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
When should blood be taken to measure a patient's lithium level?
- AAbout 12 hours after the last dose
- BAt any time of day, since it makes no difference
- CImmediately after the morning dose
- D1 hour after the last dose
2.Mental health nursingHard
A patient in a manic episode is interrupting other patients and becoming louder in the day room. What is the most appropriate nursing action?
- ATurn up the music to distract the group
- BArgue with the patient about the behaviour in front of everyone until the patient agrees to stop
- CCalmly guide the patient to a quieter area with less stimulation and set clear, simple limits
- DEncourage a competitive group game to use up energy
3.Clinical psychologyMedium
Exposure and response prevention is the main psychological treatment for:
- AADHD
- BBipolar disorder
- CInsomnia
- DOCD
4.Clinical psychologyHard
Concordance rates for schizophrenia are higher in identical than in fraternal twins. What does this suggest?
- AThe environment plays no role
- BGenes contribute to the risk, but the environment also matters
- CSchizophrenia is caused entirely by genes
- DTwins are more likely than other siblings to be misdiagnosed by clinicians
5.PharmacologyMedium
A patient takes low-dose weekly methotrexate for rheumatoid arthritis. Which monitoring is needed?
- ARegular blood count, liver and kidney function tests
- BDaily blood glucose checks
- CWeekly INR checks and a monthly ECG to check the heart rhythm
- DMonthly hearing tests
6.PharmacologyHard
Why may omeprazole be avoided in a patient taking clopidogrel?
- AIt binds clopidogrel in the stomach and makes it insoluble
- BIt speeds up kidney excretion of clopidogrel
- CIt increases clopidogrel absorption from the gut and causes bleeding
- DIt inhibits CYP2C19, so less clopidogrel is converted to its active form
3Solutions
1.Mental health nursing
Answer: A · About 12 hours after the last dose
Why this is the answer
Lithium levels are drawn about 12 hours after the last dose, usually in the morning before the next dose, so results can be compared with the target range.
A · About 12 hours after the last dose
2.Mental health nursing
Answer: C · Calmly guide the patient to a quieter area with less stimulation and set clear, simple limits
Why this is the answer
Patients with mania benefit from a calm, low-stimulus environment, firm and consistent limits and simple, non-competitive activities.
C · Calmly guide the patient to a quieter area with less stimulation and set clear, simple limits
3.Clinical psychology
Answer: D · OCD
Why this is the answer
ERP exposes patients to obsessional triggers while preventing compulsions, so anxiety falls without the ritual.
4.Clinical psychology
Answer: B · Genes contribute to the risk, but the environment also matters
Why this is the answer
Higher MZ than DZ concordance shows a genetic contribution, while concordance well below 100% means environmental factors are also important.
B · Genes contribute to the risk, but the environment also matters
5.Pharmacology
Answer: A · Regular blood count, liver and kidney function tests
Why this is the answer
Methotrexate can cause bone marrow suppression and liver damage, and poor kidney function raises its levels. Blood tests are regular, alcohol is limited and folic acid is usually given on another day.
A · Regular blood count, liver and kidney function tests
6.Pharmacology
Answer: D · 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.
D · It inhibits CYP2C19, so less clopidogrel is converted to its active form