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
The wife of a man with alcohol dependence organises her life around his drinking, hides it from others and neglects her own needs. What does this pattern suggest?
- ACodependency
- BEnabling by the healthcare team
- CDelirium tremens
- DLearned helplessness in the patient
2.Mental health nursingHard
During a session, a patient says he intends to seriously harm a named neighbour. What is the correct general principle?
- AThe threat should be ignored because patients often say things they don't mean
- BThe nurse should personally go and warn the neighbour without telling the team
- CConfidentiality means nothing can be shared
- DThe 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 psychologyMedium
Which feature distinguishes generalised anxiety disorder from panic disorder?
- AFear of a single specific object, such as spiders or heights
- BPersistent, excessive worry about many everyday matters
- CRepetitive rituals
- DSudden attacks of intense fear peaking within minutes
4.Clinical psychologyHard
A student believes "If I'm not perfect, I'm worthless." In Beck's model, this belief is best classed as:
- AA defence mechanism called sublimation, which channels distress into socially valued work
- BA negative symptom of schizophrenia
- CA hallucination that requires antipsychotics
- DA dysfunctional assumption or core belief that makes the person vulnerable
5.PharmacologyMedium
How are most medication doses for children calculated?
- ABy the child's age in years only
- BBy the child's height alone
- CBy body weight in kilograms, or sometimes body surface area
- DBy giving half of the adult dose to all children under 12
6.PharmacologyHard
In myxoedema coma, why is hydrocortisone often given before or with thyroid hormone?
- AHydrocortisone prevents the hypoglycaemia caused by levothyroxine
- BHydrocortisone makes thyroid hormone work faster
- CThyroid hormone is inactive unless hydrocortisone is given
- DThyroid hormone can trigger adrenal crisis if cortisol is also low
3Solutions
1.Mental health nursing
Answer: A · Codependency
Why this is the answer
Codependency describes a family member whose life becomes centred on the other person's addiction, often with caretaking, covering up and neglect of self. Support groups such as Al-Anon can help.
2.Mental health nursing
Answer: D · 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.
D · 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: B · Persistent, excessive worry about many everyday matters
Why this is the answer
GAD involves ongoing, hard-to-control worry about various topics for at least six months. Panic disorder involves recurrent unexpected panic attacks.
B · Persistent, excessive worry about many everyday matters
4.Clinical psychology
Answer: D · A dysfunctional assumption or core belief that makes the person vulnerable
Why this is the answer
Beck distinguished surface negative automatic thoughts from deeper schemas and conditional assumptions. Such beliefs remain dormant until activated by a matching stressor, such as failure.
D · A dysfunctional assumption or core belief that makes the person vulnerable
5.Pharmacology
Answer: C · By body weight in kilograms, or sometimes body surface area
Why this is the answer
Children's doses are usually weight-based, sometimes using body surface area, and must not exceed the adult maximum. Accurate, recent weight in kilograms is essential.
C · By body weight in kilograms, or sometimes body surface area
6.Pharmacology
Answer: D · Thyroid hormone can trigger adrenal crisis if cortisol is also low
Why this is the answer
Restoring thyroid hormone increases metabolic rate and cortisol clearance. If adrenal reserve is also low, this can precipitate adrenal crisis, so steroid cover is given until adrenal insufficiency is excluded.
D · Thyroid hormone can trigger adrenal crisis if cortisol is also low