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 who started lithium 2 weeks ago has a fine tremor of the hands and is passing more urine than usual. Her level is within the therapeutic range. How should the nurse interpret this?

  1. AThese are definite signs of severe lithium toxicity, so emergency dialysis is needed straight away
  2. BThese are common side effects that are not by themselves signs of toxicity, but they should be reported and monitored
  3. CThese are signs of an allergic reaction, so she should never take lithium again
  4. DThese symptoms mean that the lithium is not working, so the dose should be stopped and a new drug chosen
2.Mental health nursingHard

A patient with a known panic disorder says she has chest pain and difficulty breathing. What should the nurse do first?

  1. AAsk her to breathe slowly into a paper bag and leave her alone until the panic has passed, as it always does in panic disorder
  2. BTell her it is just another panic attack
  3. CAssess her physically, including vital signs, and get an ECG according to policy, before assuming it is panic
  4. DGive her a lecture on cognitive restructuring
3.Clinical psychologyMedium

Which defence mechanism is shown when someone with strong hostile feelings towards a colleague acts in an excessively friendly way towards them?

  1. ADisplacement
  2. BDenial
  3. CReaction formation
  4. DRationalisation
4.Clinical psychologyHard

Ayllon and Azrin introduced a token economy on a psychiatric ward. What was the main finding and limitation?

  1. APatients' hallucinations disappeared permanently, and the gains lasted after discharge
  2. BThe method cured schizophrenia within weeks
  3. CTokens had no effect on behaviour
  4. DTarget behaviours increased, but gains often did not generalise outside the ward
5.PharmacologyMedium

A patient taking levodopa finds that the drug works poorly after large meals. Which advice is most appropriate?

  1. ADouble the dose after each meal
  2. BTake every dose with a large glass of milk and a protein snack
  3. CTake the drug only at bedtime
  4. DAvoid taking doses at the same time as high-protein meals
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. A160 mg
  2. B42 mg
  3. C20 mg
  4. D80 mg

3Solutions

1.Mental health nursing

Answer: B · These are common side effects that are not by themselves signs of toxicity, but they should be reported and monitored

Why this is the answer

Fine tremor, thirst, polyuria and mild nausea are common early effects of lithium. A coarse tremor, vomiting, diarrhoea, confusion or unsteadiness suggest toxicity.

Answer

B · These are common side effects that are not by themselves signs of toxicity, but they should be reported and monitored
2.Mental health nursing

Answer: C · Assess her physically, including vital signs, and get an ECG according to policy, before assuming it is panic

Why this is the answer

Physical causes such as a heart attack or pulmonary embolism must be ruled out. "Diagnostic overshadowing", assuming symptoms are psychiatric, is a common and dangerous error.

Answer

C · Assess her physically, including vital signs, and get an ECG according to policy, before assuming it is panic
3.Clinical psychology

Answer: C · Reaction formation

Why this is the answer

Reaction formation turns an unacceptable impulse into its opposite, often in an exaggerated form.

Answer

C · Reaction formation
4.Clinical psychology

Answer: D · Target behaviours increased, but gains often did not generalise outside the ward

Why this is the answer

Token economies increased self-care and work behaviours in long-stay patients, but changes tended to fade without reinforcement, and the approach raised ethical concerns about control.

Answer

D · Target behaviours increased, but gains often did not generalise outside the ward
5.Pharmacology

Answer: D · Avoid taking doses at the same time as high-protein meals

Why this is the answer

Dietary amino acids compete with levodopa for absorption in the gut and transport into the brain. Spreading protein through the day or timing doses away from high-protein meals improves the effect.

Answer

D · Avoid taking doses at the same time as high-protein meals
6.Pharmacology

Answer: D · 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

D · 80 mg

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