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
How should the nurse position herself when talking to an agitated patient?
- ABehind the patient and close to him, so that the patient does not feel threatened by eye contact
- BDirectly face to face, as close as possible, to show confidence
- CBetween the patient and the wall, so the patient can leave easily
- DAt a safe distance, slightly to the side, with a clear exit available
2.Mental health nursingHard
A woman arrives in the emergency department after a sexual assault and has a cut on her head that is bleeding. What is the priority?
- AAsk her for a detailed account of the assault before any care
- BAssess and treat her physical injuries, then offer forensic examination with her consent
- CCollect forensic evidence before treating any injuries
- DCall the police and wait until they arrive before doing anything else, so that no evidence is lost by mistake
3.Clinical psychologyMedium
Which is a main criticism of defining abnormality as deviation from social norms?
- AIt only applies to children
- BIt ignores how rare or statistically unusual a behaviour is
- CIt requires expensive brain scans
- DNorms vary across cultures and change over time
4.Clinical psychologyHard
Why is the medical model of mental illness criticised by proponents of the psychological approaches?
- AIt may overlook psychological and social causes and reduce people's sense of agency
- BIt rejects the use of medication entirely
- CIt is based only on dream analysis
- DIt denies that the brain and biological factors have any role in behaviour or emotion
5.PharmacologyMedium
A patient takes isoniazid. Which advice is most important?
- AExpect the urine to turn orange
- BTake it with antacids to protect the stomach from irritation
- CAvoid alcohol and report jaundice, dark urine or poor appetite
- DStop the drug when the cough improves
6.PharmacologyHard
Which heart failure drug improves symptoms and reduces hospital admissions but has not been shown to reduce mortality?
- ADigoxin
- BA mineralocorticoid receptor antagonist such as spironolactone
- CAn ACE inhibitor
- DA beta blocker such as bisoprolol
3Solutions
1.Mental health nursing
Answer: D · At a safe distance, slightly to the side, with a clear exit available
Why this is the answer
Standing at an angle and outside arm's reach is less confrontational and safer. The nurse makes sure neither she nor the patient is trapped, so both have an exit.
D · At a safe distance, slightly to the side, with a clear exit available
2.Mental health nursing
Answer: B · Assess and treat her physical injuries, then offer forensic examination with her consent
Why this is the answer
Medical care for injuries comes first. Forensic examination is offered, explained and carried out only with consent, and the nurse supports the survivor's control over each step.
B · Assess and treat her physical injuries, then offer forensic examination with her consent
3.Clinical psychology
Answer: D · Norms vary across cultures and change over time
Why this is the answer
Social norms are culture- and era-specific, so this definition can label harmless non-conformity as disorder and has been used to justify social control.
D · Norms vary across cultures and change over time
4.Clinical psychology
Answer: A · It may overlook psychological and social causes and reduce people's sense of agency
Why this is the answer
The medical model treats disorders as illnesses with biological causes, which reduces blame but can neglect life events, meaning and context, and may encourage passive reliance on drugs.
A · It may overlook psychological and social causes and reduce people's sense of agency
5.Pharmacology
Answer: C · Avoid alcohol and report jaundice, dark urine or poor appetite
Why this is the answer
Isoniazid can cause hepatitis, and alcohol increases the risk. Signs of liver injury are reported at once, and liver tests may be checked.
C · Avoid alcohol and report jaundice, dark urine or poor appetite
6.Pharmacology
Answer: A · Digoxin
Why this is the answer
ACE inhibitors (or ARBs/ARNI), beta blockers, mineralocorticoid antagonists and SGLT2 inhibitors reduce mortality in heart failure with reduced ejection fraction. Digoxin improves symptoms and reduces admissions without reducing mortality.