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 taking phenelzine, an MAOI, is being taught before discharge. Which statement shows a need for further teaching?
- A"I'll tell any new doctor or dentist that I take an MAOI."
- B"A sudden severe headache is a reason to get help straight away."
- C"I'll avoid aged cheese and cured meats."
- D"I can take any cold and flu remedy from the pharmacy."
2.Mental health nursingHard
A nurse notices that a colleague smells of alcohol, has slurred speech and is about to give medicines. What should the nurse do?
- AGive the colleague some strong coffee and let her continue with the medicine round if she says she feels fine
- BSay nothing, because it is not her responsibility
- CWait until the end of the shift, then talk privately with the colleague
- DReport the concern immediately to the nurse in charge, following policy, to protect patients
3.Clinical psychologyMedium
Reliability of a diagnosis refers to:
- AWhether the diagnosis accurately predicts the course and outcome of the illness
- BWhether different clinicians reach the same diagnosis for the same patient
- CWhether the diagnosis is accepted by the patient
- DWhether the diagnosis uses medical tests
4.Clinical psychologyHard
Ayllon and Azrin introduced a token economy on a psychiatric ward. What was the main finding and limitation?
- ATokens had no effect on behaviour
- BPatients' hallucinations disappeared permanently, and the gains lasted after discharge
- CThe method cured schizophrenia within weeks
- DTarget behaviours increased, but gains often did not generalise outside the ward
5.PharmacologyMedium
A patient given haloperidol develops a sudden painful twisting of the neck and the eyes roll upward. Which drug is usually given?
- ADantrolene by mouth to relax the twisted neck muscles
- BA second dose of haloperidol
- CNaloxone
- DAn anticholinergic such as benzatropine (benztropine)
6.PharmacologyHard
Lithium taken in the first trimester of pregnancy has been linked to which type of birth defect?
- ANeural tube defects such as spina bifida
- BLimb defects similar to thalidomide
- CHeart malformations, such as Ebstein's anomaly
- DCleft lip and palate only
3Solutions
1.Mental health nursing
Answer: D · "I can take any cold and flu remedy from the pharmacy."
Why this is the answer
Decongestants such as pseudoephedrine are sympathomimetics and can cause a hypertensive crisis with MAOIs. Patients should check any new medicine, including over-the-counter remedies, with a pharmacist or prescriber.
D · "I can take any cold and flu remedy from the pharmacy."
2.Mental health nursing
Answer: D · Report the concern immediately to the nurse in charge, following policy, to protect patients
Why this is the answer
An impaired nurse is a risk to patients. The concern is reported at once through the proper channel so the colleague can be removed from patient care and offered support through the organisation's procedures.
D · Report the concern immediately to the nurse in charge, following policy, to protect patients
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: D · Target behaviours increased, but gains often did not generalise outside the ward
Why this is the answer
Token economies increased self-care and work behaviours in long-stay patients, but changes tended to fade without reinforcement, and the approach raised ethical concerns about control.
D · Target behaviours increased, but gains often did not generalise outside the ward
5.Pharmacology
Answer: D · An anticholinergic such as benzatropine (benztropine)
Why this is the answer
Acute dystonia is caused by dopamine blockade, which leaves acetylcholine activity relatively high. An IM or IV anticholinergic usually relieves it within minutes.
D · An anticholinergic such as benzatropine (benztropine)
6.Pharmacology
Answer: C · Heart malformations, such as Ebstein's anomaly
Why this is the answer
First-trimester lithium is associated with a small increased risk of cardiac malformations, classically Ebstein's anomaly. Women of childbearing age need counselling and specialist planning before pregnancy.
C · Heart malformations, such as Ebstein's anomaly