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
What should a patient taking disulfiram be taught?
- AIt cures alcohol dependence after one dose
- BSmall amounts of beer are safe
- CAvoid all alcohol, including hidden sources such as some mouthwashes and sauces
- DIt works only if alcohol is drunk with it, so a small amount of wine is needed daily
2.Mental health nursingHard
A nurse is teaching a patient with anxiety how to do progressive muscle relaxation. Which instruction is correct?
- AHold your breath for as long as possible while lying completely still on the floor
- 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
- DTense all your muscles at once and keep them tight for 10 minutes
3.Clinical psychologyMedium
Which personality disorder is characterised by a pervasive pattern of disregard for the rights of others?
- ADependent personality disorder
- BAntisocial personality disorder
- CAvoidant personality disorder
- DBorderline personality disorder
4.Clinical psychologyHard
A study compares a new therapy with a waiting-list control and finds a large benefit. Why might this overestimate the therapy's specific effect?
- AWaiting-list participants cannot be randomised
- BWaiting-list controls always receive the same therapy
- CWaiting lists remove the placebo effect completely, so any benefit must come from the therapy itself
- DA waiting list controls for time passing but not for attention, expectation or the alliance
5.PharmacologyMedium
Why is propranolol usually avoided in patients with asthma?
- AIt stimulates alpha-1 receptors in the airways and raises blood pressure
- BIt blocks beta-2 receptors in the airways and can cause bronchospasm
- CIt increases mucus production by blocking histamine
- DIt causes tolerance to inhaled corticosteroids
6.PharmacologyHard
A 500 mg intravenous dose gives an initial plasma concentration of 10 mg/L. What is the volume of distribution?
- A5 L
- B500 L
- C5000 L
- D50 L
3Solutions
1.Mental health nursing
Answer: C · Avoid all alcohol, including hidden sources such as some mouthwashes and sauces
Why this is the answer
Disulfiram blocks the breakdown of acetaldehyde, so alcohol causes flushing, nausea, vomiting, palpitations and hypotension. Patients must avoid alcohol in any form.
C · Avoid all alcohol, including hidden sources such as some mouthwashes and sauces
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: B · Antisocial personality disorder
Why this is the answer
Antisocial personality disorder includes deceitfulness, impulsivity, aggression and lack of remorse, with evidence of conduct disorder in childhood.
B · Antisocial personality disorder
4.Clinical psychology
Answer: D · A waiting list controls for time passing but not for attention, expectation or the alliance
Why this is the answer
Waiting-list designs show that therapy beats no treatment, but common factors such as hope and therapist contact are not controlled. An active comparison or attention-placebo control is needed to test specific ingredients.
D · A waiting list controls for time passing but not for attention, expectation or the alliance
5.Pharmacology
Answer: B · It blocks beta-2 receptors in the airways and can cause bronchospasm
Why this is the answer
Non-selective beta blockers block both beta-1 and beta-2 receptors. Blocking beta-2 receptors in the bronchi removes their relaxing effect and can trigger severe bronchospasm.
B · It blocks beta-2 receptors in the airways and can cause bronchospasm
6.Pharmacology
Answer: D · 50 L
Why this is the answer
Vd = 500 mg ÷ 10 mg/L = 50 L. This is close to total body water, so the drug spreads beyond the plasma but is not extensively stored in tissues.