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
A patient taking sertraline wants to take ibuprofen regularly for arthritis. What should the nurse teach?
- AIbuprofen should be taken instead of sertraline on the days when the arthritis pain is bad, to avoid any interaction
- BThe combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
- CIbuprofen will make the sertraline work faster
- DThe combination is completely safe because they act on different systems
2.Mental health nursingHard
A patient in a mental health unit asks to read his own health records. What is the correct general principle?
- AOnly his family can request access to his records on his behalf
- BThe nurse should give him the records immediately without following any procedure
- CPatients generally have a right of access, with limited exceptions to prevent serious harm
- DPsychiatric patients are never allowed to see their records
3.Clinical psychologyMedium
Exposure and response prevention is the main psychological treatment for:
- AADHD
- BOCD
- CInsomnia
- DBipolar disorder
4.Clinical psychologyHard
Which finding best supports the role of serotonin and other monoamines, rather than circumstance alone, in depression?
- ADrugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
- BEveryone who experiences a loss becomes depressed
- CDepression rates are equal in all countries, regardless of large differences in social and economic circumstances
- DDepression never runs in families
5.PharmacologyMedium
Why is a spacer recommended with a metered-dose inhaler?
- AIt doubles the dose of drug released by each puff of the inhaler
- BIt turns the inhaler into a nebuliser
- CIt removes the need to shake the inhaler
- DMore drug reaches the lungs and less stays in the mouth
6.PharmacologyHard
A malnourished patient with low serum albumin shows nystagmus and unsteady gait. Her total phenytoin level is within range. What is the most likely explanation?
- ALow albumin speeds up phenytoin metabolism
- BMore phenytoin is unbound when albumin is low, so free levels rise
- CLow albumin makes phenytoin bind more tightly, so the drug is less active
- DThe total level is high, but the laboratory is wrong
3Solutions
1.Mental health nursing
Answer: B · The combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
Why this is the answer
SSRIs reduce serotonin uptake into platelets, which impairs clotting. Combined with NSAIDs, aspirin or anticoagulants, the risk of gastrointestinal bleeding rises.
B · The combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
2.Mental health nursing
Answer: C · Patients generally have a right of access, with limited exceptions to prevent serious harm
Why this is the answer
Data protection and health records laws in many countries give patients a right to access their records. Requests follow a formal procedure, and information may be withheld only in limited cases, for example if it could cause serious harm.
C · Patients generally have a right of access, with limited exceptions to prevent serious harm
3.Clinical psychology
Answer: B · OCD
Why this is the answer
ERP exposes patients to obsessional triggers while preventing compulsions, so anxiety falls without the ritual.
4.Clinical psychology
Answer: A · Drugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
Why this is the answer
Antidepressants targeting monoamines outperform placebo on average, though by modest margins. This supports a biological contribution but does not show that low serotonin alone causes depression.
A · Drugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
5.Pharmacology
Answer: D · More drug reaches the lungs and less stays in the mouth
Why this is the answer
A spacer holds the aerosol so it can be inhaled slowly, without precise coordination. This improves lung delivery and reduces mouth side effects such as thrush from inhaled steroids.
D · More drug reaches the lungs and less stays in the mouth
6.Pharmacology
Answer: B · More phenytoin is unbound when albumin is low, so free levels rise
Why this is the answer
Phenytoin is highly protein bound. When albumin is low, the free fraction rises, so toxicity can occur with a "normal" total level; a free phenytoin level or corrected level is more useful.
B · More phenytoin is unbound when albumin is low, so free levels rise