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

Which pattern suggests premenstrual dysphoric disorder?

  1. AMood symptoms that begin only after the menopause and last for several years
  2. BMild bloating the day before a period, without any mood changes
  3. CMarked mood symptoms in the week before menstruation that improve within a few days after it starts
  4. DLow mood throughout the whole month that is not linked to the menstrual cycle
2.Mental health nursingHard

Which patient has the highest risk of suicide?

  1. AA 20-year-old student with exam stress who has no thoughts of suicide and good friends
  2. BA 30-year-old woman with mild anxiety who has a supportive family
  3. CA 72-year-old widowed man with alcohol dependence who has a gun at home and a plan
  4. DA 45-year-old man with well-controlled hypertension who works full time
3.Clinical psychologyMedium

Motivational interviewing is especially used to help clients who:

  1. AFeel ambivalent about changing a behaviour such as drinking
  2. BNeed a formal diagnosis for insurance
  3. CFear a single specific object
  4. DHave hallucinations that need immediate medication and hospital care
4.Clinical psychologyHard

Dialectical behaviour therapy (DBT) was originally developed for:

  1. ABipolar disorder
  2. BSpecific phobias
  3. CBorderline personality disorder with self-harm
  4. DDementia
5.PharmacologyMedium

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

  1. ABlood pressure of 160/105 mmHg
  2. BTemperature of 37.2 °C (99 °F)
  3. CHaemoglobin slightly below normal
  4. DHeart rate of 88 per minute
6.PharmacologyHard

A patient on long-term prednisolone has been vomiting for two days and could not take her tablets. She is now hypotensive and confused, with low sodium and high potassium. What is the most urgent treatment?

  1. AIV furosemide
  2. BIV insulin with glucose only
  3. COral prednisolone with a glass of water
  4. DIV hydrocortisone and IV fluids

3Solutions

1.Mental health nursing

Answer: C · Marked mood symptoms in the week before menstruation that improve within a few days after it starts

Why this is the answer

In PMDD, symptoms such as irritability, low mood, anxiety and mood swings occur in the final week before menses, improve after onset and are minimal in the week after. Symptoms should be confirmed with daily ratings over at least two cycles.

Answer

C · Marked mood symptoms in the week before menstruation that improve within a few days after it starts
2.Mental health nursing

Answer: C · A 72-year-old widowed man with alcohol dependence who has a gun at home and a plan

Why this is the answer

Older age, male sex, being widowed, substance misuse, access to lethal means and a specific plan all raise suicide risk. Having several factors together greatly increases the overall risk.

Answer

C · A 72-year-old widowed man with alcohol dependence who has a gun at home and a plan
3.Clinical psychology

Answer: A · Feel ambivalent about changing a behaviour such as drinking

Why this is the answer

Motivational interviewing (Miller and Rollnick) is a collaborative style that resolves ambivalence and strengthens the client's own motivation for change, widely used in addiction.

Answer

A · Feel ambivalent about changing a behaviour such as drinking
4.Clinical psychology

Answer: C · Borderline personality disorder with self-harm

Why this is the answer

DBT combines CBT with mindfulness, emotion regulation and distress tolerance skills, initially for people with borderline personality disorder and chronic suicidality.

Answer

C · Borderline personality disorder with self-harm
5.Pharmacology

Answer: A · 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

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

Answer: D · IV hydrocortisone and IV fluids

Why this is the answer

This suggests an adrenal crisis triggered by missed steroids and illness. Treatment is immediate IV or IM hydrocortisone, IV fluids with glucose as needed, and treating the cause.

Answer

D · IV hydrocortisone and IV fluids

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