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?
- AAt a safe distance, slightly to the side, with a clear exit available
- BBehind the patient and close to him, so that the patient does not feel threatened by eye contact
- CDirectly face to face, as close as possible, to show confidence
- DBetween the patient and the wall, so the patient can leave easily
2.Mental health nursingHard
A patient who takes fluoxetine in the evening says he has had trouble falling asleep since starting it. What should the nurse suggest?
- ADrink a small glass of wine or beer before bed to help him fall asleep
- BStop the fluoxetine at once and tell the prescriber at his next appointment
- CDiscuss with the prescriber whether he can take it in the morning instead
- DTake a double dose at night to make him sleepy
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
- CNorms vary across cultures and change over time
- DIt requires expensive brain scans
4.Clinical psychologyHard
Which finding best supports the role of serotonin and other monoamines, rather than circumstance alone, in depression?
- ADepression rates are equal in all countries, regardless of large differences in social and economic circumstances
- BDepression never runs in families
- CDrugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
- DEveryone who experiences a loss becomes depressed
5.PharmacologyMedium
Why is propranolol usually avoided in patients with asthma?
- AIt blocks beta-2 receptors in the airways and can cause bronchospasm
- BIt causes tolerance to inhaled corticosteroids
- CIt increases mucus production by blocking histamine
- DIt stimulates alpha-1 receptors in the airways and raises blood pressure
6.PharmacologyHard
A patient taking hydralazine for several months develops joint pain, fever and a rash. Anti-histone antibodies are positive. What is the most likely diagnosis?
- ARheumatoid arthritis
- BDrug-induced lupus
- CGout
- DAn acute viral infection
3Solutions
1.Mental health nursing
Answer: A · 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.
A · At a safe distance, slightly to the side, with a clear exit available
2.Mental health nursing
Answer: C · Discuss with the prescriber whether he can take it in the morning instead
Why this is the answer
Fluoxetine can be activating and cause insomnia. Taking it in the morning, with the prescriber's agreement, often helps. Stopping suddenly or using alcohol is unsafe.
C · Discuss with the prescriber whether he can take it in the morning instead
3.Clinical psychology
Answer: C · 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.
C · Norms vary across cultures and change over time
4.Clinical psychology
Answer: C · 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.
C · Drugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
5.Pharmacology
Answer: A · 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.
A · It blocks beta-2 receptors in the airways and can cause bronchospasm
6.Pharmacology
Answer: B · Drug-induced lupus
Why this is the answer
Hydralazine and procainamide are classic causes of drug-induced lupus, especially in slow acetylators. Symptoms usually resolve after the drug is stopped.