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 phenelzine, an MAOI, is being taught before discharge. Which statement shows a need for further teaching?
- A"I can take any cold and flu remedy from the pharmacy."
- B"A sudden severe headache is a reason to get help straight away."
- C"I'll avoid aged cheese and cured meats."
- D"I'll tell any new doctor or dentist that I take an MAOI."
2.Mental health nursingHard
A patient who believes he is a famous religious leader becomes upset when other patients laugh at him. What is the most appropriate nursing action?
- AProtect him from ridicule, avoid arguing and focus on real activities
- BEncourage the other patients to explain why the belief is wrong
- CAsk him to prove his identity in front of the group, so that the laughing stops
- DAgree that he is the religious leader so that he feels respected
3.Clinical psychologyMedium
Mindfulness-based cognitive therapy (MBCT) has best evidence for:
- ATreating attention problems in young children with ADHD
- BTreating acute psychosis
- CPreventing relapse in people with recurrent depression
- DCuring dementia
4.Clinical psychologyHard
An interview that follows a fixed set of questions in a fixed order to reach a diagnosis is called:
- AAn unstructured interview
- BA projective test
- CA free association session
- DA structured clinical interview
5.PharmacologyMedium
A patient must mix regular (soluble) insulin and NPH (isophane) insulin in one syringe. What is the correct order?
- ADraw them up in separate syringes, then mix them in a cup
- BShake both vials hard, then draw them up in any order
- CDraw up the clear regular insulin first, then the cloudy NPH insulin
- DDraw up the cloudy NPH insulin first, then the clear regular insulin
6.PharmacologyHard
A patient with Parkinson's disease has nausea. Why should metoclopramide be avoided?
- AIt inhibits the absorption of all oral drugs
- BIt increases dopamine levels in the brain too much and causes psychosis
- CIt blocks dopamine receptors in the brain and can worsen the parkinsonism
- DIt causes severe diarrhoea in Parkinson's disease
3Solutions
1.Mental health nursing
Answer: A · "I can take any cold and flu remedy from the pharmacy."
Why this is the answer
Decongestants such as pseudoephedrine are sympathomimetics and can cause a hypertensive crisis with MAOIs. Patients should check any new medicine, including over-the-counter remedies, with a pharmacist or prescriber.
A · "I can take any cold and flu remedy from the pharmacy."
2.Mental health nursing
Answer: A · Protect him from ridicule, avoid arguing and focus on real activities
Why this is the answer
Arguing or agreeing strengthens a delusion. The nurse protects the patient's dignity, responds to his feelings and focuses on real, present activities and concerns.
A · Protect him from ridicule, avoid arguing and focus on real activities
3.Clinical psychology
Answer: C · Preventing relapse in people with recurrent depression
Why this is the answer
MBCT combines mindfulness practice with cognitive therapy. Trials show it reduces relapse in people with three or more previous depressive episodes.
C · Preventing relapse in people with recurrent depression
4.Clinical psychology
Answer: D · A structured clinical interview
Why this is the answer
Structured interviews such as the SCID ask standard questions tied to diagnostic criteria, increasing reliability compared with unstructured interviews.
D · A structured clinical interview
5.Pharmacology
Answer: C · Draw up the clear regular insulin first, then the cloudy NPH insulin
Why this is the answer
Drawing up regular insulin first prevents NPH from contaminating the regular insulin vial. NPH is gently rolled, not shaken, to mix it.
C · Draw up the clear regular insulin first, then the cloudy NPH insulin
6.Pharmacology
Answer: C · It blocks dopamine receptors in the brain and can worsen the parkinsonism
Why this is the answer
Metoclopramide crosses the blood–brain barrier and antagonises D2 receptors. In Parkinson's disease this worsens rigidity and bradykinesia, so antiemetics that do not block central dopamine receptors are preferred.
C · It blocks dopamine receptors in the brain and can worsen the parkinsonism