NCNZ Mental Health Nursing (NZ Mental Health Act) 2 β Questions and Answers
Question 1: Which tool is most commonly used in NZ to assess suicide risk in a mental health assessment?
- Structured clinical interview incorporating risk factors, protective factors, and intent β tools like the Columbia Suicide Severity Rating Scale (C-SSRS) may supplement (Correct answer)
- Hamilton Depression Rating Scale alone
- GAD-7 for anxiety
- Confusion Assessment Method (CAM)
Correct answer: Structured clinical interview incorporating risk factors, protective factors, and intent β tools like the Columbia Suicide Severity Rating Scale (C-SSRS) may supplement
Suicide risk assessment in NZ uses a structured clinical approach exploring ideation, plan, intent, access to means, and protective factors. Tools like C-SSRS provide a standardised framework. No single tool is sufficient β clinical judgement is essential.
Question 2: A patient with bipolar disorder is being prescribed lithium. Which monitoring parameters are most important for a mental health nurse?
- Serum lithium levels, renal function (eGFR, creatinine), thyroid function, and signs of toxicity (tremor, nausea, ataxia) (Correct answer)
- Blood glucose and HbA1c
- Liver function tests and full blood count only
- Blood pressure and ECG only
Correct answer: Serum lithium levels, renal function (eGFR, creatinine), thyroid function, and signs of toxicity (tremor, nausea, ataxia)
Lithium has a narrow therapeutic index. Monitoring includes: serum levels (0.6β1.0 mmol/L for maintenance), renal function (lithium is renally excreted), thyroid function (lithium causes hypothyroidism), and clinical signs of toxicity (tremor, nausea, coarse tremor, ataxia, confusion).
Question 3: What is the primary purpose of a 'safety plan' in mental health nursing?
- A collaboratively developed plan to help the patient identify warning signs, coping strategies, support people, and crisis contacts to use when suicidal thoughts escalate (Correct answer)
- A document limiting the patient's movements within the ward
- A plan for physical safety including fall prevention
- A legal document for compulsory treatment
Correct answer: A collaboratively developed plan to help the patient identify warning signs, coping strategies, support people, and crisis contacts to use when suicidal thoughts escalate
A safety plan is a personalised, collaborative document developed with the patient that outlines: warning signs of escalating distress, personal coping strategies, social supports, professional contacts, and reasons for living. It empowers patients to manage suicidal crises.
Question 4: Under NZ legislation, which Act specifically governs the use of alcohol and other drug (AOD) treatment without consent?
- Substance Addiction (Compulsory Assessment and Treatment) Act 2017 (Correct answer)
- Mental Health (Compulsory Assessment and Treatment) Act 1992
- Misuse of Drugs Act 1975
- Alcoholism and Drug Addiction Act 1966 (repealed)
Correct answer: Substance Addiction (Compulsory Assessment and Treatment) Act 2017
The Substance Addiction (Compulsory Assessment and Treatment) Act 2017 allows compulsory assessment and treatment for people with severe substance addiction who pose a serious risk. This is separate from the MH(CAT) Act 1992.
Question 5: A mental health inpatient on a compulsory treatment order wishes to contact a patient rights advocate. What is the correct nursing response?
- Facilitate this immediately β access to a rights advisor is a legal right under the MH(CAT) Act that cannot be restricted (Correct answer)
- Advise the patient to wait until their treatment team meeting
- Inform the patient that advocacy is only available after discharge
- Refer the request to the charge nurse to decide at their discretion
Correct answer: Facilitate this immediately β access to a rights advisor is a legal right under the MH(CAT) Act that cannot be restricted
Under the MH(CAT) Act 1992, every compulsorily detained patient has the right to a patient rights advisor and access to advocacy services. This right cannot be withheld by clinical staff. Facilitating this access is a legal and ethical obligation.
Question 6: Which de-escalation technique is most effective when a patient with psychosis becomes acutely distressed and threatening?
- Speak calmly in a quiet voice, reduce environmental stimulation, avoid direct confrontation, and acknowledge the patient's distress without reinforcing delusional content (Correct answer)
- Raise your voice to assert authority and establish control
- Argue with the patient to correct their delusional beliefs
- Ignore the patient and wait for them to calm down
Correct answer: Speak calmly in a quiet voice, reduce environmental stimulation, avoid direct confrontation, and acknowledge the patient's distress without reinforcing delusional content
Effective de-escalation uses calm, low-volume speech, reduces environmental stimulation (noise, crowding), avoids confrontation, and validates the patient's emotional distress without agreeing with delusional content. Arguing or shouting escalates fear and aggression.
NCNZ Mental Health Nursing (NZ Mental Health Act) 2
Which tool is most commonly used in NZ to assess suicide risk in a mental health assessment?