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 from a culture in which communication with ancestors is common says she sometimes hears her late grandmother giving advice. What is the most appropriate nursing approach?

  1. AExplore the experience in her cultural context before calling it a symptom
  2. BTell her that her beliefs are not real
  3. CRecord it immediately as a command hallucination
  4. DAvoid asking about it, because culture is not relevant to mental health
2.Mental health nursingHard

A patient says, "My boss didn't say hello this morning, so she must think I'm useless." Which cognitive distortion is shown, and what is a helpful nursing response?

  1. AMind reading; ask what other reasons there might be for the boss's behaviour
  2. BPersonalisation; advise the patient to ask for a new manager
  3. CAll-or-nothing thinking; agree that the boss is being unfair
  4. DCatastrophising; tell the patient that she will definitely not be fired
3.Clinical psychologyMedium

Mindfulness-based cognitive therapy (MBCT) has best evidence for:

  1. ATreating acute psychosis
  2. BCuring dementia
  3. CTreating attention problems in young children with ADHD
  4. DPreventing relapse in people with recurrent depression
4.Clinical psychologyHard

A clinician considers whether a categorical or dimensional approach to personality disorders is better. Which point favours a dimensional approach?

  1. APersonality traits are either fully present or fully absent in any one person
  2. BTraits vary continuously, and categories overlap with arbitrary cut-offs
  3. CDimensional models cannot be measured with questionnaires or interviews
  4. DCategories have been shown to give perfect inter-rater reliability
5.PharmacologyMedium

A patient is starting doxazosin, an alpha-1 blocker. What should the nurse advise about the first dose?

  1. ATake it only if the urine is darker than usual
  2. BTake it at bedtime, because it can cause dizziness and fainting
  3. CExpect a short rise in blood pressure after the dose
  4. DTake it in the morning with a cup of strong coffee to stay alert
6.PharmacologyHard

Methotrexate for rheumatoid arthritis is taken once a week. A patient mistakenly takes the same dose every day. What is the main danger?

  1. AHypoglycaemia because methotrexate strongly stimulates insulin release
  2. BBone marrow suppression and mucositis from methotrexate toxicity
  3. CSevere hypertension from fluid retention
  4. DThe arthritis gets worse because of drug tolerance

3Solutions

1.Mental health nursing

Answer: A · Explore the experience in her cultural context before calling it a symptom

Why this is the answer

A belief or experience that is accepted in the person's culture is not classed as a delusion or hallucination in itself. The nurse explores its meaning, how it is shared by others and whether it causes distress.

Answer

A · Explore the experience in her cultural context before calling it a symptom
2.Mental health nursing

Answer: A · Mind reading; ask what other reasons there might be for the boss's behaviour

Why this is the answer

Mind reading is assuming others' thoughts without evidence. Exploring alternative explanations, such as the boss being busy, helps the patient test the thought and reduce distress.

Answer

A · Mind reading; ask what other reasons there might be for the boss's behaviour
3.Clinical psychology

Answer: D · Preventing relapse in people with recurrent depression

Why this is the answer

MBCT combines mindfulness practice with cognitive therapy. Trials show it reduces relapse in people with three or more previous depressive episodes.

Answer

D · Preventing relapse in people with recurrent depression
4.Clinical psychology

Answer: B · Traits vary continuously, and categories overlap with arbitrary cut-offs

Why this is the answer

Categorical diagnoses overlap heavily and treat a continuum as present/absent. DSM-5 Section III and ICD-11 therefore offer trait-based dimensional models of personality disorder.

Answer

B · Traits vary continuously, and categories overlap with arbitrary cut-offs
5.Pharmacology

Answer: B · Take it at bedtime, because it can cause dizziness and fainting

Why this is the answer

Alpha-1 blockers dilate blood vessels and can cause marked orthostatic hypotension after the first dose. Taking it at bedtime and rising slowly reduces the risk of falls.

Answer

B · Take it at bedtime, because it can cause dizziness and fainting
6.Pharmacology

Answer: B · Bone marrow suppression and mucositis from methotrexate toxicity

Why this is the answer

Methotrexate inhibits dihydrofolate reductase. Daily dosing causes toxicity in dividing tissues such as bone marrow and gut lining, which can be fatal. Folinic acid is used as a rescue treatment.

Answer

B · Bone marrow suppression and mucositis from methotrexate toxicity

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