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 should a patient on clozapine be taught to report immediately?
- AFever, sore throat or other signs of infection
- BIncreased saliva at night
- CMild drowsiness after the evening dose
- DA wish to eat more
2.Mental health nursingHard
During a session, a patient says he intends to seriously harm a named neighbour. What is the correct general principle?
- AConfidentiality means nothing can be shared
- BThe risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy
- CThe threat should be ignored because patients often say things they don't mean
- DThe nurse should personally go and warn the neighbour without telling the team
3.Clinical psychologyMedium
According to the duty established in the Tarasoff case in California, a therapist may need to:
- ARefuse to treat clients with a history of violence
- BReport every client who expresses anger
- CTake steps to protect an identifiable person whom a client seriously threatens
- DKeep all information confidential under every circumstance, whatever the risk to others
4.Clinical psychologyHard
A researcher finds that adoptees whose biological mothers had schizophrenia develop it more often than adoptees whose biological mothers did not, despite being raised by unaffected families. What does this design help to separate?
- APositive symptoms from negative symptoms
- BGenetic influences from the effects of the rearing environment
- CDiagnosis by DSM from diagnosis by ICD
- DThe effects of antipsychotic medication from the effects of psychological therapy
5.PharmacologyMedium
Why should long-term oral corticosteroids not be stopped suddenly?
- AStopping causes a sudden rise in blood glucose
- BThe immune system would immediately attack the liver and adrenal glands
- CThe adrenal glands are suppressed and may not make enough cortisol
- DThe drug forms toxic metabolites when stopped
6.PharmacologyHard
Why is strict aseptic technique and a limited hang time needed for propofol infusions?
- APropofol breaks down into a toxic gas after a few hours
- BIts lipid emulsion lets bacteria grow if it is contaminated
- CPropofol becomes more potent the longer it hangs
- DLight exposure changes propofol into an opioid
3Solutions
1.Mental health nursing
Answer: A · Fever, sore throat or other signs of infection
Why this is the answer
Fever, sore throat or flu-like symptoms may be the first signs of agranulocytosis and need an urgent blood count. Sedation and hypersalivation are common side effects.
A · Fever, sore throat or other signs of infection
2.Mental health nursing
Answer: B · The risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy
Why this is the answer
A serious threat against an identifiable person overrides confidentiality. The nurse informs the team, documents the threat and follows the legal and policy procedures for protecting the person.
B · The risk to an identifiable person must be shared with the team and may need to be disclosed to protect that person, following the law and policy
3.Clinical psychology
Answer: C · Take steps to protect an identifiable person whom a client seriously threatens
Why this is the answer
The Tarasoff rulings held that when a client poses a serious danger of violence to an identifiable victim, the therapist has a duty to take reasonable steps to protect that person.
C · Take steps to protect an identifiable person whom a client seriously threatens
4.Clinical psychology
Answer: B · Genetic influences from the effects of the rearing environment
Why this is the answer
Adoption studies, such as Heston's and the Danish studies, separate genetic risk from family environment because the child is raised away from the biological parent.
B · Genetic influences from the effects of the rearing environment
5.Pharmacology
Answer: C · The adrenal glands are suppressed and may not make enough cortisol
Why this is the answer
Steroid therapy suppresses the hypothalamic–pituitary–adrenal axis. Sudden withdrawal can cause an adrenal crisis, so doses are reduced gradually.
C · The adrenal glands are suppressed and may not make enough cortisol
6.Pharmacology
Answer: B · Its lipid emulsion lets bacteria grow if it is contaminated
Why this is the answer
Propofol is formulated in a soybean oil emulsion, which is a good growth medium for bacteria. Contaminated propofol has caused sepsis, so it is handled aseptically and tubing and containers are changed at set intervals.
B · Its lipid emulsion lets bacteria grow if it is contaminated