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 at high risk of suicide is placed on constant (one-to-one) observation. What does this mean?
- AThe patient is checked every hour during the day only
- BThe patient is seen once a shift by the nurse in charge, and otherwise checked by camera from the office when staff are free
- CA staff member stays with the patient at all times, at the distance set by policy, including in the bathroom
- DThe patient can be left alone while asleep
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?
- ATake a double dose at night to make him sleepy
- BDiscuss with the prescriber whether he can take it in the morning instead
- CStop the fluoxetine at once and tell the prescriber at his next appointment
- DDrink a small glass of wine or beer before bed to help him fall asleep
3.Clinical psychologyMedium
The key difference between factitious disorder and malingering is that in malingering:
- ASymptoms are faked for an obvious external reward such as money or avoiding work
- BThe person truly has a physical illness
- CThe person seeks to take on the sick role itself, without any obvious external gain
- DSymptoms are produced unconsciously without any intention
4.Clinical psychologyHard
Research on cultural factors shows that the Japanese syndrome taijin kyofusho mainly involves fear of:
- ABeing possessed by spirits
- BLosing one's soul after a sudden fright, leading to weakness and loss of appetite
- CThe genitals retracting into the body
- DOffending or embarrassing others through one's appearance or behaviour
5.PharmacologyMedium
A patient with difficulty swallowing is prescribed several tablets. Which one should not be crushed?
- AA plain paracetamol tablet
- BA plain aspirin dispersible tablet
- CA modified-release (extended-release) tablet
- DA tablet that the pharmacist says may be crushed
6.PharmacologyHard
A patient taking azathioprine is prescribed allopurinol for gout. What is the main danger?
- ASevere bone marrow suppression, because azathioprine breakdown is reduced
- BSevere hypertension from the combination
- CGout becomes worse because allopurinol is inactivated by azathioprine
- DLiver enzyme induction, making azathioprine ineffective
3Solutions
1.Mental health nursing
Answer: C · A staff member stays with the patient at all times, at the distance set by policy, including in the bathroom
Why this is the answer
Constant observation means a member of staff is always with the patient, at a distance set by policy, so they can intervene immediately. It is reviewed regularly and stepped down as risk reduces.
C · A staff member stays with the patient at all times, at the distance set by policy, including in the bathroom
2.Mental health nursing
Answer: B · 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.
B · Discuss with the prescriber whether he can take it in the morning instead
3.Clinical psychology
Answer: A · Symptoms are faked for an obvious external reward such as money or avoiding work
Why this is the answer
Both involve deliberate falsification. In factitious disorder the motive is to be seen as ill without obvious external reward; in malingering there is a clear external incentive. Malingering is not a mental disorder in DSM-5.
A · Symptoms are faked for an obvious external reward such as money or avoiding work
4.Clinical psychology
Answer: D · Offending or embarrassing others through one's appearance or behaviour
Why this is the answer
Taijin kyofusho is a cultural concept of distress in which the person fears that their gaze, odour or appearance will offend others. It shows that culture shapes how anxiety is expressed.
D · Offending or embarrassing others through one's appearance or behaviour
5.Pharmacology
Answer: C · A modified-release (extended-release) tablet
Why this is the answer
Crushing modified-release products destroys the release mechanism and can cause toxic peaks. Enteric-coated tablets should also not be crushed; the pharmacist can advise on liquid or other forms.
C · A modified-release (extended-release) tablet
6.Pharmacology
Answer: A · Severe bone marrow suppression, because azathioprine breakdown is reduced
Why this is the answer
Azathioprine is converted to mercaptopurine, which is partly inactivated by xanthine oxidase. Allopurinol blocks this enzyme, so levels rise and dangerous myelosuppression can occur unless the dose is greatly reduced or the combination avoided.
A · Severe bone marrow suppression, because azathioprine breakdown is reduced