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 man with an intellectual disability is becoming irritable. Staff say it is "just his learning disability". What is this an example of?
- APositive reinforcement
- BSplitting by the patient
- CDiagnostic overshadowing
- DTransference
2.Mental health nursingHard
A patient says the voices are telling him to hurt his roommate. What should the nurse do first?
- ATell him the voices are not real and leave
- BAsk more about what the voices say and whether he feels he must obey, and ensure the safety of others
- CMove the roommate without telling anyone why
- DIgnore it, because command hallucinations are common in schizophrenia and patients rarely act on them
3.Clinical psychologyMedium
Reliability of a diagnosis refers to:
- AWhether different clinicians reach the same diagnosis for the same patient
- BWhether the diagnosis accurately predicts the course and outcome of the illness
- CWhether the diagnosis uses medical tests
- DWhether the diagnosis is accepted by the patient
4.Clinical psychologyHard
The "scientist-practitioner" (Boulder) model in clinical psychology means that clinicians should:
- APrescribe medication as their main treatment, following psychiatric guidelines closely
- BOnly conduct laboratory experiments
- CAvoid research completely
- DUse research evidence to guide practice and evaluate their own interventions
5.PharmacologyMedium
After instilling eye drops, why should the patient press gently on the inner corner of the eye for a minute or two?
- ATo make the pupil dilate faster
- BTo reduce drainage into the nose and absorption into blood
- CTo stop the eye from producing tears for about an hour
- DTo spread the drop evenly over the eyelid
6.PharmacologyHard
A patient on stable warfarin is prescribed a course of metronidazole. What is the likely effect, and what should the nurse expect?
- AThe INR stays the same, as these drugs do not interact
- BThe INR rises, so closer INR monitoring is needed
- CThe INR falls, so the risk of clotting increases
- DMetronidazole replaces warfarin, so warfarin is stopped
3Solutions
1.Mental health nursing
Answer: C · Diagnostic overshadowing
Why this is the answer
Diagnostic overshadowing happens when new symptoms are attributed to a known disability or mental illness, so a physical or other cause is missed. It contributes to poorer health outcomes.
C · Diagnostic overshadowing
2.Mental health nursing
Answer: B · Ask more about what the voices say and whether he feels he must obey, and ensure the safety of others
Why this is the answer
Command hallucinations to harm others need immediate assessment of content, intent and ability to resist them. The nurse keeps everyone safe, informs the team and documents the risk.
B · Ask more about what the voices say and whether he feels he must obey, and ensure the safety of others
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: D · Use research evidence to guide practice and evaluate their own interventions
Why this is the answer
The Boulder model trains clinical psychologists to integrate scientific research and clinical practice, the basis of evidence-based practice.
D · Use research evidence to guide practice and evaluate their own interventions
5.Pharmacology
Answer: B · To reduce drainage into the nose and absorption into blood
Why this is the answer
Nasolacrimal occlusion keeps the drop in the eye longer and reduces systemic absorption through the nasal mucosa. This matters for drugs such as timolol, which can cause bradycardia or bronchospasm.
B · To reduce drainage into the nose and absorption into blood
6.Pharmacology
Answer: B · The INR rises, so closer INR monitoring is needed
Why this is the answer
Metronidazole inhibits the metabolism of warfarin (mainly via CYP2C9), so warfarin levels and the INR rise. The bleeding risk increases, and the INR is checked more often during and after the course.
B · The INR rises, so closer INR monitoring is needed