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
Which behaviour is a warning sign of possible suicidal intent in a depressed patient?
- AAsking for help with a job application for after discharge
- BTalking about their favourite music
- CMaking plans for a family holiday
- DGiving away valued possessions and suddenly seeming calm
2.Mental health nursingHard
Which patient should the nurse check first?
- AA patient with schizophrenia who wants a cigarette break in the garden
- BA patient with depression who is asking for help to phone his mother
- CA patient with OCD who is late for breakfast because of a long washing ritual in the bathroom
- DA patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
3.Clinical psychologyMedium
Which personality disorder is characterised by a pervasive pattern of disregard for the rights of others?
- ABorderline personality disorder
- BDependent personality disorder
- CAvoidant personality disorder
- DAntisocial personality disorder
4.Clinical psychologyHard
In Clark and Wells' cognitive model of social anxiety, which factor maintains the anxiety?
- APositive reinforcement from being praised in public, which rewards the anxious behaviour
- BLow levels of dopamine in the frontal lobe
- CRepressed sexual impulses from childhood
- DSelf-focused attention and safety behaviours that prevent disconfirmation of fears
5.PharmacologyMedium
Why is IV promethazine given with great caution?
- AIt can cause severe tissue injury if it leaks or enters an artery
- BIt causes immediate kidney failure
- CIt causes a severe rise in blood pressure when it is given intravenously
- DIt is a strong opioid that causes addiction
6.PharmacologyHard
A patient on disulfiram becomes flushed, nauseated and has palpitations after using a mouthwash. What is the most likely cause?
- AAlcohol in the mouthwash caused a disulfiram–alcohol reaction
- BLow blood glucose from skipping breakfast
- CAn allergy to mint flavouring in the mouthwash
- DDisulfiram toxicity from taking too many tablets by mistake
3Solutions
1.Mental health nursing
Answer: D · Giving away valued possessions and suddenly seeming calm
Why this is the answer
Warning signs include talk of death, giving away possessions, saying goodbye, a sudden improvement in mood after deep depression, and searching for means.
D · Giving away valued possessions and suddenly seeming calm
2.Mental health nursing
Answer: D · A patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
Why this is the answer
Over-sedation with respiratory depression after rapid tranquillisation is a medical emergency. Airway, breathing and vital signs are checked immediately, and help is called.
D · A patient given IM haloperidol and lorazepam 30 minutes ago who is hard to rouse, breathing 8/min
3.Clinical psychology
Answer: D · Antisocial personality disorder
Why this is the answer
Antisocial personality disorder includes deceitfulness, impulsivity, aggression and lack of remorse, with evidence of conduct disorder in childhood.
D · Antisocial personality disorder
4.Clinical psychology
Answer: D · Self-focused attention and safety behaviours that prevent disconfirmation of fears
Why this is the answer
Socially anxious people focus on an internal, negative image of themselves and use safety behaviours. These behaviours make them seem odd and stop them learning that feared outcomes rarely happen.
D · Self-focused attention and safety behaviours that prevent disconfirmation of fears
5.Pharmacology
Answer: A · It can cause severe tissue injury if it leaks or enters an artery
Why this is the answer
Promethazine is a vesicant. Deep intramuscular injection is the preferred parenteral route, and if given IV it is diluted, given slowly into a well-running large vein, and stopped at once if the patient reports burning or pain.
A · It can cause severe tissue injury if it leaks or enters an artery
6.Pharmacology
Answer: A · Alcohol in the mouthwash caused a disulfiram–alcohol reaction
Why this is the answer
Disulfiram reactions can occur with small amounts of alcohol in mouthwash, cough syrups, sauces or aftershave. Patients are taught to check labels and avoid all alcohol-containing products.
A · Alcohol in the mouthwash caused a disulfiram–alcohol reaction