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 just been admitted says, "I don't want to talk to anyone." What is the best initial nursing approach?
- ASpend short, regular periods with the patient without forcing conversation
- BAsk a series of direct questions until he answers
- CTell the patient that talking is required to be discharged
- DLeave the patient alone until he asks to talk
2.Mental health nursingHard
An older woman living with her son looks thin and unkempt. She says her son "looks after the money" and she is often hungry. What should the nurse do?
- ATalk to her privately, document the findings and raise an adult safeguarding concern
- BAsk the son in front of her whether he is stealing her money
- CTell her that she must move out of her son's home at once and stay with friends until the matter is sorted out
- DIgnore it, because family finances are a private matter
3.Clinical psychologyMedium
The therapeutic alliance refers to:
- AA group of therapists who share referrals
- BA legal contract between a clinic and an insurer
- CThe client's diagnosis, as agreed independently by two psychiatrists at the initial assessment
- DThe collaborative bond and agreement on goals and tasks between therapist and client
4.Clinical psychologyHard
Concordance rates for schizophrenia are higher in identical than in fraternal twins. What does this suggest?
- ATwins are more likely than other siblings to be misdiagnosed by clinicians
- BThe environment plays no role
- CSchizophrenia is caused entirely by genes
- DGenes contribute to the risk, but the environment also matters
5.PharmacologyMedium
While giving medicines, a patient says, "That pill looks different from the one I usually take." What should the nurse do?
- AReassure the patient and give the pill anyway
- BExplain that only the staff decide which medicines are given
- CStop and recheck the order and the medicine before giving it
- DGive the pill and check the chart afterwards
6.PharmacologyHard
Codeine is converted to morphine by CYP2D6. What happens in a patient who is a CYP2D6 ultra-rapid metaboliser?
- ACodeine gives almost no pain relief because little morphine is formed
- BCodeine is converted to an inactive compound only
- CMore morphine is formed, increasing the risk of opioid toxicity
- DCodeine is excreted unchanged in the urine
3Solutions
1.Mental health nursing
Answer: A · Spend short, regular periods with the patient without forcing conversation
Why this is the answer
Short, frequent, predictable contacts show acceptance and help build trust. Forcing conversation increases anxiety, while leaving the patient alone can reinforce withdrawal.
A · Spend short, regular periods with the patient without forcing conversation
2.Mental health nursing
Answer: A · Talk to her privately, document the findings and raise an adult safeguarding concern
Why this is the answer
Signs of financial abuse and neglect require a private conversation, careful documentation and reporting through safeguarding procedures. Confrontation could increase the risk to her.
A · Talk to her privately, document the findings and raise an adult safeguarding concern
3.Clinical psychology
Answer: D · The collaborative bond and agreement on goals and tasks between therapist and client
Why this is the answer
The therapeutic alliance consistently predicts therapy outcome across different approaches, which supports the importance of common factors in psychotherapy.
D · The collaborative bond and agreement on goals and tasks between therapist and client
4.Clinical psychology
Answer: D · 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.
D · Genes contribute to the risk, but the environment also matters
5.Pharmacology
Answer: C · Stop and recheck the order and the medicine before giving it
Why this is the answer
A patient's concern can reveal a wrong drug or wrong patient error. The nurse rechecks the order and product, and may call the pharmacy; a different brand or strength may explain the change.
C · Stop and recheck the order and the medicine before giving it
6.Pharmacology
Answer: C · More morphine is formed, increasing the risk of opioid toxicity
Why this is the answer
Ultra-rapid metabolisers convert more codeine to morphine, which can cause respiratory depression. Poor metabolisers form little morphine and get poor pain relief. This is a classic example of pharmacogenetics.
C · More morphine is formed, increasing the risk of opioid toxicity