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 may depression present differently in adolescents than in adults?
- AWith irritability rather than obvious sadness
- BWith increased energy and less need for sleep
- CWith a high fever and a rash
- DAlways with psychotic symptoms
2.Mental health nursingHard
A school nurse is teaching about inhalant use such as sniffing glue or aerosols. Which risk should be stressed?
- ASudden death from a heart arrhythmia, even on the first use
- BInhalants cause only a mild headache and nothing else
- CInhalants are only dangerous if they are mixed with alcohol
- DThere is no physical risk, because the substances are legal
3.Clinical psychologyMedium
Reliability of a diagnosis refers to:
- AWhether the diagnosis uses medical tests
- BWhether different clinicians reach the same diagnosis for the same patient
- CWhether the diagnosis accurately predicts the course and outcome of the illness
- DWhether the diagnosis is accepted by the patient
4.Clinical psychologyHard
Which finding best supports the role of serotonin and other monoamines, rather than circumstance alone, in depression?
- ADepression never runs in families
- BDrugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
- CDepression rates are equal in all countries, regardless of large differences in social and economic circumstances
- DEveryone who experiences a loss becomes depressed
5.PharmacologyMedium
Which rule applies to intravenous potassium chloride?
- AIt is given as a rapid IV push to correct low levels quickly
- BIt may be given intramuscularly if there is no IV access
- CIt is mixed into blood products to save time
- DIt must be diluted and given as an infusion, never as an IV push
6.PharmacologyHard
A patient on adalimumab for rheumatoid arthritis has a fever and cough on the day of her next injection. What should the nurse advise?
- AGive the injection, as it will help the fever
- BStop the drug permanently without telling the prescriber
- CWithhold the injection and get the infection assessed first
- DDouble the next dose to make up for the infection
3Solutions
1.Mental health nursing
Answer: A · With irritability rather than obvious sadness
Why this is the answer
In children and adolescents, depressed mood can appear as irritability. Other signs include falling school performance, withdrawal from friends, and changes in sleep and appetite.
A · With irritability rather than obvious sadness
2.Mental health nursing
Answer: A · Sudden death from a heart arrhythmia, even on the first use
Why this is the answer
Inhalants can sensitise the heart to adrenaline and cause fatal arrhythmias ("sudden sniffing death"), even in first-time users. They can also cause suffocation and brain, liver and kidney damage.
A · Sudden death from a heart arrhythmia, even on the first use
3.Clinical psychology
Answer: B · Whether different clinicians reach the same diagnosis for the same patient
Why this is the answer
Reliability is consistency of diagnosis between clinicians or over time. Validity is whether the diagnosis reflects a real, meaningful category.
B · Whether different clinicians reach the same diagnosis for the same patient
4.Clinical psychology
Answer: B · Drugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
Why this is the answer
Antidepressants targeting monoamines outperform placebo on average, though by modest margins. This supports a biological contribution but does not show that low serotonin alone causes depression.
B · Drugs that act on monoamine systems reduce depressive symptoms more than placebo in randomised trials
5.Pharmacology
Answer: D · It must be diluted and given as an infusion, never as an IV push
Why this is the answer
Concentrated potassium given as a bolus can cause fatal cardiac arrhythmias. It is always diluted and given at a controlled rate, usually with an infusion pump.
D · It must be diluted and given as an infusion, never as an IV push
6.Pharmacology
Answer: C · Withhold the injection and get the infection assessed first
Why this is the answer
TNF inhibitors increase the risk of serious infections and can mask their signs. Doses are usually withheld during an active infection until it has been assessed and treated.
C · Withhold the injection and get the infection assessed first