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 who has started chlorpromazine feels dizzy when she gets out of bed. What should the nurse teach her?
- ADrink a cup of strong coffee before getting out of bed each morning
- BStop the medicine if the dizziness happens more than once
- CGet up quickly to get the blood flowing to the brain
- DSit on the edge of the bed for a moment and then stand up slowly
2.Mental health nursingHard
A patient with borderline personality disorder says, "If you don't make Anna my nurse again tomorrow, I'll cut myself." What is the most appropriate response?
- ATell her that if she cuts herself again, she will be discharged from the ward at once without any follow-up
- BIgnore the threat, because she is only trying to manipulate staff
- CTake the statement seriously, assess her risk and explain that nursing assignments are decided by the team
- DAgree to assign Anna to her every day so that she stays safe
3.Clinical psychologyMedium
Which criterion of abnormality judges behaviour as abnormal when it is rare in the population?
- AFailure to function adequately
- BDeviation from ideal mental health
- CStatistical infrequency
- DDeviation from social norms
4.Clinical psychologyHard
A client with OCD checks the stove twenty times before leaving home. Why does checking maintain the disorder, according to the cognitive-behavioural model?
- AChecking raises anxiety each time, which punishes and gradually weakens the urge to check
- BChecking produces a strong pleasure that the client becomes addicted to
- CChecking is mainly caused by low intelligence and poor working memory
- DRelief after checking reinforces it and blocks learning that the fear is unfounded
5.PharmacologyMedium
A patient starting niacin (nicotinic acid) complains of flushing and warmth after doses. Which advice may reduce this?
- ATake aspirin 30 minutes before the niacin, if the prescriber agrees
- BTake it on an empty stomach in a hot bath
- CDouble the dose to build tolerance faster
- DTake the niacin with a hot drink so that it dissolves and acts faster
6.PharmacologyHard
Why is pethidine (meperidine) avoided in older people and in kidney impairment?
- AIts metabolite norpethidine builds up and can cause seizures
- BIt has no pain-relieving effect in older people
- CIt is not absorbed from the gut when kidney function is poor
- DIt causes severe hypoglycaemia in these groups
3Solutions
1.Mental health nursing
Answer: D · Sit on the edge of the bed for a moment and then stand up slowly
Why this is the answer
Many antipsychotics cause orthostatic hypotension through alpha-1 blockade. Rising slowly reduces dizziness and the risk of falls; the nurse also checks lying and standing blood pressure.
D · Sit on the edge of the bed for a moment and then stand up slowly
2.Mental health nursing
Answer: C · Take the statement seriously, assess her risk and explain that nursing assignments are decided by the team
Why this is the answer
Every threat of self-harm needs assessment, but giving in to it reinforces the behaviour and supports splitting. The nurse addresses safety and feelings while keeping consistent team boundaries.
C · Take the statement seriously, assess her risk and explain that nursing assignments are decided by the team
3.Clinical psychology
Answer: C · Statistical infrequency
Why this is the answer
Statistical infrequency defines abnormality as behaviour far from the average. Its weakness is that some rare traits, such as very high IQ, are desirable.
C · Statistical infrequency
4.Clinical psychology
Answer: D · Relief after checking reinforces it and blocks learning that the fear is unfounded
Why this is the answer
Compulsions are negatively reinforced by short-term relief and stop the person learning that anxiety falls on its own. This is why ERP blocks the ritual.
D · Relief after checking reinforces it and blocks learning that the fear is unfounded
5.Pharmacology
Answer: A · Take aspirin 30 minutes before the niacin, if the prescriber agrees
Why this is the answer
Niacin causes prostaglandin-mediated vasodilation and flushing. Aspirin beforehand, taking it with food and avoiding hot drinks and alcohol reduce this effect.
A · Take aspirin 30 minutes before the niacin, if the prescriber agrees
6.Pharmacology
Answer: A · Its metabolite norpethidine builds up and can cause seizures
Why this is the answer
Norpethidine is excreted by the kidney and is a CNS stimulant. When it accumulates, it causes tremor, agitation and seizures, so other opioids are preferred.
A · Its metabolite norpethidine builds up and can cause seizures