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
How should a patient take sublingual buprenorphine-naloxone tablets?
- AChew the tablet quickly and then swallow it with juice so that it reaches the stomach faster
- BLet the tablet dissolve completely under the tongue without chewing or swallowing it
- CSwallow the tablet whole with a large glass of water
- DCrush the tablet and mix it with a spoonful of soft food such as yoghurt
2.Mental health nursingHard
A patient who has worked well with the nurse for three weeks becomes angry and refuses to attend their sessions after being told that discharge is planned for next week. What is the best interpretation?
- AThe patient has developed a new psychotic illness
- BThe patient is reacting to the coming end of the relationship
- CThe nurse has made an error and should cancel the discharge
- DThe patient no longer needs the sessions and should be discharged at once
3.Clinical psychologyMedium
Patients taking monoamine oxidase inhibitors (MAOIs) must avoid foods rich in tyramine because:
- ATyramine blocks the antidepressant effect of MAOIs completely
- BThe combination causes tardive dyskinesia
- CTyramine causes severe weight loss
- DThe combination can cause a dangerous rise in blood pressure
4.Clinical psychologyHard
A man who hears the word "thud" is admitted to hospital, then behaves normally. Staff record his note-taking as "engages in writing behaviour". In Rosenhan's study, what does this illustrate?
- APseudopatients developed real symptoms in hospital
- BNote-taking is a recognised symptom of schizophrenia, so the staff were right to record it as such
- COnce a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
- DStaff deliberately falsified records
5.PharmacologyMedium
Why should NSAIDs be used with caution in some people with asthma?
- AThey block the anti-inflammatory effect of inhaled corticosteroids
- BThey can trigger bronchospasm in aspirin-sensitive asthma
- CThey increase the clearance of salbutamol
- DThey cause mucus plugs by drying the airways
6.PharmacologyHard
During an alteplase infusion for acute ischaemic stroke, the patient develops a sudden severe headache and her level of consciousness falls. What is the nurse's first action?
- AStop the alteplase infusion and notify the provider urgently
- BGive paracetamol for the headache and continue the infusion
- CGive a bolus of heparin to prevent a new clot
- DSlow the infusion to half the rate and recheck in 30 minutes
3Solutions
1.Mental health nursing
Answer: B · Let the tablet dissolve completely under the tongue without chewing or swallowing it
Why this is the answer
Buprenorphine is poorly absorbed if swallowed, so it is dissolved under the tongue. Naloxone is added to discourage injection, because it is poorly absorbed sublingually but active if injected.
B · Let the tablet dissolve completely under the tongue without chewing or swallowing it
2.Mental health nursing
Answer: B · The patient is reacting to the coming end of the relationship
Why this is the answer
Anger, withdrawal or return of symptoms are common responses to termination. The nurse acknowledges the feelings, reviews progress and helps the patient prepare for the ending.
B · The patient is reacting to the coming end of the relationship
3.Clinical psychology
Answer: D · The combination can cause a dangerous rise in blood pressure
Why this is the answer
MAO normally breaks down dietary tyramine. When it is inhibited, tyramine can trigger a hypertensive crisis, which is why MAOIs require dietary restrictions.
D · The combination can cause a dangerous rise in blood pressure
4.Clinical psychology
Answer: C · Once a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
Why this is the answer
Rosenhan argued that the label "schizophrenic" made staff see ordinary behaviour as pathological. Critics such as Spitzer argued the study did not prove diagnosis was invalid.
C · Once a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
5.Pharmacology
Answer: B · They can trigger bronchospasm in aspirin-sensitive asthma
Why this is the answer
In aspirin-exacerbated respiratory disease, COX inhibition increases leukotriene production, causing bronchospasm. These patients should avoid aspirin and other non-selective NSAIDs.
B · They can trigger bronchospasm in aspirin-sensitive asthma
6.Pharmacology
Answer: A · Stop the alteplase infusion and notify the provider urgently
Why this is the answer
A sudden headache and neurological decline during thrombolysis suggest intracranial haemorrhage. The infusion is stopped at once and the provider is called for urgent assessment and imaging.
A · Stop the alteplase infusion and notify the provider urgently