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 in a manic episode makes repeated sexual comments to a nurse. What is the most appropriate response?
- ALaugh at the comments so he does not feel rejected
- BRespond with similar comments to build rapport
- CAvoid the patient for the rest of the shift
- DCalmly say that the comments are not acceptable and redirect him
2.Mental health nursingHard
A patient who was admitted after a serious suicide attempt says, "I'm angry they saved me. Next time I'll do it properly." What should the nurse do?
- AMaintain close observation, report the statement and reassess the risk with the team
- BReduce observation because he is talking openly about his feelings
- CChange the subject to something more positive, such as his family and his plans for after discharge
- DTell him that he should be grateful to be alive and think about how his family would feel
3.Clinical psychologyMedium
Which of these is a positive symptom of schizophrenia?
- AFlat affect
- BPoverty of speech
- CSocial withdrawal
- DDelusions
4.Clinical psychologyHard
The "scientist-practitioner" (Boulder) model in clinical psychology means that clinicians should:
- AUse research evidence to guide practice and evaluate their own interventions
- BOnly conduct laboratory experiments
- CPrescribe medication as their main treatment, following psychiatric guidelines closely
- DAvoid research completely
5.PharmacologyMedium
A man taking tamsulosin is planning cataract surgery. What should the nurse advise?
- ATake a double dose on the day of surgery
- BThe drug has no link with eye surgery
- CTell the eye surgeon, as it can cause floppy iris syndrome
- DStop the drug for one day and no further action is needed
6.PharmacologyHard
Why may omeprazole be avoided in a patient taking clopidogrel?
- AIt inhibits CYP2C19, so less clopidogrel is converted to its active form
- BIt binds clopidogrel in the stomach and makes it insoluble
- CIt increases clopidogrel absorption from the gut and causes bleeding
- DIt speeds up kidney excretion of clopidogrel
3Solutions
1.Mental health nursing
Answer: D · Calmly say that the comments are not acceptable and redirect him
Why this is the answer
Disinhibition is common in mania. Clear, calm limit setting and redirection protect both staff and patient and maintain boundaries without punishing him.
D · Calmly say that the comments are not acceptable and redirect him
2.Mental health nursing
Answer: A · Maintain close observation, report the statement and reassess the risk with the team
Why this is the answer
Anger at surviving and stated future intent show high, ongoing risk. Close observation continues, the team reassesses the risk, and the nurse explores his feelings without judging him.
A · Maintain close observation, report the statement and reassess the risk with the team
3.Clinical psychology
Answer: D · Delusions
Why this is the answer
Positive symptoms are additions (hallucinations, delusions, disorganised speech). Negative symptoms are losses (flat affect, avolition, alogia).
4.Clinical psychology
Answer: A · Use research evidence to guide practice and evaluate their own interventions
Why this is the answer
The Boulder model trains clinical psychologists to integrate scientific research and clinical practice, the basis of evidence-based practice.
A · Use research evidence to guide practice and evaluate their own interventions
5.Pharmacology
Answer: C · Tell the eye surgeon, as it can cause floppy iris syndrome
Why this is the answer
Tamsulosin can cause intraoperative floppy iris syndrome, which complicates cataract surgery. The surgeon needs to know so that the technique can be adapted.
C · Tell the eye surgeon, as it can cause floppy iris syndrome
6.Pharmacology
Answer: A · 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.
A · It inhibits CYP2C19, so less clopidogrel is converted to its active form