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 with PTSD begins to dissociate during a conversation. Which grounding technique can the nurse use?
- ALeave her alone until the episode has passed on its own
- BAsk her to close her eyes and think back to the worst moment of the trauma
- CAsk her to name things she can see, hear and touch in the room right now
- DAsk her to describe the traumatic event in as much detail as she can
2.Mental health nursingHard
A patient with an anxiety disorder speaks so quickly about her worries that the nurse cannot follow. Which response is most helpful?
- A"Let me tell you what I think your problem is, and then we can talk."
- B"There's really nothing to worry about, so just try to relax."
- C"Let's slow down and talk about one thing at a time. What worries you most right now?"
- D"You're talking too fast, so we'll have to stop for today."
3.Clinical psychologyMedium
A woman has had a depressed mood most of the day, on most days, for three years, though not severe enough for major depression. Which DSM-5 diagnosis fits best?
- ABipolar II disorder
- BAdjustment disorder with depressed mood
- CCyclothymic disorder
- DPersistent depressive disorder (dysthymia)
4.Clinical psychologyHard
A study compares a new therapy with a waiting-list control and finds a large benefit. Why might this overestimate the therapy's specific effect?
- AWaiting lists remove the placebo effect completely, so any benefit must come from the therapy itself
- BWaiting-list controls always receive the same therapy
- CWaiting-list participants cannot be randomised
- DA waiting list controls for time passing but not for attention, expectation or the alliance
5.PharmacologyMedium
A child is starting methylphenidate for ADHD. Which advice is appropriate?
- AExpect weight gain as the main side effect
- BGive doses early in the day and monitor appetite and growth
- CGive the last dose at bedtime to help the child sleep
- DGive the drug only at weekends
6.PharmacologyHard
Why may omeprazole be avoided in a patient taking clopidogrel?
- AIt increases clopidogrel absorption from the gut and causes bleeding
- BIt binds clopidogrel in the stomach and makes it insoluble
- CIt inhibits CYP2C19, so less clopidogrel is converted to its active form
- DIt speeds up kidney excretion of clopidogrel
3Solutions
1.Mental health nursing
Answer: C · Ask her to name things she can see, hear and touch in the room right now
Why this is the answer
Grounding techniques use the senses to bring the person back to the here and now. Asking for details of the trauma during dissociation can deepen distress.
C · Ask her to name things she can see, hear and touch in the room right now
2.Mental health nursing
Answer: C · "Let's slow down and talk about one thing at a time. What worries you most right now?"
Why this is the answer
Focusing directs the conversation to one main concern, which reduces overwhelm and makes the problem easier to work on. A calm, slow pace from the nurse also helps lower anxiety.
C · "Let's slow down and talk about one thing at a time. What worries you most right now?"
3.Clinical psychology
Answer: D · Persistent depressive disorder (dysthymia)
Why this is the answer
Persistent depressive disorder requires depressed mood for at least two years in adults, with additional symptoms such as poor appetite, low energy or hopelessness.
D · Persistent depressive disorder (dysthymia)
4.Clinical psychology
Answer: D · A waiting list controls for time passing but not for attention, expectation or the alliance
Why this is the answer
Waiting-list designs show that therapy beats no treatment, but common factors such as hope and therapist contact are not controlled. An active comparison or attention-placebo control is needed to test specific ingredients.
D · A waiting list controls for time passing but not for attention, expectation or the alliance
5.Pharmacology
Answer: B · Give doses early in the day and monitor appetite and growth
Why this is the answer
Stimulants can cause insomnia, so doses are given in the morning and early afternoon. Reduced appetite can slow growth, so height and weight are tracked.
B · Give doses early in the day and monitor appetite and growth
6.Pharmacology
Answer: C · It inhibits CYP2C19, so less clopidogrel is converted to its active form
Why this is the answer
Clopidogrel must be activated by liver enzymes, mainly CYP2C19. Omeprazole inhibits this enzyme and can reduce its antiplatelet effect, so another acid suppressant may be chosen.
C · It inhibits CYP2C19, so less clopidogrel is converted to its active form