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
What is the main advantage of a long-acting injectable antipsychotic?
- AIt improves adherence because the patient does not need to take daily tablets
- BIt cures schizophrenia after a fixed course of injections
- CIt works faster than any oral antipsychotic in an acute crisis
- DIt has no side effects, unlike the oral forms of the same antipsychotic drugs
2.Mental health nursingHard
A woman who is being abused by her partner says she will not leave him. What is the most appropriate response?
- ATell her that she must leave him today or the nurse cannot help her
- BRespect her decision, give information about support services and help her make a safety plan
- CCall her partner to discuss his behaviour with him
- DTell her that if she stays and is hurt again, it will be her own fault because she was warned about the risks
3.Clinical psychologyMedium
Behavioural activation treats depression mainly by:
- AExposing the person to feared bodily sensations in a graded way
- BPrescribing a period of complete rest
- CExploring childhood conflicts in detail
- DIncreasing engagement in rewarding and valued activities
4.Clinical psychologyHard
Which brain finding has been repeatedly reported in groups of people with schizophrenia compared with controls?
- AA tumour in the pituitary gland
- BA complete absence of the hippocampus
- CAn enlarged frontal lobe in all patients
- DEnlarged lateral ventricles
5.PharmacologyMedium
A patient has severe kidney impairment. A drug is mainly excreted unchanged in the urine. What is the usual adjustment?
- AGive the drug orally instead of intravenously
- BReduce the dose or lengthen the dosing interval
- CIncrease the dose to make up for poor absorption
- DNo change is needed, because the liver takes over
6.PharmacologyHard
Five days after starting clindamycin, a patient has frequent watery diarrhoea, abdominal cramps and a fever. What should the nurse suspect and do?
- AAn allergy to clindamycin; give an antihistamine and continue the antibiotic
- BFood poisoning; encourage a high-fibre diet and plenty of milk products
- CA normal side effect; give loperamide and continue as usual
- DC. difficile infection; send stool, use contact precautions, avoid antidiarrhoeals
3Solutions
1.Mental health nursing
Answer: A · It improves adherence because the patient does not need to take daily tablets
Why this is the answer
Depot or long-acting injections are given every few weeks, so adherence can be checked and missed doses are noticed. They have the same kinds of side effects as the oral form of the drug.
A · It improves adherence because the patient does not need to take daily tablets
2.Mental health nursing
Answer: B · Respect her decision, give information about support services and help her make a safety plan
Why this is the answer
Adults have the right to make their own decisions. Many survivors leave and return several times. The nurse documents carefully, provides resources and a safety plan, and keeps the door open for future help.
B · Respect her decision, give information about support services and help her make a safety plan
3.Clinical psychology
Answer: D · Increasing engagement in rewarding and valued activities
Why this is the answer
Behavioural activation schedules activities that bring pleasure or mastery, breaking the cycle of withdrawal and low reinforcement. It is an evidence-based treatment for depression.
D · Increasing engagement in rewarding and valued activities
4.Clinical psychology
Answer: D · Enlarged lateral ventricles
Why this is the answer
Enlarged ventricles and reduced grey matter are found on average in schizophrenia. The differences are group averages and are not diagnostic for individuals.
D · Enlarged lateral ventricles
5.Pharmacology
Answer: B · Reduce the dose or lengthen the dosing interval
Why this is the answer
When renal clearance falls, drugs excreted by the kidney accumulate. The dose is lowered or given less often, guided by kidney function and, where possible, drug levels.
B · Reduce the dose or lengthen the dosing interval
6.Pharmacology
Answer: D · C. difficile infection; send stool, use contact precautions, avoid antidiarrhoeals
Why this is the answer
Broad-spectrum antibiotics, especially clindamycin, allow C. difficile to overgrow and release toxins. Stool is tested, contact precautions with soap-and-water handwashing are used, and antidiarrhoeals are avoided because they keep toxin in the gut.
D · C. difficile infection; send stool, use contact precautions, avoid antidiarrhoeals