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
What should a patient starting zolpidem for insomnia be taught to report?
- ADoing things while not fully awake, such as sleepwalking or driving, with no memory of it
- BFeeling sleepy about 30 minutes after taking it at bedtime
- CFeeling slightly more rested and alert the next morning than before starting the medicine
- DSleeping through the night without waking up
2.Mental health nursingHard
A resident with dementia accuses staff of stealing her purse, which she has misplaced. What is the most appropriate response?
- AInsist that nobody would steal from her
- BTell her that her memory is the problem and that the purse is not stolen
- CStay calm, acknowledge her worry and offer to help her look for it
- DIgnore the accusation and walk away until she forgets about it
3.Clinical psychologyMedium
The key difference between factitious disorder and malingering is that in malingering:
- ASymptoms are faked for an obvious external reward such as money or avoiding work
- BThe person truly has a physical illness
- CThe person seeks to take on the sick role itself, without any obvious external gain
- DSymptoms are produced unconsciously without any intention
4.Clinical psychologyHard
Why did DSM-5 replace "substance abuse" and "substance dependence" with a single "substance use disorder"?
- AThe WHO banned the terms
- BAbuse was reclassified as a personality disorder, while dependence became a purely medical condition
- CDependence was found not to exist
- DThe two categories were found to reflect one dimension better described by severity levels
5.PharmacologyMedium
Which adverse effect of doxorubicin requires monitoring of heart function?
- ACumulative heart muscle damage leading to heart failure
- BPericarditis caused by infection
- CSevere hypertension during the infusion itself
- DRapid rise in cholesterol
6.PharmacologyHard
Why do infants absorb more of a topical corticosteroid than adults?
- AInfants do not absorb topical drugs at all
- BTheir liver changes the cream into a much stronger form
- CTheir skin contains no blood vessels
- DThey have more skin area per kilogram and thinner skin
3Solutions
1.Mental health nursing
Answer: A · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it
Why this is the answer
Zolpidem and similar "Z-drugs" can cause complex sleep behaviours, such as sleep-walking, sleep-driving or cooking while not fully awake, which can cause serious injury. These must be reported and the drug stopped.
A · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it
2.Mental health nursing
Answer: C · Stay calm, acknowledge her worry and offer to help her look for it
Why this is the answer
False accusations of theft are common in dementia when items are misplaced. Acknowledging the feeling, helping to search and keeping items in regular places reduce distress.
C · Stay calm, acknowledge her worry and offer to help her look for it
3.Clinical psychology
Answer: A · Symptoms are faked for an obvious external reward such as money or avoiding work
Why this is the answer
Both involve deliberate falsification. In factitious disorder the motive is to be seen as ill without obvious external reward; in malingering there is a clear external incentive. Malingering is not a mental disorder in DSM-5.
A · Symptoms are faked for an obvious external reward such as money or avoiding work
4.Clinical psychology
Answer: D · 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.
D · The two categories were found to reflect one dimension better described by severity levels
5.Pharmacology
Answer: A · Cumulative heart muscle damage leading to heart failure
Why this is the answer
Anthracyclines such as doxorubicin can damage heart muscle, and the risk increases with cumulative dose. Heart function is assessed before and during treatment; the drug can also turn urine red.
A · Cumulative heart muscle damage leading to heart failure
6.Pharmacology
Answer: D · They have more skin area per kilogram and thinner skin
Why this is the answer
Infants have a high surface area-to-weight ratio and a thinner skin barrier, so topical drugs reach higher systemic levels. Nappies can act as an occlusive dressing and increase absorption further.
D · They have more skin area per kilogram and thinner skin