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 taking sertraline wants to take ibuprofen regularly for arthritis. What should the nurse teach?
- AThe combination is completely safe because they act on different systems
- BIbuprofen should be taken instead of sertraline on the days when the arthritis pain is bad, to avoid any interaction
- CThe combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
- DIbuprofen will make the sertraline work faster
2.Mental health nursingHard
A patient who was admitted after a serious suicide attempt says, "I'm angry they saved me. Next time I'll do it properly." What should the nurse do?
- AReduce observation because he is talking openly about his feelings
- BTell him that he should be grateful to be alive and think about how his family would feel
- CChange the subject to something more positive, such as his family and his plans for after discharge
- DMaintain close observation, report the statement and reassess the risk with the team
3.Clinical psychologyMedium
Which statement about the monoamine hypothesis of depression is most accurate?
- AIt predicts that antidepressants improve mood within a few hours of a dose
- BIt proves that depression is caused only by low dopamine in the frontal lobe
- CIt links depression to low monoamine activity but struggles to explain the delayed drug response
- DIt has been fully confirmed by direct measurements of serotonin levels in the brains of living patients
4.Clinical psychologyHard
Why did DSM-5 replace "substance abuse" and "substance dependence" with a single "substance use disorder"?
- ADependence was found not to exist
- BThe two categories were found to reflect one dimension better described by severity levels
- CThe WHO banned the terms
- DAbuse was reclassified as a personality disorder, while dependence became a purely medical condition
5.PharmacologyMedium
A transplant patient takes tacrolimus. Which monitoring is most important?
- ABlood drug levels and kidney function
- BSerum amylase
- CPeak expiratory flow
- DThyroid function and bone density
6.PharmacologyHard
A patient taking long-term morphine for cancer pain becomes very sedated with slow breathing. Why is naloxone given in small, diluted doses?
- ABecause naloxone is toxic to the liver in large doses
- BTo make the effect of naloxone last longer than morphine
- CTo restore breathing without causing severe withdrawal and pain
- DBecause naloxone is much more potent and toxic in patients with cancer
3Solutions
1.Mental health nursing
Answer: C · The combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
Why this is the answer
SSRIs reduce serotonin uptake into platelets, which impairs clotting. Combined with NSAIDs, aspirin or anticoagulants, the risk of gastrointestinal bleeding rises.
C · The combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
2.Mental health nursing
Answer: D · Maintain close observation, report the statement and reassess the risk with the team
Why this is the answer
Anger at surviving and stated future intent show high, ongoing risk. Close observation continues, the team reassesses the risk, and the nurse explores his feelings without judging him.
D · Maintain close observation, report the statement and reassess the risk with the team
3.Clinical psychology
Answer: C · It links depression to low monoamine activity but struggles to explain the delayed drug response
Why this is the answer
The hypothesis grew from the effects of drugs on monoamines. The delay of several weeks before benefit suggests that downstream changes, such as receptor adaptation, matter too.
C · It links depression to low monoamine activity but struggles to explain the delayed drug response
4.Clinical psychology
Answer: B · The two categories were found to reflect one dimension better described by severity levels
Why this is the answer
Research suggested that abuse and dependence criteria form a single continuum. DSM-5 merged them into one disorder rated by the number of criteria met.
B · The two categories were found to reflect one dimension better described by severity levels
5.Pharmacology
Answer: A · Blood drug levels and kidney function
Why this is the answer
Tacrolimus levels are kept in a target range to prevent rejection and toxicity. Kidney damage, hyperkalaemia, high glucose and tremor are adverse effects, and interacting drugs and grapefruit are avoided.
A · Blood drug levels and kidney function
6.Pharmacology
Answer: C · To restore breathing without causing severe withdrawal and pain
Why this is the answer
In opioid-dependent patients, a large dose of naloxone can cause abrupt withdrawal, severe pain and agitation. Small titrated doses aim to restore adequate breathing while keeping some analgesia.
C · To restore breathing without causing severe withdrawal and pain