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 has taken a benzodiazepine daily for many months. Why must it not be stopped abruptly?
- AThere is no risk; benzodiazepines can be stopped at any time without tapering
- BSudden withdrawal can cause severe anxiety, insomnia and seizures
- CThe patient would become allergic to it
- DIt would cause immediate weight gain
2.Mental health nursingHard
A nurse is teaching a patient with anxiety how to do progressive muscle relaxation. Which instruction is correct?
- ATense all your muscles at once and keep them tight for 10 minutes
- BDo the exercise only during a panic attack, never at other times
- CTense each muscle group in turn for a few seconds, then let go and notice the difference
- DHold your breath for as long as possible while lying completely still on the floor
3.Clinical psychologyMedium
Validity scales on the MMPI are designed to detect:
- AInconsistent, exaggerated or defensive answering
- BThe client's intelligence level
- CWhich therapy will work best
- DBrain damage
4.Clinical psychologyHard
The dopamine hypothesis of schizophrenia is supported by the observation that:
- AAll patients respond equally well to antidepressants
- BDrugs that increase dopamine, such as amphetamines, can trigger psychotic symptoms
- CSerotonin levels alone predict symptoms
- DAntipsychotics increase dopamine activity in the mesolimbic pathway and reduce symptoms
5.PharmacologyMedium
Ipratropium is a bronchodilator used in COPD. How does it work?
- AIt reduces inflammation like a corticosteroid
- BIt stimulates beta-2 adrenergic receptors in the airways
- CIt blocks muscarinic receptors in airway smooth muscle
- DIt blocks leukotriene receptors
6.PharmacologyHard
A patient who uses insulin is taught sick-day rules. Which statement shows a need for further teaching?
- A"If I am ill and not eating, I will stop my insulin completely."
- B"I will seek help if I keep vomiting or have ketones."
- C"I will check my blood glucose and ketones more often while I am ill."
- D"I will keep drinking fluids, even if I cannot eat much."
3Solutions
1.Mental health nursing
Answer: B · Sudden withdrawal can cause severe anxiety, insomnia and seizures
Why this is the answer
Long-term benzodiazepine use causes physical dependence. Abrupt discontinuation can cause rebound anxiety, tremor and seizures, so the dose is tapered gradually.
B · Sudden withdrawal can cause severe anxiety, insomnia and seizures
2.Mental health nursing
Answer: C · Tense each muscle group in turn for a few seconds, then let go and notice the difference
Why this is the answer
Progressive muscle relaxation involves tensing and then relaxing muscle groups in turn. Regular practice when calm makes it easier to use the skill when anxious.
C · Tense each muscle group in turn for a few seconds, then let go and notice the difference
3.Clinical psychology
Answer: A · Inconsistent, exaggerated or defensive answering
Why this is the answer
Validity scales flag random responding, faking bad or faking good, so clinicians know whether the clinical scale profile can be interpreted.
A · Inconsistent, exaggerated or defensive answering
4.Clinical psychology
Answer: B · Drugs that increase dopamine, such as amphetamines, can trigger psychotic symptoms
Why this is the answer
Amphetamines can induce psychosis and D2-blocking antipsychotics reduce positive symptoms. Negative symptoms are less well explained, so the hypothesis has been revised.
B · Drugs that increase dopamine, such as amphetamines, can trigger psychotic symptoms
5.Pharmacology
Answer: C · It blocks muscarinic receptors in airway smooth muscle
Why this is the answer
Ipratropium is an inhaled antimuscarinic. It blocks vagally mediated bronchoconstriction and mucus secretion, which is especially useful in COPD.
C · It blocks muscarinic receptors in airway smooth muscle
6.Pharmacology
Answer: A · "If I am ill and not eating, I will stop my insulin completely."
Why this is the answer
Stress hormones during illness often raise glucose, so basal insulin is usually continued and doses may need adjusting. Stopping insulin in type 1 diabetes can lead to ketoacidosis.
A · "If I am ill and not eating, I will stop my insulin completely."