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 is switching from an MAOI to an SSRI. What is essential?

  1. AA washout period of about 2 weeks before starting the SSRI
  2. BDouble the SSRI dose at the start
  3. CTake both drugs together for a month
  4. DStart the SSRI the same day
2.Mental health nursingHard

The day before discharge, a patient with depression says, "Soon I'll finally be at peace and won't be a burden to anyone." What should the nurse do?

  1. AAssume she means she is relieved about going home
  2. BSay she will feel better at home
  3. CNote the remark in her record and let the discharge go ahead as planned, without any further action
  4. DAsk directly whether she is thinking of suicide and inform the team before discharge goes ahead
3.Clinical psychologyMedium

Behavioural activation treats depression mainly by:

  1. APrescribing a period of complete rest
  2. BIncreasing engagement in rewarding and valued activities
  3. CExploring childhood conflicts in detail
  4. DExposing the person to feared bodily sensations in a graded way
4.Clinical psychologyHard

A therapist asks a client to rate the evidence for and against the thought "I always fail". Which technique is this?

  1. ASystematic desensitisation
  2. BFree association
  3. CToken economy
  4. DCognitive restructuring
5.PharmacologyMedium

A patient has severe kidney impairment. A drug is mainly excreted unchanged in the urine. What is the usual adjustment?

  1. AReduce the dose or lengthen the dosing interval
  2. BNo change is needed, because the liver takes over
  3. CGive the drug orally instead of intravenously
  4. DIncrease the dose to make up for poor absorption
6.PharmacologyHard

Which statement correctly contrasts donepezil and memantine in Alzheimer's disease?

  1. ABoth drugs are dopamine agonists that differ only in their half-lives
  2. BDonepezil blocks NMDA receptors; memantine inhibits acetylcholinesterase
  3. CBoth drugs remove amyloid plaques from the brain
  4. DDonepezil inhibits cholinesterase; memantine blocks NMDA receptors

3Solutions

1.Mental health nursing

Answer: A · A washout period of about 2 weeks before starting the SSRI

Why this is the answer

Combining an MAOI with an SSRI can cause serotonin syndrome. A washout of about 2 weeks is usual after stopping an MAOI, and a longer gap (about 5 weeks) is needed when switching from fluoxetine to an MAOI because of its long half-life.

Answer

A · A washout period of about 2 weeks before starting the SSRI
2.Mental health nursing

Answer: D · Ask directly whether she is thinking of suicide and inform the team before discharge goes ahead

Why this is the answer

Statements about being at peace or a burden may indicate suicidal intent. The nurse asks directly, assesses risk and informs the team, and discharge may need to be reconsidered.

Answer

D · Ask directly whether she is thinking of suicide and inform the team before discharge goes ahead
3.Clinical psychology

Answer: B · Increasing engagement in rewarding and valued activities

Why this is the answer

Behavioural activation schedules activities that bring pleasure or mastery, breaking the cycle of withdrawal and low reinforcement. It is an evidence-based treatment for depression.

Answer

B · Increasing engagement in rewarding and valued activities
4.Clinical psychology

Answer: D · Cognitive restructuring

Why this is the answer

Cognitive restructuring identifies automatic thoughts, examines evidence and replaces distortions such as overgeneralisation with balanced thoughts.

Answer

D · Cognitive restructuring
5.Pharmacology

Answer: A · Reduce the dose or lengthen the dosing interval

Why this is the answer

When renal clearance falls, drugs excreted by the kidney accumulate. The dose is lowered or given less often, guided by kidney function and, where possible, drug levels.

Answer

A · Reduce the dose or lengthen the dosing interval
6.Pharmacology

Answer: D · Donepezil inhibits cholinesterase; memantine blocks NMDA receptors

Why this is the answer

Donepezil raises acetylcholine levels, while memantine reduces excitotoxic glutamate activity at NMDA receptors. Both give symptomatic benefit only.

Answer

D · Donepezil inhibits cholinesterase; memantine blocks NMDA receptors

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