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 asks the nurse for her home phone number so they can keep in touch after discharge. What is the best response?
- A"I'll give you my number, but please only call me at weekends when I'm not working, and keep it short."
- B"I can't give you my number, because our relationship is a professional one. Let's talk about support you can contact after discharge."
- C"That would be against the rules, so please stop asking about it."
- D"Of course, as long as you don't tell the other patients."
2.Mental health nursingHard
A patient on suicide precautions asks for his razor to shave. What is the most appropriate response?
- AGive him the razor, because he has the right to his own belongings
- BLet another patient lend him a razor so that staff do not need to be involved and he can keep his privacy
- CFollow policy, for example by supervising the shave or offering an electric razor
- DRefuse, and tell him he cannot shave at all while in hospital
3.Clinical psychologyMedium
Which of these is a positive symptom of schizophrenia?
- ASocial withdrawal
- BFlat affect
- CDelusions
- DPoverty of speech
4.Clinical psychologyHard
The dopamine hypothesis of schizophrenia is supported by the observation that:
- AAll patients respond equally well to antidepressants
- BAntipsychotics increase dopamine activity in the mesolimbic pathway and reduce symptoms
- CDrugs that increase dopamine, such as amphetamines, can trigger psychotic symptoms
- DSerotonin levels alone predict symptoms
5.PharmacologyMedium
Which factor increases the risk of lithium toxicity?
- AA high-salt diet
- BTaking the dose with food
- CDehydration
- DDrinking extra water
6.PharmacologyHard
A patient taking long-term hydroxychloroquine for lupus is advised to have regular eye examinations. Why?
- AThe drug raises pressure inside the eye
- BThe drug stains the cornea blue
- CThe drug causes cataracts within a few weeks of starting
- DThe drug can cause retinal toxicity that may be permanent
3Solutions
1.Mental health nursing
Answer: B · "I can't give you my number, because our relationship is a professional one. Let's talk about support you can contact after discharge."
Why this is the answer
Personal contact outside the therapeutic relationship crosses a professional boundary. The nurse explains the boundary kindly and redirects to appropriate after-discharge support.
B · "I can't give you my number, because our relationship is a professional one. Let's talk about support you can contact after discharge."
2.Mental health nursing
Answer: C · Follow policy, for example by supervising the shave or offering an electric razor
Why this is the answer
Patients at risk still need hygiene and dignity. Policies usually allow supervised use of sharps or safer alternatives, which balance safety with respect.
C · Follow policy, for example by supervising the shave or offering an electric razor
3.Clinical psychology
Answer: C · Delusions
Why this is the answer
Positive symptoms are additions (hallucinations, delusions, disorganised speech). Negative symptoms are losses (flat affect, avolition, alogia).
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: C · Dehydration
Why this is the answer
When the body is short of water or sodium, the kidney reabsorbs more lithium, so its level rises. Thiazides, ACE inhibitors and NSAIDs can have the same effect.
6.Pharmacology
Answer: D · The drug can cause retinal toxicity that may be permanent
Why this is the answer
Hydroxychloroquine can damage the retina, and the risk rises with dose and duration. Regular screening allows the drug to be stopped before vision is seriously affected.
D · The drug can cause retinal toxicity that may be permanent