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 difference between disulfiram and naltrexone in alcohol dependence?
- ABoth work in exactly the same way, so they are fully interchangeable
- BDisulfiram reduces craving; naltrexone causes vomiting when alcohol is drunk
- CDisulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward
- DNaltrexone is used only for alcohol withdrawal; disulfiram is used only for treating an alcohol overdose
2.Mental health nursingHard
An 82-year-old started amitriptyline last week. Which finding is most concerning?
- ANew confusion and difficulty passing urine
- BA slightly dry mouth
- CFeeling a little drowsy in the evening
- DMild constipation that responds to extra fluids and fibre in the diet
3.Clinical psychologyMedium
Which is a main criticism of defining abnormality as deviation from social norms?
- AIt requires expensive brain scans
- BIt ignores how rare or statistically unusual a behaviour is
- CIt only applies to children
- DNorms vary across cultures and change over time
4.Clinical psychologyHard
Learned helplessness (Seligman) was proposed as a model for:
- ADepression
- BSpecific phobias
- CAutism spectrum disorder
- DSchizophrenia
5.PharmacologyMedium
Why is propranolol usually avoided in patients with asthma?
- AIt causes tolerance to inhaled corticosteroids
- BIt blocks beta-2 receptors in the airways and can cause bronchospasm
- CIt stimulates alpha-1 receptors in the airways and raises blood pressure
- DIt increases mucus production by blocking histamine
6.PharmacologyHard
A patient on weekly methotrexate is prescribed trimethoprim for a urinary infection. What is the main risk?
- ASevere hypertension from the combination
- BLoss of antibiotic effect because methotrexate binds trimethoprim
- CBone marrow suppression, because both drugs inhibit folate metabolism
- DHypoglycaemia from reduced liver glucose output
3Solutions
1.Mental health nursing
Answer: C · Disulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward
Why this is the answer
Disulfiram blocks the breakdown of acetaldehyde, so drinking causes flushing, nausea and palpitations. Naltrexone blocks opioid receptors and reduces the pleasurable effect of alcohol.
C · Disulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward
2.Mental health nursing
Answer: A · New confusion and difficulty passing urine
Why this is the answer
Tricyclic antidepressants have strong anticholinergic effects. In older adults these can cause urinary retention, delirium and falls, which need prompt review.
A · New confusion and difficulty passing urine
3.Clinical psychology
Answer: D · Norms vary across cultures and change over time
Why this is the answer
Social norms are culture- and era-specific, so this definition can label harmless non-conformity as disorder and has been used to justify social control.
D · Norms vary across cultures and change over time
4.Clinical psychology
Answer: A · Depression
Why this is the answer
After uncontrollable aversive events, animals and people may stop trying even when escape becomes possible, resembling the passivity and hopelessness of depression.
5.Pharmacology
Answer: B · It blocks beta-2 receptors in the airways and can cause bronchospasm
Why this is the answer
Non-selective beta blockers block both beta-1 and beta-2 receptors. Blocking beta-2 receptors in the bronchi removes their relaxing effect and can trigger severe bronchospasm.
B · It blocks beta-2 receptors in the airways and can cause bronchospasm
6.Pharmacology
Answer: C · Bone marrow suppression, because both drugs inhibit folate metabolism
Why this is the answer
Trimethoprim and methotrexate both inhibit dihydrofolate reductase, and trimethoprim also reduces methotrexate excretion. The combination can cause severe pancytopenia, so another antibiotic is chosen.
C · Bone marrow suppression, because both drugs inhibit folate metabolism