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

Under the Mental Capacity Act 2005 (England and Wales), a person lacks capacity for a decision if they cannot do which of the following?

  1. AAgree with the decision that the doctor and the rest of the healthcare team recommend for them
  2. BUnderstand, retain and weigh the information, or communicate their decision
  3. CRead and write in the language used by the staff
  4. DRemember the decision for more than a year afterwards
2.Mental health nursingHard

A behaviour plan states that staff will no longer give attention to a child's tantrums but will praise calm behaviour. For the first few days, the tantrums become worse. What does this most likely show?

  1. AThat the plan has failed and should be stopped immediately
  2. BThat the tantrums are caused by a physical illness
  3. CAn extinction burst, which is expected before the behaviour decreases
  4. DThat the child needs firm punishment for each tantrum instead
3.Clinical psychologyMedium

A woman has had a depressed mood most of the day, on most days, for three years, though not severe enough for major depression. Which DSM-5 diagnosis fits best?

  1. ACyclothymic disorder
  2. BPersistent depressive disorder (dysthymia)
  3. CBipolar II disorder
  4. DAdjustment disorder with depressed mood
4.Clinical psychologyHard

A therapist asks a client to rate the evidence for and against the thought "I always fail". Which technique is this?

  1. AFree association
  2. BCognitive restructuring
  3. CSystematic desensitisation
  4. DToken economy
5.PharmacologyMedium

How does neostigmine improve muscle strength in myasthenia gravis?

  1. AIt increases the number of acetylcholine receptors at the neuromuscular junction
  2. BIt directly stimulates muscarinic receptors in muscle
  3. CIt blocks the autoantibodies against the receptor
  4. DIt inhibits acetylcholinesterase so more acetylcholine reaches the receptors
6.PharmacologyHard

In myxoedema coma, why is hydrocortisone often given before or with thyroid hormone?

  1. AHydrocortisone makes thyroid hormone work faster
  2. BThyroid hormone is inactive unless hydrocortisone is given
  3. CHydrocortisone prevents the hypoglycaemia caused by levothyroxine
  4. DThyroid hormone can trigger adrenal crisis if cortisol is also low

3Solutions

1.Mental health nursing

Answer: B · Understand, retain and weigh the information, or communicate their decision

Why this is the answer

The Act's functional test asks whether the person can understand, retain, use or weigh the information, and communicate a decision. Making an unwise decision does not by itself mean a person lacks capacity.

Answer

B · Understand, retain and weigh the information, or communicate their decision
2.Mental health nursing

Answer: C · An extinction burst, which is expected before the behaviour decreases

Why this is the answer

When a reinforced behaviour stops being rewarded, it often increases temporarily (an extinction burst) before declining. Consistency by all staff is essential, while safety is always maintained.

Answer

C · An extinction burst, which is expected before the behaviour decreases
3.Clinical psychology

Answer: B · Persistent depressive disorder (dysthymia)

Why this is the answer

Persistent depressive disorder requires depressed mood for at least two years in adults, with additional symptoms such as poor appetite, low energy or hopelessness.

Answer

B · Persistent depressive disorder (dysthymia)
4.Clinical psychology

Answer: B · Cognitive restructuring

Why this is the answer

Cognitive restructuring identifies automatic thoughts, examines evidence and replaces distortions such as overgeneralisation with balanced thoughts.

Answer

B · Cognitive restructuring
5.Pharmacology

Answer: D · It inhibits acetylcholinesterase so more acetylcholine reaches the receptors

Why this is the answer

Neostigmine inhibits acetylcholinesterase at the neuromuscular junction, so acetylcholine lasts longer and can activate the remaining nicotinic receptors more effectively.

Answer

D · It inhibits acetylcholinesterase so more acetylcholine reaches the receptors
6.Pharmacology

Answer: D · Thyroid hormone can trigger adrenal crisis if cortisol is also low

Why this is the answer

Restoring thyroid hormone increases metabolic rate and cortisol clearance. If adrenal reserve is also low, this can precipitate adrenal crisis, so steroid cover is given until adrenal insufficiency is excluded.

Answer

D · Thyroid hormone can trigger adrenal crisis if cortisol is also low

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