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 taking fluoxetine says she has started taking St John's wort to feel even better. What is the main risk?

  1. ASerotonin syndrome
  2. BHypertensive crisis from tyramine
  3. CAgranulocytosis
  4. DLithium toxicity
2.Mental health nursingHard

A malnourished patient with alcohol dependence needs an IV glucose infusion. Which order should the nurse expect first?

  1. AA diuretic
  2. BGlucose with no vitamin replacement
  3. CThiamine before or with the glucose
  4. DGlucose first, thiamine a week later
3.Clinical psychologyMedium

In Beck's cognitive model of depression, the "cognitive triad" consists of negative views about:

  1. ABody, mind and spirit
  2. BOne's past, present and future only
  3. COneself, the world and the future
  4. DParents, friends and teachers
4.Clinical psychologyHard

Which evidence best supports CBT as a treatment for anxiety disorders, rather than a placebo effect?

  1. ARandomised trials show CBT outperforms credible attention-placebo control conditions
  2. BCBT has been used for over fifty years
  3. CCBT is cheaper than medication
  4. DClients say they like their therapists
5.PharmacologyMedium

During an amphotericin B infusion, the patient has fever, chills and shaking. What is the most likely explanation?

  1. AA sign that the fungal infection is cured
  2. BA sign that the drug has been given into an artery
  3. CSevere hypoglycaemia caused by the drug
  4. DA common infusion reaction to amphotericin B
6.PharmacologyHard

A patient on digoxin is started on amiodarone. What change should the nurse expect?

  1. AAmiodarone levels fall to zero
  2. BNo interaction is expected
  3. CDigoxin levels fall sharply, so the digoxin dose is doubled
  4. DDigoxin levels rise, so the digoxin dose is often reduced

3Solutions

1.Mental health nursing

Answer: A · Serotonin syndrome

Why this is the answer

St John's wort has serotonergic effects, so combining it with an SSRI can cause serotonin syndrome. It also induces liver enzymes and interacts with many other drugs, so patients should tell the prescriber about herbal products.

Answer

A · Serotonin syndrome
2.Mental health nursing

Answer: C · Thiamine before or with the glucose

Why this is the answer

Giving glucose to a thiamine-deficient patient can precipitate or worsen Wernicke's encephalopathy. Thiamine is given before or with the glucose, although treatment of hypoglycaemia must not be delayed.

Answer

C · Thiamine before or with the glucose
3.Clinical psychology

Answer: C · Oneself, the world and the future

Why this is the answer

Beck proposed that depressed people hold negative views of the self, the world (or experiences) and the future, maintained by cognitive distortions.

Answer

C · Oneself, the world and the future
4.Clinical psychology

Answer: A · Randomised trials show CBT outperforms credible attention-placebo control conditions

Why this is the answer

Showing superiority over a credible placebo control rules out non-specific factors as the only explanation. Many trials and meta-analyses report this for CBT in anxiety disorders.

Answer

A · Randomised trials show CBT outperforms credible attention-placebo control conditions
5.Pharmacology

Answer: D · A common infusion reaction to amphotericin B

Why this is the answer

Amphotericin B often causes fever, rigors and nausea during infusion. Premedication and a slower rate can reduce them, and kidney function and electrolytes are monitored.

Answer

D · A common infusion reaction to amphotericin B
6.Pharmacology

Answer: D · Digoxin levels rise, so the digoxin dose is often reduced

Why this is the answer

Amiodarone inhibits P-glycoprotein and reduces digoxin clearance, so digoxin levels rise. The digoxin dose is often reduced, and the patient is monitored for bradycardia and toxicity; amiodarone also raises warfarin levels.

Answer

D · Digoxin levels rise, so the digoxin dose is often reduced

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