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
Which risk applies when antipsychotics are used in older people with dementia?
- AA lower risk of falls than with no medicine at all
- BA guaranteed cure of the dementia
- CAn increased risk of stroke and death
- DImproved memory within a few days
2.Mental health nursingHard
A nurse is teaching a patient with anxiety how to do progressive muscle relaxation. Which instruction is correct?
- ATense each muscle group in turn for a few seconds, then let go and notice the difference
- BTense all your muscles at once and keep them tight for 10 minutes
- CDo the exercise only during a panic attack, never at other times
- DHold your breath for as long as possible while lying completely still on the floor
3.Clinical psychologyMedium
Which statement best distinguishes obsessive-compulsive personality disorder (OCPD) from OCD?
- AIn OCPD, intrusive unwanted thoughts trigger rituals that the person recognises as excessive
- BOCPD always involves hand washing
- COCPD is a psychotic disorder
- DIn OCPD, perfectionism and rigidity are usually experienced as acceptable parts of the self
4.Clinical psychologyHard
Concordance rates for schizophrenia are higher in identical than in fraternal twins. What does this suggest?
- AGenes contribute to the risk, but the environment also matters
- BSchizophrenia is caused entirely by genes
- CTwins are more likely than other siblings to be misdiagnosed by clinicians
- DThe environment plays no role
5.PharmacologyMedium
A patient takes low-dose weekly methotrexate for rheumatoid arthritis. Which monitoring is needed?
- ARegular blood count, liver and kidney function tests
- BWeekly INR checks and a monthly ECG to check the heart rhythm
- CDaily blood glucose checks
- DMonthly hearing tests
6.PharmacologyHard
Codeine is converted to morphine by CYP2D6. What happens in a patient who is a CYP2D6 ultra-rapid metaboliser?
- ACodeine is converted to an inactive compound only
- BCodeine gives almost no pain relief because little morphine is formed
- CCodeine is excreted unchanged in the urine
- DMore morphine is formed, increasing the risk of opioid toxicity
3Solutions
1.Mental health nursing
Answer: C · An increased risk of stroke and death
Why this is the answer
Antipsychotics in older people with dementia are linked to increased rates of stroke and death. They are used only when non-drug approaches have failed and distress or risk is severe, at the lowest dose for the shortest time.
C · An increased risk of stroke and death
2.Mental health nursing
Answer: A · Tense each muscle group in turn for a few seconds, then let go and notice the difference
Why this is the answer
Progressive muscle relaxation involves tensing and then relaxing muscle groups in turn. Regular practice when calm makes it easier to use the skill when anxious.
A · Tense each muscle group in turn for a few seconds, then let go and notice the difference
3.Clinical psychology
Answer: D · In OCPD, perfectionism and rigidity are usually experienced as acceptable parts of the self
Why this is the answer
OCPD is a pervasive pattern of perfectionism, orderliness and control that the person sees as appropriate (ego-syntonic). OCD obsessions are unwanted and distressing (ego-dystonic).
D · In OCPD, perfectionism and rigidity are usually experienced as acceptable parts of the self
4.Clinical psychology
Answer: A · Genes contribute to the risk, but the environment also matters
Why this is the answer
Higher MZ than DZ concordance shows a genetic contribution, while concordance well below 100% means environmental factors are also important.
A · Genes contribute to the risk, but the environment also matters
5.Pharmacology
Answer: A · Regular blood count, liver and kidney function tests
Why this is the answer
Methotrexate can cause bone marrow suppression and liver damage, and poor kidney function raises its levels. Blood tests are regular, alcohol is limited and folic acid is usually given on another day.
A · Regular blood count, liver and kidney function tests
6.Pharmacology
Answer: D · More morphine is formed, increasing the risk of opioid toxicity
Why this is the answer
Ultra-rapid metabolisers convert more codeine to morphine, which can cause respiratory depression. Poor metabolisers form little morphine and get poor pain relief. This is a classic example of pharmacogenetics.
D · More morphine is formed, increasing the risk of opioid toxicity