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
In the termination phase of the nurse–patient relationship, which behaviour is common and should be expected?
- AThe patient finally begins to share their problems for the first time
- BThe patient may show anger, sadness or a return of earlier symptoms
- CThe patient always feels relieved and shows no feelings
- DThe patient asks for the relationship to start again from the beginning
2.Mental health nursingHard
An 8-year-old taking methylphenidate for 6 months has dropped from the 50th to the 25th centile for weight. What is the most appropriate nursing action?
- AAdvise giving a double dose at night instead, so that the medicine does not affect his appetite during the day
- BStop the medicine immediately without telling the prescriber
- CIgnore it, because weight changes in children are always normal
- DReport the finding, review his eating pattern and suggest giving the medicine after breakfast
3.Clinical psychologyMedium
Selective serotonin reuptake inhibitors (SSRIs) increase serotonin in the synapse by:
- ABlocking the reuptake of serotonin into the presynaptic neuron
- BSpeeding up the breakdown of serotonin by monoamine oxidase enzymes
- CBlocking dopamine release
- DDestroying serotonin receptors
4.Clinical psychologyHard
A man who hears the word "thud" is admitted to hospital, then behaves normally. Staff record his note-taking as "engages in writing behaviour". In Rosenhan's study, what does this illustrate?
- AOnce a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
- BStaff deliberately falsified records
- CNote-taking is a recognised symptom of schizophrenia, so the staff were right to record it as such
- DPseudopatients developed real symptoms in hospital
5.PharmacologyMedium
Which approach is usually recommended to prevent constipation in a patient on regular opioids?
- AAn antidiarrhoeal drug at night to slow the gut
- BA stimulant laxative such as senna, often with a stool softener
- CBulk-forming fibre alone, with fluid intake restricted
- DNo laxative until the patient has not opened the bowels for a week
6.PharmacologyHard
Why can an ACE inhibitor cause acute kidney injury in a patient with bilateral renal artery stenosis?
- AACE inhibitors are directly toxic to the proximal tubule cells in the kidney
- BACE inhibitors constrict the afferent arteriole
- CThe drug crystallises in the renal tubules
- DGFR depends on angiotensin II constricting the efferent arteriole
3Solutions
1.Mental health nursing
Answer: B · The patient may show anger, sadness or a return of earlier symptoms
Why this is the answer
Ending a relationship can trigger feelings of loss, so regression, anger or sadness are common. The nurse prepares the patient for the ending from the start and helps them talk about these feelings.
B · The patient may show anger, sadness or a return of earlier symptoms
2.Mental health nursing
Answer: D · Report the finding, review his eating pattern and suggest giving the medicine after breakfast
Why this is the answer
Appetite suppression is a common stimulant effect and can affect growth. The prescriber needs to know, and strategies such as giving the dose after breakfast and offering a good evening meal can help.
D · Report the finding, review his eating pattern and suggest giving the medicine after breakfast
3.Clinical psychology
Answer: A · Blocking the reuptake of serotonin into the presynaptic neuron
Why this is the answer
SSRIs block the serotonin transporter, so serotonin stays longer in the synaptic cleft. Clinical effects usually take several weeks.
A · Blocking the reuptake of serotonin into the presynaptic neuron
4.Clinical psychology
Answer: A · Once a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
Why this is the answer
Rosenhan argued that the label "schizophrenic" made staff see ordinary behaviour as pathological. Critics such as Spitzer argued the study did not prove diagnosis was invalid.
A · Once a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
5.Pharmacology
Answer: B · A stimulant laxative such as senna, often with a stool softener
Why this is the answer
Opioid-induced constipation does not usually resolve with time, so a laxative is started with the opioid. Stimulant laxatives counter reduced motility; bulk-forming laxatives alone can worsen symptoms if fluid intake is low.
B · A stimulant laxative such as senna, often with a stool softener
6.Pharmacology
Answer: D · GFR depends on angiotensin II constricting the efferent arteriole
Why this is the answer
When renal perfusion is low, angiotensin II constricts the efferent arteriole to maintain glomerular pressure. Blocking it lets the pressure and GFR fall, so kidney function can drop sharply.
D · GFR depends on angiotensin II constricting the efferent arteriole