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 asks the nurse for her home phone number so they can keep in touch after discharge. What is the best response?
- A"That would be against the rules, so please stop asking about it."
- B"Of course, as long as you don't tell the other patients."
- C"I can't give you my number, because our relationship is a professional one. Let's talk about support you can contact after discharge."
- D"I'll give you my number, but please only call me at weekends when I'm not working, and keep it short."
2.Mental health nursingHard
Which patient should the nurse check first?
- AA patient with OCD who is late for breakfast because of a long washing ritual in the bathroom
- BA patient with schizophrenia who wants a cigarette break in the garden
- CA patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
- DA patient with depression who is asking for help to phone his mother
3.Clinical psychologyMedium
The diathesis–stress model proposes that mental disorders arise from:
- APoor parenting alone
- BStress alone
- CAn underlying vulnerability combined with environmental stress
- DGenes alone
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 hallucination that requires antipsychotics
- BA dysfunctional assumption or core belief that makes the person vulnerable
- CA defence mechanism called sublimation, which channels distress into socially valued work
- DA negative symptom of schizophrenia
5.PharmacologyMedium
How should a patient take oral alendronate?
- AWith plain water on an empty stomach, staying upright for 30 minutes
- BWith milk at bedtime, then lying down straight away to aid absorption
- CCrushed into yoghurt with calcium supplements
- DWith breakfast and coffee to protect the stomach
6.PharmacologyHard
Why should a dose never be written as "5.0 mg" on a medication order?
- AIt means the dose must be given five times
- BThe pharmacy cannot supply doses that contain a decimal point
- CThe decimal point may be missed, and the dose read as 50 mg
- DIt is too precise for most drugs
3Solutions
1.Mental health nursing
Answer: C · "I can't give you my number, because our relationship is a professional one. Let's talk about support you can contact after discharge."
Why this is the answer
Personal contact outside the therapeutic relationship crosses a professional boundary. The nurse explains the boundary kindly and redirects to appropriate after-discharge support.
C · "I can't give you my number, because our relationship is a professional one. Let's talk about support you can contact after discharge."
2.Mental health nursing
Answer: C · A patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
Why this is the answer
Over-sedation with respiratory depression after rapid tranquillisation is a medical emergency. Airway, breathing and vital signs are checked immediately, and help is called.
C · A patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
3.Clinical psychology
Answer: C · An underlying vulnerability combined with environmental stress
Why this is the answer
The model holds that a predisposition (biological or psychological) leads to disorder only when triggered by sufficient stress.
C · An underlying vulnerability combined with environmental stress
4.Clinical psychology
Answer: B · 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.
B · A dysfunctional assumption or core belief that makes the person vulnerable
5.Pharmacology
Answer: A · With plain water on an empty stomach, staying upright for 30 minutes
Why this is the answer
Alendronate is taken first thing in the morning with water only, before food or other drugs. Staying upright reduces the risk of oesophageal ulceration, and food or calcium blocks its absorption.
A · With plain water on an empty stomach, staying upright for 30 minutes
6.Pharmacology
Answer: C · The decimal point may be missed, and the dose read as 50 mg
Why this is the answer
Trailing zeros (5.0) and missing leading zeros (.5) are well-known causes of tenfold errors. Safe practice is to write 5 mg and 0.5 mg.
C · The decimal point may be missed, and the dose read as 50 mg