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 young person who took LSD at a festival is frightened by what he is seeing. What is the most helpful nursing approach?

  1. AStay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass
  2. BShine a bright light in his eyes every few minutes to check his pupils and keep him alert until it wears off
  3. CLeave him alone in a dark room so that he can sleep it off
  4. DArgue with him that what he sees is not real until he accepts it
2.Mental health nursingHard

A man has odd beliefs about being able to read minds, dresses eccentrically and has few friends because others make him anxious. He has never had sustained hallucinations or delusions. Which diagnosis fits best?

  1. AAntisocial personality disorder
  2. BHistrionic personality disorder with odd dress
  3. CSchizotypal personality disorder
  4. DSchizophrenia
3.Clinical psychologyMedium

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

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

An older patient becomes confused over two days after starting a new medication, with attention that varies through the day. Her daughter says her memory was normal last week. What is the most appropriate interpretation?

  1. ALate-onset schizophrenia
  2. BDelirium, which needs a search for a physical or drug cause
  3. CNormal ageing
  4. DEarly Alzheimer's disease, which needs a referral to a memory clinic
5.PharmacologyMedium

Why are patients taking simvastatin often advised to avoid large amounts of grapefruit juice?

  1. AGrapefruit inhibits CYP3A4 in the gut, raising simvastatin levels and myopathy risk
  2. BGrapefruit blocks cholesterol absorption and causes low cholesterol
  3. CGrapefruit makes the tablet dissolve in the mouth
  4. DGrapefruit speeds up simvastatin breakdown in the liver, so the drug stops working
6.PharmacologyHard

A patient with asthma starts timolol eye drops for glaucoma and soon becomes wheezy. What is the most likely explanation?

  1. ATimolol is absorbed and blocks beta-2 receptors in the airways
  2. BThe eye drops contain an allergen that causes hay fever and asthma
  3. CTimolol activates histamine receptors in the lungs
  4. DThe wheeze is unrelated to the eye drops

3Solutions

1.Mental health nursing

Answer: A · Stay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass

Why this is the answer

For a frightening hallucinogen experience, a calm setting, a supportive person and simple reassurance usually help. The nurse also monitors vital signs and watches for injury or other substances.

Answer

A · Stay with him in a calm, quiet place and reassure him that the effects are from the drug and will pass
2.Mental health nursing

Answer: C · Schizotypal personality disorder

Why this is the answer

Schizotypal personality disorder involves odd beliefs, magical thinking, eccentric behaviour and social anxiety. It lies on the schizophrenia spectrum, but without the sustained psychotic symptoms of schizophrenia.

Answer

C · Schizotypal personality disorder
3.Clinical psychology

Answer: A · 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

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

Answer: B · Delirium, which needs a search for a physical or drug cause

Why this is the answer

Acute onset with fluctuating attention suggests delirium, a medical emergency with causes such as drugs, infection or dehydration. Dementia develops gradually over months to years.

Answer

B · Delirium, which needs a search for a physical or drug cause
5.Pharmacology

Answer: A · Grapefruit inhibits CYP3A4 in the gut, raising simvastatin levels and myopathy risk

Why this is the answer

Grapefruit compounds inhibit intestinal CYP3A4, so more simvastatin is absorbed. Higher levels increase the risk of muscle damage; drugs such as some calcium channel blockers and ciclosporin are also affected.

Answer

A · Grapefruit inhibits CYP3A4 in the gut, raising simvastatin levels and myopathy risk
6.Pharmacology

Answer: A · Timolol is absorbed and blocks beta-2 receptors in the airways

Why this is the answer

Ophthalmic timolol is a non-selective beta blocker and can reach the circulation in amounts that cause bronchospasm or bradycardia. It is generally avoided in asthma.

Answer

A · Timolol is absorbed and blocks beta-2 receptors in the airways

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