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

During a panic attack, a patient breathes very fast and complains of light-headedness and tingling in her fingers and around her mouth. What should the nurse do?

  1. AAsk her to breathe into a paper bag for at least 10 minutes
  2. BLeave her alone so that she can calm down without anyone watching
  3. CGive her oxygen at a high flow rate through a mask
  4. DStay with her and coach her to breathe slowly and steadily
3.Clinical psychologyMedium

Which treatment is recommended as first-line for chronic insomnia in adults?

  1. AElectroconvulsive therapy
  2. BLong-term daily benzodiazepines or other hypnotic drugs
  3. CCognitive behavioural therapy for insomnia (CBT-I)
  4. DPsychoanalysis
4.Clinical psychologyHard

A patient has had psychotic symptoms for a year; for several weeks they had hallucinations without any mood episode, while at other times psychosis occurred during major depressive episodes. Which diagnosis is most likely?

  1. ASchizoaffective disorder
  2. BBipolar I disorder
  3. CDelusional disorder
  4. DMajor depressive disorder with psychotic features
5.PharmacologyMedium

A patient is starting lisinopril. Which rare but serious adverse effect should the nurse teach the patient to report immediately?

  1. ADarker skin after exposure to sunlight
  2. BA harmless rash on the palms of the hands
  3. CAn increase in appetite in the evening
  4. DSwelling of the lips, tongue or face
6.PharmacologyHard

A ventilated ICU patient receives vecuronium, a neuromuscular blocker. Why must sedation and pain relief also be given?

  1. ASedatives are needed to prevent vecuronium from causing seizures and agitation
  2. BVecuronium causes severe pain at the injection site
  3. CNeuromuscular blockers paralyse muscles but do not cause sedation or analgesia
  4. DVecuronium stops working unless a sedative is also given

3Solutions

1.Mental health nursing

Answer: A · 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

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

Answer: D · Stay with her and coach her to breathe slowly and steadily

Why this is the answer

Hyperventilation causes respiratory alkalosis, which leads to tingling and dizziness. Calm coaching of slow breathing restores carbon dioxide levels. Breathing into a paper bag is not recommended, because it can cause hypoxia and mask a medical cause.

Answer

D · Stay with her and coach her to breathe slowly and steadily
3.Clinical psychology

Answer: C · Cognitive behavioural therapy for insomnia (CBT-I)

Why this is the answer

CBT-I combines sleep restriction, stimulus control, sleep hygiene and cognitive techniques. It has lasting effects and is recommended before hypnotic drugs.

Answer

C · Cognitive behavioural therapy for insomnia (CBT-I)
4.Clinical psychology

Answer: A · Schizoaffective disorder

Why this is the answer

Schizoaffective disorder involves a mood episode together with schizophrenia symptoms, plus at least two weeks of psychosis without a mood episode. In psychotic depression, psychosis occurs only during the mood episode.

Answer

A · Schizoaffective disorder
5.Pharmacology

Answer: D · Swelling of the lips, tongue or face

Why this is the answer

ACE inhibitors can cause angioedema, which can obstruct the airway and needs emergency care. It is linked to raised bradykinin levels and can occur even after long use.

Answer

D · Swelling of the lips, tongue or face
6.Pharmacology

Answer: C · Neuromuscular blockers paralyse muscles but do not cause sedation or analgesia

Why this is the answer

Neuromuscular blockers cause paralysis but leave awareness and pain sensation intact. Without sedation and analgesia, the patient could be awake and in pain while unable to move.

Answer

C · Neuromuscular blockers paralyse muscles but do not cause sedation or analgesia

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