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 effects of methadone should the nurse monitor for?
- AHair loss, weight loss and a painful red rash on the face
- BRespiratory depression, sedation and a prolonged QT interval
- CHypertensive crisis after eating aged cheese
- DAgranulocytosis and a sore throat
2.Mental health nursingHard
A patient says, "I'm such a failure. My wife left me and I lost my job." The nurse answers, "Don't worry, things will get better soon." What is wrong with this response?
- AIt is false reassurance that dismisses the patient's feelings
- BIt explores the problem too deeply too early
- CIt uses the technique of presenting reality wrongly
- DIt is too direct and confronting
3.Clinical psychologyMedium
Rosenhan's study "On being sane in insane places" raised concerns about:
- AThe validity of psychiatric diagnosis
- BThe effectiveness of CBT
- CThe safety of antidepressants
- DThe ethics of animal research
4.Clinical psychologyHard
Which finding best supports the role of serotonin and other monoamines, rather than circumstance alone, in depression?
- ADepression never runs in families
- BDrugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
- CEveryone who experiences a loss becomes depressed
- DDepression rates are equal in all countries, regardless of large differences in social and economic circumstances
5.PharmacologyMedium
Why are benzodiazepines used with great caution in older people?
- AThey cause severe high blood pressure in older people
- BThey are not absorbed from the gut after age 65
- CThey cause permanent hearing loss in older people
- DThey raise the risk of confusion, falls and fractures
6.PharmacologyHard
Why can an ACE inhibitor cause acute kidney injury in a patient with bilateral renal artery stenosis?
- AThe drug crystallises in the renal tubules
- BACE inhibitors constrict the afferent arteriole
- CGFR depends on angiotensin II constricting the efferent arteriole
- DACE inhibitors are directly toxic to the proximal tubule cells in the kidney
3Solutions
1.Mental health nursing
Answer: B · Respiratory depression, sedation and a prolonged QT interval
Why this is the answer
Methadone can cause respiratory depression, especially when starting or with other sedatives, and it can prolong the QT interval. It has a long half-life, so toxicity can build up over several days.
B · Respiratory depression, sedation and a prolonged QT interval
2.Mental health nursing
Answer: A · It is false reassurance that dismisses the patient's feelings
Why this is the answer
False reassurance minimises the patient's concerns and discourages further talk. A therapeutic response would acknowledge the losses and invite the patient to share more.
A · It is false reassurance that dismisses the patient's feelings
3.Clinical psychology
Answer: A · The validity of psychiatric diagnosis
Why this is the answer
Pseudopatients who reported hearing a single word were admitted and kept for weeks, suggesting diagnosis was influenced by context. The study's methods have been questioned since.
A · The validity of psychiatric diagnosis
4.Clinical psychology
Answer: B · Drugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
Why this is the answer
Antidepressants targeting monoamines outperform placebo on average, though by modest margins. This supports a biological contribution but does not show that low serotonin alone causes depression.
B · Drugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
5.Pharmacology
Answer: D · They raise the risk of confusion, falls and fractures
Why this is the answer
Older people are more sensitive to benzodiazepines and often eliminate them more slowly. Sedation, unsteadiness and confusion raise the risk of falls and fractures.
D · They raise the risk of confusion, falls and fractures
6.Pharmacology
Answer: C · 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.
C · GFR depends on angiotensin II constricting the efferent arteriole