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 serum lithium range is commonly quoted as the maintenance therapeutic range?

  1. AAbout 0.6 to 1.2 mmol/L (target ranges vary between guidelines)
  2. BAbout 3.5 to 5.0 mmol/L
  3. CAbout 0.01 to 0.05 mmol/L
  4. DAbout 2.0 to 3.0 mmol/L (higher levels are needed for acute mania)
2.Mental health nursingHard

On the third day of refeeding, a patient with severe anorexia nervosa develops swollen ankles, a low phosphate and an irregular pulse. What is most likely?

  1. ANormal weight gain
  2. BAn allergic reaction to the food
  3. CRefeeding syndrome
  4. DSerotonin syndrome
3.Clinical psychologyMedium

Which defence mechanism is shown when someone with strong hostile feelings towards a colleague acts in an excessively friendly way towards them?

  1. ADenial
  2. BDisplacement
  3. CRationalisation
  4. DReaction formation
4.Clinical psychologyHard

Learned helplessness (Seligman) was proposed as a model for:

  1. ADepression
  2. BAutism spectrum disorder
  3. CSpecific phobias
  4. DSchizophrenia
5.PharmacologyMedium

Digoxin 0.25 mg is ordered. The tablets available are 0.125 mg. How many tablets should be given?

  1. A0.5 tablet
  2. B1 tablet
  3. C2 tablets
  4. D4 tablets
6.PharmacologyHard

A patient taking azathioprine is prescribed allopurinol for gout. What is the main danger?

  1. ASevere hypertension from the combination
  2. BGout becomes worse because allopurinol is inactivated by azathioprine
  3. CLiver enzyme induction, making azathioprine ineffective
  4. DSevere bone marrow suppression, because azathioprine breakdown is reduced

3Solutions

1.Mental health nursing

Answer: A · About 0.6 to 1.2 mmol/L (target ranges vary between guidelines)

Why this is the answer

Many textbooks quote 0.6–1.2 mmol/L (mEq/L) for maintenance, and some guidelines recommend lower targets such as 0.6–0.8. Levels above about 1.5 are associated with toxicity. Follow the local laboratory and prescriber.

Answer

A · About 0.6 to 1.2 mmol/L (target ranges vary between guidelines)
2.Mental health nursing

Answer: C · Refeeding syndrome

Why this is the answer

Refeeding after starvation causes insulin release that drives phosphate, potassium and magnesium into cells, causing heart failure, oedema, arrhythmias and confusion. Electrolytes are monitored closely and replaced, and feeding is increased gradually.

Answer

C · Refeeding syndrome
3.Clinical psychology

Answer: D · Reaction formation

Why this is the answer

Reaction formation turns an unacceptable impulse into its opposite, often in an exaggerated form.

Answer

D · Reaction formation
4.Clinical psychology

Answer: A · Depression

Why this is the answer

After uncontrollable aversive events, animals and people may stop trying even when escape becomes possible, resembling the passivity and hopelessness of depression.

Answer

A · Depression
5.Pharmacology

Answer: C · 2 tablets

Why this is the answer

0.25 mg ÷ 0.125 mg = 2 tablets. Doses that need more than a few tablets or unusual fractions should be double-checked.

Answer

C · 2 tablets
6.Pharmacology

Answer: D · Severe bone marrow suppression, because azathioprine breakdown is reduced

Why this is the answer

Azathioprine is converted to mercaptopurine, which is partly inactivated by xanthine oxidase. Allopurinol blocks this enzyme, so levels rise and dangerous myelosuppression can occur unless the dose is greatly reduced or the combination avoided.

Answer

D · Severe bone marrow suppression, because azathioprine breakdown is reduced

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