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 with borderline personality disorder praises one nurse as "the only one who understands me" and calls the others useless. What is the best team response?
- ALet the favoured nurse make all decisions for this patient
- BAgree on consistent rules and responses across the whole team
- CAvoid the patient
- DTell the patient that the other nurses are also useless
2.Mental health nursingHard
A patient in a manic episode is interrupting other patients and becoming louder in the day room. What is the most appropriate nursing action?
- AEncourage a competitive group game to use up energy
- BCalmly guide the patient to a quieter area with less stimulation and set clear, simple limits
- CTurn up the music to distract the group
- DArgue with the patient about the behaviour in front of everyone until the patient agrees to stop
3.Clinical psychologyMedium
Reliability of a diagnosis refers to:
- AWhether different clinicians reach the same diagnosis for the same patient
- BWhether the diagnosis is accepted by the patient
- CWhether the diagnosis accurately predicts the course and outcome of the illness
- DWhether the diagnosis uses medical tests
4.Clinical psychologyHard
A man who hears the word "thud" is admitted to hospital, then behaves normally. Staff record his note-taking as "engages in writing behaviour". In Rosenhan's study, what does this illustrate?
- ANote-taking is a recognised symptom of schizophrenia, so the staff were right to record it as such
- BStaff deliberately falsified records
- COnce a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
- DPseudopatients developed real symptoms in hospital
5.PharmacologyMedium
Why is aspirin avoided in children and teenagers with viral illnesses such as flu or chickenpox?
- AIt is linked to Reye's syndrome, which harms the liver and brain
- BIt stops the vaccine from working
- CIt causes grey baby syndrome
- DIt causes severe, permanent hearing loss in young children
6.PharmacologyHard
Why is pyridoxine (vitamin B6) often given together with isoniazid for tuberculosis?
- ATo reduce bacterial resistance
- BTo prevent liver damage from isoniazid
- CTo increase the absorption of isoniazid
- DTo prevent peripheral neuropathy
3Solutions
1.Mental health nursing
Answer: B · Agree on consistent rules and responses across the whole team
Why this is the answer
Splitting divides staff into "all good" and "all bad". A consistent team approach, clear boundaries and good communication between staff prevent manipulation of the team and help the patient.
B · Agree on consistent rules and responses across the whole team
2.Mental health nursing
Answer: B · Calmly guide the patient to a quieter area with less stimulation and set clear, simple limits
Why this is the answer
Patients with mania benefit from a calm, low-stimulus environment, firm and consistent limits and simple, non-competitive activities.
B · Calmly guide the patient to a quieter area with less stimulation and set clear, simple limits
3.Clinical psychology
Answer: A · Whether different clinicians reach the same diagnosis for the same patient
Why this is the answer
Reliability is consistency of diagnosis between clinicians or over time. Validity is whether the diagnosis reflects a real, meaningful category.
A · Whether different clinicians reach the same diagnosis for the same patient
4.Clinical psychology
Answer: C · Once a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
Why this is the answer
Rosenhan argued that the label "schizophrenic" made staff see ordinary behaviour as pathological. Critics such as Spitzer argued the study did not prove diagnosis was invalid.
C · Once a label is applied, normal behaviour tends to be interpreted as a sign of the disorder
5.Pharmacology
Answer: A · It is linked to Reye's syndrome, which harms the liver and brain
Why this is the answer
Aspirin given during viral infections in young people is associated with Reye's syndrome, causing acute encephalopathy and liver failure. Paracetamol or ibuprofen is used for fever instead.
A · It is linked to Reye's syndrome, which harms the liver and brain
6.Pharmacology
Answer: D · To prevent peripheral neuropathy
Why this is the answer
Isoniazid causes pyridoxine deficiency, which can lead to peripheral neuropathy. The risk is greater in slow acetylators, malnourished patients and people with diabetes or alcohol dependence.
D · To prevent peripheral neuropathy