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 lies awake in bed for hours worrying about not sleeping. Which stimulus control advice is correct?
- AIf still awake after about 20 minutes, get up, do something calm and return when sleepy
- BLook at the clock often to check how much sleep is being lost
- CDo vigorous exercise in the bedroom until tired enough to fall asleep straight away
- DStay in bed and watch television or use a phone until sleep finally comes
2.Mental health nursingHard
A patient says she has saved a large supply of tablets at home and plans to take them all this weekend. What is the priority action?
- ATell her things will look better after the weekend
- BAsk her to sign a written promise not to harm herself, then let her go home for the weekend as planned
- CKeep her under close observation, ensure her immediate safety and inform the team urgently
- DArrange a routine follow-up appointment in a month
3.Clinical psychologyMedium
Which treatment is recommended as first-line for chronic insomnia in adults?
- ALong-term daily benzodiazepines or other hypnotic drugs
- BCognitive behavioural therapy for insomnia (CBT-I)
- CPsychoanalysis
- DElectroconvulsive therapy
4.Clinical psychologyHard
Concordance rates for schizophrenia are higher in identical than in fraternal twins. What does this suggest?
- ATwins are more likely than other siblings to be misdiagnosed by clinicians
- BGenes contribute to the risk, but the environment also matters
- CSchizophrenia is caused entirely by genes
- DThe environment plays no role
5.PharmacologyMedium
How are most medication doses for children calculated?
- ABy body weight in kilograms, or sometimes body surface area
- BBy the child's age in years only
- CBy giving half of the adult dose to all children under 12
- DBy the child's height alone
6.PharmacologyHard
A patient with severe liver cirrhosis takes oral propranolol, a drug with a high first-pass metabolism. What effect is expected?
- AThe first-pass effect increases, so the drug becomes inactive
- BThe drug is excreted faster by the kidney, so it works for a shorter time
- CMore drug reaches the circulation, so a lower dose may be needed
- DLess drug is absorbed from the gut, so a higher dose is needed
3Solutions
1.Mental health nursing
Answer: A · If still awake after about 20 minutes, get up, do something calm and return when sleepy
Why this is the answer
Stimulus control strengthens the bed as a cue for sleep. Getting up when unable to sleep, using the bed only for sleep and intimacy, and keeping a regular wake time are key parts.
A · If still awake after about 20 minutes, get up, do something calm and return when sleepy
2.Mental health nursing
Answer: C · Keep her under close observation, ensure her immediate safety and inform the team urgently
Why this is the answer
A specific plan, available means and a time frame indicate high risk. The patient must not be left alone, the team is informed at once, and access to means is reduced as part of urgent assessment and safety planning.
C · Keep her under close observation, ensure her immediate safety and inform the team urgently
3.Clinical psychology
Answer: B · Cognitive behavioural therapy for insomnia (CBT-I)
Why this is the answer
CBT-I combines sleep restriction, stimulus control, sleep hygiene and cognitive techniques. It has lasting effects and is recommended before hypnotic drugs.
B · Cognitive behavioural therapy for insomnia (CBT-I)
4.Clinical psychology
Answer: B · Genes contribute to the risk, but the environment also matters
Why this is the answer
Higher MZ than DZ concordance shows a genetic contribution, while concordance well below 100% means environmental factors are also important.
B · Genes contribute to the risk, but the environment also matters
5.Pharmacology
Answer: A · By body weight in kilograms, or sometimes body surface area
Why this is the answer
Children's doses are usually weight-based, sometimes using body surface area, and must not exceed the adult maximum. Accurate, recent weight in kilograms is essential.
A · By body weight in kilograms, or sometimes body surface area
6.Pharmacology
Answer: C · More drug reaches the circulation, so a lower dose may be needed
Why this is the answer
In cirrhosis, less of the oral dose is removed by the liver on its first pass, partly because blood bypasses the liver through shunts. Bioavailability and plasma levels rise, so doses of such drugs often need to be reduced.
C · More drug reaches the circulation, so a lower dose may be needed