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 insists that the staff are poisoning his food. What is the best initial approach?
- ATell him firmly that he will not be given any food until he stops making the accusation
- BAcknowledge his fear without arguing about the belief and focus on reality-based topics
- CArgue logically until he admits he is wrong
- DAgree with him so he trusts you
2.Mental health nursingHard
A patient with schizophrenia has marked negative symptoms. He stays in bed most of the day and neglects his hygiene. Which nursing approach is most helpful?
- ATell him firmly that he will lose his ward privileges unless he gets up and showers at once
- BLet him stay in bed, because negative symptoms cannot change
- CAgree a simple daily routine with small, achievable activities and give positive feedback
- DWait until he asks to join activities before involving him
3.Clinical psychologyMedium
Selective serotonin reuptake inhibitors (SSRIs) increase serotonin in the synapse by:
- ASpeeding up the breakdown of serotonin by monoamine oxidase enzymes
- BBlocking dopamine release
- CBlocking the reuptake of serotonin into the presynaptic neuron
- DDestroying serotonin receptors
4.Clinical psychologyHard
Why is the medical model of mental illness criticised by proponents of the psychological approaches?
- AIt rejects the use of medication entirely
- BIt is based only on dream analysis
- CIt may overlook psychological and social causes and reduce people's sense of agency
- DIt denies that the brain and biological factors have any role in behaviour or emotion
5.PharmacologyMedium
What is a loading dose used for?
- ATo slow down the absorption of the drug
- BTo reduce side effects at the start of treatment
- CTo reach the target plasma concentration quickly
- DTo test for allergic reactions
6.PharmacologyHard
A patient with an epidural infusion of local anaesthetic becomes hypotensive. What is the most likely mechanism?
- AThe epidural catheter has caused heavy bleeding
- BThe local anaesthetic causes a severe allergic reaction
- CBlockade of sympathetic nerves causes vasodilation
- DThe drug increases urine output and causes dehydration
3Solutions
1.Mental health nursing
Answer: B · Acknowledge his fear without arguing about the belief and focus on reality-based topics
Why this is the answer
Arguing strengthens delusions and damages trust, and agreeing reinforces them. Respond to the feeling (fear), keep to reality, and offer practical options such as sealed or packaged food.
B · Acknowledge his fear without arguing about the belief and focus on reality-based topics
2.Mental health nursing
Answer: C · Agree a simple daily routine with small, achievable activities and give positive feedback
Why this is the answer
Negative symptoms such as avolition and anhedonia improve with structure, step-by-step goals and encouragement. Punishment or waiting for the patient to start on his own usually makes withdrawal worse.
C · Agree a simple daily routine with small, achievable activities and give positive feedback
3.Clinical psychology
Answer: C · Blocking the reuptake of serotonin into the presynaptic neuron
Why this is the answer
SSRIs block the serotonin transporter, so serotonin stays longer in the synaptic cleft. Clinical effects usually take several weeks.
C · Blocking the reuptake of serotonin into the presynaptic neuron
4.Clinical psychology
Answer: C · It may overlook psychological and social causes and reduce people's sense of agency
Why this is the answer
The medical model treats disorders as illnesses with biological causes, which reduces blame but can neglect life events, meaning and context, and may encourage passive reliance on drugs.
C · It may overlook psychological and social causes and reduce people's sense of agency
5.Pharmacology
Answer: C · To reach the target plasma concentration quickly
Why this is the answer
A loading dose fills the volume of distribution so the effective level is reached immediately, instead of waiting 4–5 half-lives for steady state.
C · To reach the target plasma concentration quickly
6.Pharmacology
Answer: C · Blockade of sympathetic nerves causes vasodilation
Why this is the answer
Epidural local anaesthetics block sympathetic fibres as well as sensory nerves. This dilates blood vessels and lowers blood pressure, so fluids, position changes or vasopressors may be needed.
C · Blockade of sympathetic nerves causes vasodilation