedium

Mindfulness-based cognitive therapy (MBCT) has best evidence for:

  1. ACuring dementia
  2. BTreating attention problems in young children with ADHD
  3. CTreating acute psychosis
  4. DPreventing relapse in people with recurrent depression
4.Clinical psychologyHard

In Seligman's later reformulation of learned helplessness (Abramson, Seligman and Teasdale), depression is most likely when people attribute negative events to causes that are:

  1. AInternal, stable and global
  2. BExternal, stable and specific
  3. CInternal, unstable and specific
  4. DExternal, unstable and specific
5.PharmacologyMedium

Which adverse effects are typical of donepezil?

  1. AHair loss and skin pigmentation
  2. BDry mouth, constipation and a fast heart rate
  3. CWeight gain and high blood glucose
  4. DNausea, diarrhoea and a slow heart rate
6.PharmacologyHard

A drug has a volume of distribution of 40 L and complete bioavailability. Which loading dose gives a target plasma concentration of 2 mg/L?

  1. A80 mg
  2. B160 mg
  3. C42 mg
  4. D20 mg

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: B · The risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy

Why this is the answer

A serious threat against an identifiable person overrides confidentiality. The nurse informs the team, documents the threat and follows the legal and policy procedures for protecting the person.

Answer

B · The risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy
3.Clinical psychology

Answer: D · Preventing relapse in people with recurrent depression

Why this is the answer

MBCT combines mindfulness practice with cognitive therapy. Trials show it reduces relapse in people with three or more previous depressive episodes.

Answer

D · Preventing relapse in people with recurrent depression
4.Clinical psychology

Answer: A · Internal, stable and global

Why this is the answer

The attributional reformulation proposed that a depressive attributional style explains bad events by internal, stable and global causes, which leads to hopelessness.

Answer

A · Internal, stable and global
5.Pharmacology

Answer: D · Nausea, diarrhoea and a slow heart rate

Why this is the answer

Cholinesterase inhibitors cause cholinergic effects such as nausea, vomiting, diarrhoea and bradycardia. Patients are watched for dizziness and fainting from a slow pulse.

Answer

D · Nausea, diarrhoea and a slow heart rate
6.Pharmacology

Answer: A · 80 mg

Why this is the answer

Loading dose = 40 L × 2 mg/L = 80 mg. The loading dose depends on Vd, while the maintenance dose depends on clearance.

Answer

A · 80 mg

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