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

What is the main difference between disulfiram and naltrexone in alcohol dependence?

  1. ABoth work in exactly the same way, so they are fully interchangeable
  2. BDisulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward
  3. CDisulfiram reduces craving; naltrexone causes vomiting when alcohol is drunk
  4. DNaltrexone is used only for alcohol withdrawal; disulfiram is used only for treating an alcohol overdose
2.Mental health nursingHard

A patient taking naltrexone for alcohol dependence is brought to the emergency department with a broken leg. Why should the nurse tell the team about the naltrexone?

  1. ANaltrexone causes broken bones to heal more slowly
  2. BNaltrexone makes opioids much stronger, so smaller doses must be used
  3. CIt is not relevant, because naltrexone only affects the way the body responds to alcohol
  4. DNaltrexone blocks opioid analgesics, so pain relief needs to be planned differently
3.Clinical psychologyMedium

Which personality disorder is marked by instability in relationships, self-image and emotions, together with marked impulsivity?

  1. ABorderline personality disorder
  2. BNarcissistic personality disorder
  3. CSchizoid personality disorder
  4. DAvoidant personality disorder
4.Clinical psychologyHard

A soldier develops PTSD while most comrades exposed to the same battle do not. Which model best explains this difference?

  1. AThe statistical infrequency model
  2. BThe diathesis–stress model
  3. CThe medical model of infection
  4. DThe token economy model
5.PharmacologyMedium

Which side effects are most common when starting gabapentin?

  1. ADrowsiness and dizziness
  2. BCough and runny nose
  3. CInsomnia and agitation
  4. DHair loss and weight loss
6.PharmacologyHard

During an IV glyceryl trinitrate (nitroglycerin) infusion for chest pain, the patient's blood pressure drops to 82/50 mmHg and he feels faint. What is the nurse's first action?

  1. AGive a sublingual nitroglycerin tablet and increase the rate to relieve the remaining chest pain
  2. BIncrease the infusion rate to improve blood flow to the heart
  3. CStop or reduce the infusion as per protocol, lay the patient flat and notify the prescriber
  4. DSit the patient fully upright and give paracetamol for the headache

3Solutions

1.Mental health nursing

Answer: B · Disulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward

Why this is the answer

Disulfiram blocks the breakdown of acetaldehyde, so drinking causes flushing, nausea and palpitations. Naltrexone blocks opioid receptors and reduces the pleasurable effect of alcohol.

Answer

B · Disulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward
2.Mental health nursing

Answer: D · Naltrexone blocks opioid analgesics, so pain relief needs to be planned differently

Why this is the answer

Naltrexone blocks opioid receptors, so usual opioid doses may not work, and attempts to overcome the block with high doses can be dangerous. The team needs to know so that analgesia can be planned safely.

Answer

D · Naltrexone blocks opioid analgesics, so pain relief needs to be planned differently
3.Clinical psychology

Answer: A · Borderline personality disorder

Why this is the answer

Borderline personality disorder involves unstable relationships and identity, affective instability, fear of abandonment, impulsivity and recurrent self-harm. DBT is a well-supported treatment.

Answer

A · Borderline personality disorder
4.Clinical psychology

Answer: B · The diathesis–stress model

Why this is the answer

The diathesis–stress model holds that a stressor causes disorder mainly in people with pre-existing vulnerabilities, such as genetic risk, prior trauma or poor social support.

Answer

B · The diathesis–stress model
5.Pharmacology

Answer: A · Drowsiness and dizziness

Why this is the answer

Gabapentin and pregabalin commonly cause sedation, dizziness and unsteadiness, which raise the risk of falls. They also increase sedation when combined with opioids.

Answer

A · Drowsiness and dizziness
6.Pharmacology

Answer: C · Stop or reduce the infusion as per protocol, lay the patient flat and notify the prescriber

Why this is the answer

Hypotension is a major adverse effect of nitrates due to venous and arterial dilation. The infusion is stopped or reduced, the patient is positioned flat to improve venous return, and the prescriber is informed.

Answer

C · Stop or reduce the infusion as per protocol, lay the patient flat and notify the prescriber

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