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, which finding is recorded under thought content?

  1. APressured speech
  2. BLoose associations
  3. CObsessions and delusions
  4. DFlight of ideas
2.Mental health nursingHard

An 80-year-old surgical patient becomes confused overnight, with fluctuating attention and pulling at his IV line. He was well oriented on admission. What is the most appropriate interpretation?

  1. ANormal ageing that needs no action
  2. BRapid progression of dementia that cannot be treated, so no further tests are needed
  3. CProbable delirium: look for an underlying physical cause and inform the team
  4. DBad behaviour that needs restraint immediately
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. BReport every client who expresses anger
  3. CRefuse to treat clients with a history of violence
  4. DKeep all information confidential under every circumstance, whatever the risk to others
4.Clinical psychologyHard

A patient has had psychotic symptoms for a year; for several weeks they had hallucinations without any mood episode, while at other times psychosis occurred during major depressive episodes. Which diagnosis is most likely?

  1. ASchizoaffective disorder
  2. BDelusional disorder
  3. CMajor depressive disorder with psychotic features
  4. DBipolar I disorder
5.PharmacologyMedium

During a rapid infusion of vancomycin, a patient develops flushing and a red rash on the face, neck and upper body. What is the most likely cause and action?

  1. AA sign that the infection is spreading; give a second dose
  2. BA normal effect; increase the infusion rate to finish sooner
  3. CAcute kidney failure; stop all IV fluids and antibiotics at once
  4. DAn infusion reaction; stop or slow the infusion and inform the prescriber
6.PharmacologyHard

A patient taking long-term morphine for cancer pain becomes very sedated with slow breathing. Why is naloxone given in small, diluted doses?

  1. ATo make the effect of naloxone last longer than morphine
  2. BBecause naloxone is toxic to the liver in large doses
  3. CTo restore breathing without causing severe withdrawal and pain
  4. DBecause naloxone is much more potent and toxic in patients with cancer

3Solutions

1.Mental health nursing

Answer: C · Obsessions and delusions

Why this is the answer

Thought content covers delusions, obsessions, phobias and suicidal or homicidal thoughts. Thought process (form) covers loose associations, tangentiality and flight of ideas.

Answer

C · Obsessions and delusions
2.Mental health nursing

Answer: C · Probable delirium: look for an underlying physical cause and inform the team

Why this is the answer

Acute, fluctuating confusion suggests delirium, often caused by infection, pain, drugs, dehydration, urinary retention or hypoxia. It is a medical emergency; the cause is treated and the patient is kept safe with non-drug measures first.

Answer

C · Probable delirium: look for an underlying physical cause and inform the team
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 · Schizoaffective disorder

Why this is the answer

Schizoaffective disorder involves a mood episode together with schizophrenia symptoms, plus at least two weeks of psychosis without a mood episode. In psychotic depression, psychosis occurs only during the mood episode.

Answer

A · Schizoaffective disorder
5.Pharmacology

Answer: D · An infusion reaction; stop or slow the infusion and inform the prescriber

Why this is the answer

Rapid vancomycin infusion releases histamine, causing flushing and itching of the upper body (formerly called "red man syndrome"). It is managed by stopping or slowing the infusion, and sometimes with an antihistamine.

Answer

D · An infusion reaction; stop or slow the infusion and inform the prescriber
6.Pharmacology

Answer: C · To restore breathing without causing severe withdrawal and pain

Why this is the answer

In opioid-dependent patients, a large dose of naloxone can cause abrupt withdrawal, severe pain and agitation. Small titrated doses aim to restore adequate breathing while keeping some analgesia.

Answer

C · To restore breathing without causing severe withdrawal and pain

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