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 who has started chlorpromazine feels dizzy when she gets out of bed. What should the nurse teach her?
- ASit on the edge of the bed for a moment and then stand up slowly
- BDrink a cup of strong coffee before getting out of bed each morning
- CGet up quickly to get the blood flowing to the brain
- DStop the medicine if the dizziness happens more than once
2.Mental health nursingHard
The parents of a 15-year-old with anorexia nervosa ask what treatment is usually recommended first. Which answer is most accurate?
- AFamily-based treatment, in which the parents take an active role in restoring the child's eating
- BLong-term treatment in an inpatient unit far away from her family, so that the parents cannot interfere
- CMedicine alone, because therapy is not effective in adolescents
- DLeaving the young person to decide on her own when to start eating more
3.Clinical psychologyMedium
Which side effect is a long-term risk of first-generation (typical) antipsychotics?
- APhysical dependence like benzodiazepines
- BTardive dyskinesia
- CHypertensive crisis after cheese
- DSerotonin syndrome
4.Clinical psychologyHard
A student believes "If I'm not perfect, I'm worthless." In Beck's model, this belief is best classed as:
- AA defence mechanism called sublimation, which channels distress into socially valued work
- BA negative symptom of schizophrenia
- CA hallucination that requires antipsychotics
- DA dysfunctional assumption or core belief that makes the person vulnerable
5.PharmacologyMedium
Which adverse effect of ciprofloxacin should a patient report at once?
- APain or swelling in a tendon, such as the Achilles tendon
- BA slightly bitter or metallic taste for a while after each dose
- CMild tiredness in the first few days
- DDarker stools than usual
6.PharmacologyHard
Codeine is converted to morphine by CYP2D6. What happens in a patient who is a CYP2D6 ultra-rapid metaboliser?
- ACodeine gives almost no pain relief because little morphine is formed
- BCodeine is excreted unchanged in the urine
- CMore morphine is formed, increasing the risk of opioid toxicity
- DCodeine is converted to an inactive compound only
3Solutions
1.Mental health nursing
Answer: A · Sit on the edge of the bed for a moment and then stand up slowly
Why this is the answer
Many antipsychotics cause orthostatic hypotension through alpha-1 blockade. Rising slowly reduces dizziness and the risk of falls; the nurse also checks lying and standing blood pressure.
A · Sit on the edge of the bed for a moment and then stand up slowly
2.Mental health nursing
Answer: A · Family-based treatment, in which the parents take an active role in restoring the child's eating
Why this is the answer
Family-based treatment, which developed from the Maudsley approach, is a first-line treatment for adolescents with anorexia nervosa. Parents are supported to take charge of meals at first, before control is gradually handed back.
A · Family-based treatment, in which the parents take an active role in restoring the child's eating
3.Clinical psychology
Answer: B · Tardive dyskinesia
Why this is the answer
Long-term dopamine blockade can cause tardive dyskinesia, with involuntary repetitive movements of the face, tongue and limbs, which may be irreversible.
4.Clinical psychology
Answer: D · A dysfunctional assumption or core belief that makes the person vulnerable
Why this is the answer
Beck distinguished surface negative automatic thoughts from deeper schemas and conditional assumptions. Such beliefs remain dormant until activated by a matching stressor, such as failure.
D · A dysfunctional assumption or core belief that makes the person vulnerable
5.Pharmacology
Answer: A · Pain or swelling in a tendon, such as the Achilles tendon
Why this is the answer
Fluoroquinolones can cause tendinitis and tendon rupture. Patients should stop exercise and report tendon pain promptly.
A · Pain or swelling in a tendon, such as the Achilles tendon
6.Pharmacology
Answer: C · More morphine is formed, increasing the risk of opioid toxicity
Why this is the answer
Ultra-rapid metabolisers convert more codeine to morphine, which can cause respiratory depression. Poor metabolisers form little morphine and get poor pain relief. This is a classic example of pharmacogenetics.
C · More morphine is formed, increasing the risk of opioid toxicity