1Formulas and methods
Mental health nursing
Method
- Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
- Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
- Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
- Respect rights: the least restrictive option, consent and confidentiality with its limits.
2Practice problems
1.Mental health nursingMedium
An 86-year-old nursing home resident becomes acutely confused over two days. Which cause should be considered first?
- AA first episode of schizophrenia caused by moving into the home
- BA sudden onset of Alzheimer's disease
- CAn infection such as a urinary tract infection, or a medicine side effect
- DThe normal ageing process
2.Mental health nursingHard
A woman who takes lithium for bipolar disorder tells the nurse she would like to become pregnant. What is the best response?
- A"Please don't stop your lithium on your own. Let's arrange for you to plan this with your prescriber before you conceive."
- B"Stop the lithium today so that it is out of your body before you get pregnant."
- C"You'll need to choose between treating your bipolar disorder and having a baby."
- D"Lithium is completely safe in pregnancy, so there is no need to change anything at all."
3.Clinical psychologyMedium
The therapeutic alliance refers to:
- AThe client's diagnosis, as agreed independently by two psychiatrists at the initial assessment
- BThe collaborative bond and agreement on goals and tasks between therapist and client
- CA group of therapists who share referrals
- DA legal contract between a clinic and an insurer
4.Clinical psychologyHard
The "Dodo bird verdict" in psychotherapy research refers to the finding that:
- AMedication always outperforms psychotherapy
- BUntreated clients on waiting lists improve faster than treated clients
- CDifferent bona fide therapies often produce broadly similar outcomes
- DOnly psychoanalysis is effective for depression
5.PharmacologyMedium
Why should doxycycline not be taken at the same time as milk or antacids?
- AMilk speeds up its breakdown in the liver by inducing enzymes
- BThe combination causes severe constipation
- CCalcium and other metal ions bind it and reduce absorption
- DAntacids turn it into a toxic compound
6.PharmacologyHard
Why are tetracyclines usually avoided in pregnancy and in young children (under 8 years in US guidance, under 12 years in the UK)?
- AThey cause grey baby syndrome in infants
- BThey cause severe hearing loss in children
- CThey bind to growing teeth and bone and stain the teeth permanently
- DThey block the action of growth hormone and stunt the child's growth
3Solutions
1.Mental health nursing
Answer: C · An infection such as a urinary tract infection, or a medicine side effect
Why this is the answer
Acute confusion in an older adult suggests delirium, which has an underlying cause. Common causes include infections, medicines (especially anticholinergics and sedatives), dehydration, hypoxia, pain and urinary retention.
C · An infection such as a urinary tract infection, or a medicine side effect
2.Mental health nursing
Answer: A · "Please don't stop your lithium on your own. Let's arrange for you to plan this with your prescriber before you conceive."
Why this is the answer
Lithium in early pregnancy is linked to cardiac malformations, but stopping it abruptly greatly raises the risk of relapse. Pre-conception planning with the prescriber balances these risks.
A · "Please don't stop your lithium on your own. Let's arrange for you to plan this with your prescriber before you conceive."
3.Clinical psychology
Answer: B · The collaborative bond and agreement on goals and tasks between therapist and client
Why this is the answer
The therapeutic alliance consistently predicts therapy outcome across different approaches, which supports the importance of common factors in psychotherapy.
B · The collaborative bond and agreement on goals and tasks between therapist and client
4.Clinical psychology
Answer: C · Different bona fide therapies often produce broadly similar outcomes
Why this is the answer
Meta-analyses often find small differences between established therapies, which has been taken to support common factors such as the alliance. Some disorders, such as OCD and phobias, show clear advantages for specific treatments like exposure.
C · Different bona fide therapies often produce broadly similar outcomes
5.Pharmacology
Answer: C · Calcium and other metal ions bind it and reduce absorption
Why this is the answer
Tetracyclines form complexes with calcium, magnesium, aluminium and iron in the gut, which reduces absorption. Doses are separated from these products.
C · Calcium and other metal ions bind it and reduce absorption
6.Pharmacology
Answer: C · They bind to growing teeth and bone and stain the teeth permanently
Why this is the answer
Tetracyclines chelate calcium and are deposited in growing teeth and bones. This can cause permanent yellow-brown staining of the teeth and may affect bone growth. Short courses of doxycycline are sometimes still used in younger children for specific serious infections.
C · They bind to growing teeth and bone and stain the teeth permanently