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 patient says, "The doctor says I'm getting better, but I don't think anyone here really knows me." Which nurse response is most therapeutic?

  1. A"You feel that people here don't really know you?"
  2. B"The doctor is very experienced, so you should trust her."
  3. C"Why do you think the doctor is wrong about you?"
  4. D"Everyone here knows you well, so don't worry."
2.Mental health nursingHard

The parents of a 15-year-old with anorexia nervosa ask what treatment is usually recommended first. Which answer is most accurate?

  1. ALong-term treatment in an inpatient unit far away from her family, so that the parents cannot interfere
  2. BMedicine alone, because therapy is not effective in adolescents
  3. CFamily-based treatment, in which the parents take an active role in restoring the child's eating
  4. DLeaving the young person to decide on her own when to start eating more
3.Clinical psychologyMedium

The key difference between factitious disorder and malingering is that in malingering:

  1. ASymptoms are produced unconsciously without any intention
  2. BThe person truly has a physical illness
  3. CThe person seeks to take on the sick role itself, without any obvious external gain
  4. DSymptoms are faked for an obvious external reward such as money or avoiding work
4.Clinical psychologyHard

Which brain finding has been repeatedly reported in groups of people with schizophrenia compared with controls?

  1. AEnlarged lateral ventricles
  2. BAn enlarged frontal lobe in all patients
  3. CA tumour in the pituitary gland
  4. DA complete absence of the hippocampus
5.PharmacologyMedium

Methylergometrine (methylergonovine) is prescribed for postpartum bleeding. Which finding would make the nurse withhold it and check with the prescriber?

  1. AHaemoglobin slightly below normal
  2. BBlood pressure of 160/105 mmHg
  3. CHeart rate of 88 per minute
  4. DTemperature of 37.2 °C (99 °F)
6.PharmacologyHard

A patient with early aspirin (salicylate) overdose has tinnitus and is breathing fast. Which acid–base pattern is classic?

  1. AMetabolic alkalosis followed by respiratory acidosis
  2. BRespiratory alkalosis followed by metabolic acidosis
  3. CPure metabolic alkalosis
  4. DRespiratory acidosis with normal bicarbonate

3Solutions

1.Mental health nursing

Answer: A · "You feel that people here don't really know you?"

Why this is the answer

Reflecting the patient's concern invites them to explore it. Defending the doctor, reassuring falsely or asking "why" all close the conversation down.

Answer

A · "You feel that people here don't really know you?"
2.Mental health nursing

Answer: C · Family-based treatment, in which the parents take an active role in restoring the child's eating

Why this is the answer

Family-based treatment, which developed from the Maudsley approach, is a first-line treatment for adolescents with anorexia nervosa. Parents are supported to take charge of meals at first, before control is gradually handed back.

Answer

C · Family-based treatment, in which the parents take an active role in restoring the child's eating
3.Clinical psychology

Answer: D · Symptoms are faked for an obvious external reward such as money or avoiding work

Why this is the answer

Both involve deliberate falsification. In factitious disorder the motive is to be seen as ill without obvious external reward; in malingering there is a clear external incentive. Malingering is not a mental disorder in DSM-5.

Answer

D · Symptoms are faked for an obvious external reward such as money or avoiding work
4.Clinical psychology

Answer: A · Enlarged lateral ventricles

Why this is the answer

Enlarged ventricles and reduced grey matter are found on average in schizophrenia. The differences are group averages and are not diagnostic for individuals.

Answer

A · Enlarged lateral ventricles
5.Pharmacology

Answer: B · Blood pressure of 160/105 mmHg

Why this is the answer

Ergot alkaloids cause vasoconstriction and can raise blood pressure sharply. They are contraindicated in hypertension and pre-eclampsia.

Answer

B · Blood pressure of 160/105 mmHg
6.Pharmacology

Answer: B · Respiratory alkalosis followed by metabolic acidosis

Why this is the answer

Salicylates stimulate breathing, causing respiratory alkalosis early. They then disturb cell metabolism, causing a metabolic acidosis with a raised anion gap. Adults often show a mixed picture.

Answer

B · Respiratory alkalosis followed by metabolic acidosis

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