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
How should a nurse screen a patient for intimate partner violence?
- AAsk the partner instead of the patient
- BAsk in front of the partner to see how he reacts
- CAsk in private, without the partner or family present
- DOnly ask patients who have visible injuries
2.Mental health nursingHard
A patient with borderline personality disorder says, "If you don't make Anna my nurse again tomorrow, I'll cut myself." What is the most appropriate response?
- AIgnore the threat, because she is only trying to manipulate staff
- BAgree to assign Anna to her every day so that she stays safe
- CTell her that if she cuts herself again, she will be discharged from the ward at once without any follow-up
- DTake the statement seriously, assess her risk and explain that nursing assignments are decided by the team
3.Clinical psychologyMedium
Clozapine is typically reserved for treatment-resistant schizophrenia because:
- AIt cannot be taken as tablets
- BIt only works on negative symptoms
- CIt can cause agranulocytosis, so regular blood monitoring is required
- DIt is the least effective antipsychotic available, so it is a last resort
4.Clinical psychologyHard
A study compares a new therapy with a waiting-list control and finds a large benefit. Why might this overestimate the therapy's specific effect?
- AWaiting-list participants cannot be randomised
- BWaiting lists remove the placebo effect completely, so any benefit must come from the therapy itself
- CA waiting list controls for time passing but not for attention, expectation or the alliance
- DWaiting-list controls always receive the same therapy
5.PharmacologyMedium
Which rule applies to intravenous potassium chloride?
- AIt is given as a rapid IV push to correct low levels quickly
- BIt must be diluted and given as an infusion, never as an IV push
- CIt may be given intramuscularly if there is no IV access
- DIt is mixed into blood products to save time
6.PharmacologyHard
Why are tetracyclines usually avoided in pregnancy and in young children (under 8 years in US guidance, under 12 years in the UK)?
- AThey cause severe hearing loss in children
- BThey bind to growing teeth and bone and stain the teeth permanently
- CThey block the action of growth hormone and stunt the child's growth
- DThey cause grey baby syndrome in infants
3Solutions
1.Mental health nursing
Answer: C · Ask in private, without the partner or family present
Why this is the answer
Screening should be done privately, using direct, non-judgemental questions. Abuse occurs in all groups, so routine screening is better than asking only those with obvious injuries.
C · Ask in private, without the partner or family present
2.Mental health nursing
Answer: D · Take the statement seriously, assess her risk and explain that nursing assignments are decided by the team
Why this is the answer
Every threat of self-harm needs assessment, but giving in to it reinforces the behaviour and supports splitting. The nurse addresses safety and feelings while keeping consistent team boundaries.
D · Take the statement seriously, assess her risk and explain that nursing assignments are decided by the team
3.Clinical psychology
Answer: C · It can cause agranulocytosis, so regular blood monitoring is required
Why this is the answer
Clozapine is effective when other antipsychotics fail, but it can cause a dangerous fall in neutrophils, so patients need regular blood tests.
C · It can cause agranulocytosis, so regular blood monitoring is required
4.Clinical psychology
Answer: C · A waiting list controls for time passing but not for attention, expectation or the alliance
Why this is the answer
Waiting-list designs show that therapy beats no treatment, but common factors such as hope and therapist contact are not controlled. An active comparison or attention-placebo control is needed to test specific ingredients.
C · A waiting list controls for time passing but not for attention, expectation or the alliance
5.Pharmacology
Answer: B · It must be diluted and given as an infusion, never as an IV push
Why this is the answer
Concentrated potassium given as a bolus can cause fatal cardiac arrhythmias. It is always diluted and given at a controlled rate, usually with an infusion pump.
B · It must be diluted and given as an infusion, never as an IV push
6.Pharmacology
Answer: B · They bind to growing teeth and bone and stain the teeth permanently
Why this is the answer
Tetracyclines chelate calcium and are deposited in growing teeth and bones. This can cause permanent yellow-brown staining of the teeth and may affect bone growth. Short courses of doxycycline are sometimes still used in younger children for specific serious infections.
B · They bind to growing teeth and bone and stain the teeth permanently