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 intoxicated with phencyclidine (PCP) is agitated and has nystagmus and high blood pressure. Which nursing approach is best?
- ATry to talk the patient down by discussing his feelings in detail
- BProvide a quiet, low-stimulation environment and keep staff and patient safe
- CEncourage him to walk around the ward and join in activities to help burn off the drug
- DPut him in a busy area so that staff can watch him more easily
2.Mental health nursingHard
A patient is found unresponsive with a respiratory rate of 6/min and pinpoint pupils. What should the nurse do first?
- AGive flumazenil
- BCall for help, open the airway and support breathing, and give naloxone as prescribed or per protocol
- CPlace the patient in the recovery position and wait for the patient to wake up naturally before calling anyone
- DGive a large glass of water
3.Clinical psychologyMedium
Which statement about the monoamine hypothesis of depression is most accurate?
- AIt proves that depression is caused only by low dopamine in the frontal lobe
- BIt predicts that antidepressants improve mood within a few hours of a dose
- CIt has been fully confirmed by direct measurements of serotonin levels in the brains of living patients
- DIt links depression to low monoamine activity but struggles to explain the delayed drug response
4.Clinical psychologyHard
Ayllon and Azrin introduced a token economy on a psychiatric ward. What was the main finding and limitation?
- ATarget behaviours increased, but gains often did not generalise outside the ward
- BThe method cured schizophrenia within weeks
- CTokens had no effect on behaviour
- DPatients' hallucinations disappeared permanently, and the gains lasted after discharge
5.PharmacologyMedium
Why is aspirin avoided in children and teenagers with viral illnesses such as flu or chickenpox?
- AIt causes grey baby syndrome
- BIt stops the vaccine from working
- CIt causes severe, permanent hearing loss in young children
- DIt is linked to Reye's syndrome, which harms the liver and brain
6.PharmacologyHard
Which finding most favours serotonin syndrome over neuroleptic malignant syndrome?
- AA very high creatine kinase
- BSlow onset over days with lead-pipe rigidity
- CRapid onset with hyperreflexia and clonus
- DRecent start of an antipsychotic drug
3Solutions
1.Mental health nursing
Answer: B · Provide a quiet, low-stimulation environment and keep staff and patient safe
Why this is the answer
PCP can cause agitation, violence, psychosis, nystagmus and hypertension. Reducing stimulation and keeping enough staff present for safety are key; "talking down" is less effective than with other hallucinogens.
B · Provide a quiet, low-stimulation environment and keep staff and patient safe
2.Mental health nursing
Answer: B · Call for help, open the airway and support breathing, and give naloxone as prescribed or per protocol
Why this is the answer
Airway and breathing support come first, with naloxone given to reverse opioid effects. The patient is monitored closely because naloxone may wear off before the opioid.
B · Call for help, open the airway and support breathing, and give naloxone as prescribed or per protocol
3.Clinical psychology
Answer: D · 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.
D · It links depression to low monoamine activity but struggles to explain the delayed drug response
4.Clinical psychology
Answer: A · Target behaviours increased, but gains often did not generalise outside the ward
Why this is the answer
Token economies increased self-care and work behaviours in long-stay patients, but changes tended to fade without reinforcement, and the approach raised ethical concerns about control.
A · Target behaviours increased, but gains often did not generalise outside the ward
5.Pharmacology
Answer: D · It is linked to Reye's syndrome, which harms the liver and brain
Why this is the answer
Aspirin given during viral infections in young people is associated with Reye's syndrome, causing acute encephalopathy and liver failure. Paracetamol or ibuprofen is used for fever instead.
D · It is linked to Reye's syndrome, which harms the liver and brain
6.Pharmacology
Answer: C · Rapid onset with hyperreflexia and clonus
Why this is the answer
Serotonin syndrome develops within hours of a serotonergic drug and causes clonus, hyperreflexia, agitation, dilated pupils and diarrhoea. NMS develops over days after a dopamine antagonist, with lead-pipe rigidity and slow reflexes.
C · Rapid onset with hyperreflexia and clonus