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
Which postpartum presentation is a psychiatric emergency?
- ATearfulness and mood swings on the third day after birth
- BTiredness and worry about feeding the baby in the first week
- CConfusion, hallucinations and rapidly changing mood a few days after birth
- DFeeling tearful at times but enjoying the baby and sleeping well when she can
2.Mental health nursingHard
In the second session of a new therapy group, members argue about rules and one member challenges the leader's authority. How should the leader interpret this?
- AIt is a normal stage of group development, to be handled openly and calmly
- BThe member who challenged the leader should be removed
- CThe group has failed and should be ended before anyone is upset
- DThe leader should avoid all conflict by making every decision alone
3.Clinical psychologyMedium
Mindfulness-based cognitive therapy (MBCT) has best evidence for:
- APreventing relapse in people with recurrent depression
- BCuring dementia
- CTreating attention problems in young children with ADHD
- DTreating acute psychosis
4.Clinical psychologyHard
Learned helplessness (Seligman) was proposed as a model for:
- ASchizophrenia
- BSpecific phobias
- CAutism spectrum disorder
- DDepression
5.PharmacologyMedium
A patient is starting doxazosin, an alpha-1 blocker. What should the nurse advise about the first dose?
- ATake it only if the urine is darker than usual
- BExpect a short rise in blood pressure after the dose
- CTake it at bedtime, because it can cause dizziness and fainting
- DTake it in the morning with a cup of strong coffee to stay alert
6.PharmacologyHard
A patient with epilepsy needs pain relief. Why is tramadol used with caution?
- AIt causes a sharp rise in blood glucose
- BIt speeds up the metabolism of all antiepileptic drugs
- CIt always causes respiratory arrest in epilepsy
- DIt lowers the seizure threshold
3Solutions
1.Mental health nursing
Answer: C · Confusion, hallucinations and rapidly changing mood a few days after birth
Why this is the answer
Postpartum psychosis usually begins within days to weeks of birth and can include confusion, delusions and hallucinations. It carries risks to mother and baby and needs immediate assessment, often in hospital.
C · Confusion, hallucinations and rapidly changing mood a few days after birth
2.Mental health nursing
Answer: A · It is a normal stage of group development, to be handled openly and calmly
Why this is the answer
Conflict and challenges to the leader are typical of the storming stage. Handling them openly and non-defensively helps the group develop norms and move into productive work.
A · It is a normal stage of group development, to be handled openly and calmly
3.Clinical psychology
Answer: A · Preventing relapse in people with recurrent depression
Why this is the answer
MBCT combines mindfulness practice with cognitive therapy. Trials show it reduces relapse in people with three or more previous depressive episodes.
A · Preventing relapse in people with recurrent depression
4.Clinical psychology
Answer: D · Depression
Why this is the answer
After uncontrollable aversive events, animals and people may stop trying even when escape becomes possible, resembling the passivity and hopelessness of depression.
5.Pharmacology
Answer: C · Take it at bedtime, because it can cause dizziness and fainting
Why this is the answer
Alpha-1 blockers dilate blood vessels and can cause marked orthostatic hypotension after the first dose. Taking it at bedtime and rising slowly reduces the risk of falls.
C · Take it at bedtime, because it can cause dizziness and fainting
6.Pharmacology
Answer: D · It lowers the seizure threshold
Why this is the answer
Tramadol can cause seizures, especially at high doses or with other drugs that lower the seizure threshold. Its serotonergic action also raises the risk of serotonin syndrome.
D · It lowers the seizure threshold