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 key difference between factitious disorder and malingering?
- AIn factitious disorder, the symptoms are not produced on purpose at all
- BThere is no real difference between them, and both terms mean exactly the same thing
- CIn factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward
- DMalingering is a severe mental disorder, while factitious disorder is not classed as a mental disorder at all
2.Mental health nursingHard
A patient in alcohol withdrawal had a CIWA-Ar score of 8 four hours ago. It is now 22, and he is sweating heavily and very anxious. What should the nurse do?
- AReduce monitoring, because a higher score on this scale means that his withdrawal is improving
- BEncourage him to drink a large glass of wine to settle the symptoms
- CGive the prescribed symptom-triggered benzodiazepine, increase monitoring and inform the prescriber
- DWait for the next routine score in four hours before deciding
3.Clinical psychologyMedium
A person avoids buses, shops, open car parks and queues because escape might be difficult if they panic. Which diagnosis fits best?
- AAgoraphobia
- BSocial anxiety disorder
- CClaustrophobia as a specific phobia
- DGeneralised anxiety disorder
4.Clinical psychologyHard
The dopamine hypothesis of schizophrenia is supported by the observation that:
- AAntipsychotics increase dopamine activity in the mesolimbic pathway and reduce symptoms
- BAll patients respond equally well to antidepressants
- CDrugs that increase dopamine, such as amphetamines, can trigger psychotic symptoms
- DSerotonin levels alone predict symptoms
5.PharmacologyMedium
A nurse has a needlestick injury from a patient with HIV. When should post-exposure prophylaxis start?
- AAs soon as possible, and within 72 hours at the latest
- BAfter one week, when the risk of infection is clearer
- COnly if the patient's viral load is above a set level
- DOnly after the nurse's HIV test turns positive
6.PharmacologyHard
Why is clavulanic acid combined with amoxicillin (co-amoxiclav)?
- AIt reduces the risk of penicillin allergy
- BIt makes amoxicillin cross the blood–brain barrier more easily
- CIt inhibits beta-lactamase enzymes that would destroy amoxicillin
- DIt slows the kidney excretion of amoxicillin
3Solutions
1.Mental health nursing
Answer: C · In factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward
Why this is the answer
In both, symptoms are produced or exaggerated on purpose. In factitious disorder the motivation is internal, the sick role; in malingering it is external, such as money, drugs or avoiding duties.
C · In factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward
2.Mental health nursing
Answer: C · Give the prescribed symptom-triggered benzodiazepine, increase monitoring and inform the prescriber
Why this is the answer
A rising CIWA-Ar score shows worsening withdrawal. Symptom-triggered benzodiazepine treatment, closer observation and medical review help prevent seizures and delirium tremens.
C · Give the prescribed symptom-triggered benzodiazepine, increase monitoring and inform the prescriber
3.Clinical psychology
Answer: A · Agoraphobia
Why this is the answer
Agoraphobia involves fear of at least two situations (public transport, open spaces, enclosed spaces, crowds or queues, being outside alone) because escape or help might be unavailable.
4.Clinical psychology
Answer: C · Drugs that increase dopamine, such as amphetamines, can trigger psychotic symptoms
Why this is the answer
Amphetamines can induce psychosis and D2-blocking antipsychotics reduce positive symptoms. Negative symptoms are less well explained, so the hypothesis has been revised.
C · Drugs that increase dopamine, such as amphetamines, can trigger psychotic symptoms
5.Pharmacology
Answer: A · As soon as possible, and within 72 hours at the latest
Why this is the answer
Post-exposure prophylaxis aims to stop infection becoming established. It works best when started within hours, is not started after 72 hours, and is usually taken for 28 days.
A · As soon as possible, and within 72 hours at the latest
6.Pharmacology
Answer: C · It inhibits beta-lactamase enzymes that would destroy amoxicillin
Why this is the answer
Many bacteria produce beta-lactamases that inactivate penicillins. Clavulanic acid inhibits these enzymes, so amoxicillin can work against these organisms.
C · It inhibits beta-lactamase enzymes that would destroy amoxicillin