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 goal for a patient with depression is written in a SMART way?
- A"The patient will be happier."
- B"The patient will feel better soon."
- C"The patient will improve her mood and sleep and start exercising more at some point."
- D"The patient will walk with staff for 15 minutes once a day by Friday."
2.Mental health nursingHard
Verbal de-escalation has failed, and a patient picks up a chair and threatens to throw it at the nurse. What should the nurse do first?
- AShout loudly at the patient to put the chair down at once, so that he knows the nurse is in charge
- BTurn her back and walk away slowly without saying anything
- CKeep a safe distance, call for help and avoid trying to take the chair alone
- DGrab the chair from the patient quickly before he can use it
3.Clinical psychologyMedium
In the two-factor model of phobias (Mowrer), how is a phobia maintained?
- AAvoidance reduces anxiety, which negatively reinforces the avoidance
- BThe fear is learned by watching others only
- CPunishment of approach behaviour by others, which strengthens the fear itself
- DPositive reinforcement of fear by rewards
4.Clinical psychologyHard
Expressed emotion research shows that relapse in schizophrenia is more likely when families show:
- ALow levels of contact
- BFrequent discussion of the weather
- CHigh criticism, hostility and emotional over-involvement
- DWarm, calm support
5.PharmacologyMedium
How does metformin mainly lower blood glucose?
- AIt stimulates insulin release from the pancreas
- BIt blocks glucose absorption in the kidney
- CIt replaces missing insulin
- DIt reduces glucose production by the liver
6.PharmacologyHard
A patient on digoxin and furosemide develops nausea, visual disturbances and an irregular pulse. Which electrolyte disturbance most likely made digoxin toxicity more likely?
- AHyperkalaemia
- BHypocalcaemia
- CHypernatraemia
- DHypokalaemia
3Solutions
1.Mental health nursing
Answer: D · "The patient will walk with staff for 15 minutes once a day by Friday."
Why this is the answer
A SMART goal states exactly what the patient will do, how much and by when, so that progress can be evaluated. Vague goals cannot be measured.
D · "The patient will walk with staff for 15 minutes once a day by Friday."
2.Mental health nursing
Answer: C · Keep a safe distance, call for help and avoid trying to take the chair alone
Why this is the answer
When a patient is imminently violent, the nurse protects herself and others, keeps an exit route and summons a trained team. Acting alone risks injury to everyone involved.
C · Keep a safe distance, call for help and avoid trying to take the chair alone
3.Clinical psychology
Answer: A · Avoidance reduces anxiety, which negatively reinforces the avoidance
Why this is the answer
Fear is acquired through classical conditioning and maintained because avoiding the feared object reduces anxiety, negatively reinforcing avoidance.
A · Avoidance reduces anxiety, which negatively reinforces the avoidance
4.Clinical psychology
Answer: C · High criticism, hostility and emotional over-involvement
Why this is the answer
High expressed emotion predicts higher relapse rates; family interventions that reduce it lower relapse.
C · High criticism, hostility and emotional over-involvement
5.Pharmacology
Answer: D · It reduces glucose production by the liver
Why this is the answer
Metformin mainly reduces hepatic gluconeogenesis and improves insulin sensitivity. Because it does not stimulate insulin release, hypoglycaemia is rare when used alone.
D · It reduces glucose production by the liver
6.Pharmacology
Answer: D · Hypokalaemia
Why this is the answer
Digoxin binds the Na⁺/K⁺-ATPase at the same site as potassium. Low potassium, often caused by loop or thiazide diuretics, increases digoxin binding and toxicity.