MENTAL HEALTH NURSING II AND PHARMACOLOGY III

(b) Heredity and increased levels of nor-epinephrine: While heredity (genetics) is a factor, increased levels of norepinephrine are more commonly associated with anxiety, stress responses, and mania, rather than being a primary predisposing factor for suicide directly. Some studies suggest dysregulation of the noradrenegic system in depression, but the link to suicide is less direct and consistent than that of serotonin.
(c) Structural alterations of the brain: While certain mental illnesses associated with suicide risk (like depression or schizophrenia) can involve structural brain alterations, this option is too general. Specific alterations in areas like the prefrontal cortex or hippocampus have been noted in some studies of suicidal individuals, often related to mood disorders, but "structural alterations" alone isn't as precise as the serotonin link.
(d) Temporal lobe atrophy: Temporal lobe atrophy is more characteristic of conditions like Alzheimer's disease or certain types of dementia or epilepsy. While individuals with these conditions might experience depression or hopelessness that increases suicide risk, temporal lobe atrophy itself is not a primary or direct biological factor predisposing to suicide across the broader population at risk.

(b) Establishing a therapeutic relationship: This is a fundamental and immediate priority. A trusting relationship is essential for effective assessment, communication of distress by the patient, and their willingness to engage in safety planning and treatment.
(c) Implementing safety measures immediately: This is the absolute top priority. Actions include ensuring a safe environment (removing potential ligatures, sharp objects, medications), one-to-one observation if indicated, and constant reassessment of risk.
(d) Providing education and support: This is a crucial ongoing priority. Education may involve understanding their feelings, coping mechanisms, available resources, and safety plans. Support involves empathy, validation, and fostering hope.

(a) Spend 2 hours session sharing environmental observations: While interacting with the nurse is positive, a 2-hour session focused on environmental observations might not be the most therapeutic or realistic initial outcome. It's also very specific and lengthy. The focus should be on building rapport and addressing core symptoms or needs.
(b) Listen attentively and communicate clearly in 48 hours: While improved communication is a desirable long-term goal, expecting a patient with schizophrenia (who may have thought disorder, alogia, or negative symptoms affecting communication) to achieve this within 48 hours is unrealistic, especially during an acute phase.
(c) Maintain reality based thoughts in 24 hours: Schizophrenia is characterized by disturbances in thought processes, including delusions and hallucinations. Expecting a patient to maintain "reality-based thoughts" completely within 24 hours of admission is highly unrealistic. Reduction in psychotic symptoms and improved reality testing is a longer-term goal achieved through medication and therapy.

(a) Gradual onset: A gradual, insidious onset of schizophrenia is generally associated with a poorer prognosis compared to an acute or sudden onset. Gradual onset often means a longer period of untreated psychosis and more prominent negative symptoms, which are harder to treat.
(c) Early onset: Early onset of schizophrenia (e.g., in childhood or early adolescence) is typically associated with a poorer prognosis, including more severe symptoms, greater cognitive impairment, and a more chronic course. Later onset (e.g., late 20s or 30s) often has a better prognosis.
(d) Absence of passivity phenomenon: Passivity phenomena (e.g., thought insertion, withdrawal, broadcast; delusions of control) are specific types of psychotic symptoms. While the presence of severe positive symptoms can indicate an acute phase, their specific absence isn't as strong a prognostic indicator as factors like good premorbid functioning, acute onset, good social support, or predominantly positive (as opposed to negative) symptoms.

(a) Practice mindful eating: Practicing mindful eating (paying attention to hunger and fullness cues, savoring food, eating without distractions) is a strategy that helps to prevent or manage binge eating, not support it. It encourages a healthier relationship with food.
(b) Identify triggers to this habit: Helping children identify triggers for binge eating (e.g., stress, boredom, certain emotions, specific situations) is a constructive step in addressing and managing the behavior. This awareness is part of therapeutic interventions.
(c) Become active in exercises as a family: Engaging in regular physical activity as a family promotes overall health, can improve mood, and can be a positive coping mechanism. It is generally seen as beneficial and does not support binge eating; in fact, it can be part of a healthy lifestyle that counteracts disordered eating.

(b) Alcohol in pregnancy: Maternal alcohol consumption during pregnancy can lead to Fetal Alcohol Spectrum Disorders (FASD), which can include neurological problems and an increased risk of seizures. However, it is not considered the most common cause of childhood epilepsy overall compared to genetic factors.
(c) Birth injuries: Birth injuries, such as hypoxic-ischemic encephalopathy (brain damage due to lack of oxygen or blood flow during birth), can lead to epilepsy. These are significant causes, but genetic predispositions account for a larger proportion of cases when all childhood epilepsies are considered.
(d) Infections: CNS infections, such as meningitis or encephalitis, can cause seizures and lead to epilepsy as a long-term sequela due to brain scarring. Infections are a major cause of epilepsy worldwide, especially in resource-limited settings, but again, "genetics" as a broad category encompassing many syndromes is often cited as most common overall.

(a) Tactfully escape: While ensuring one's own safety is crucial, and removing oneself from immediate danger if alone and overwhelmed is important, simply escaping without summoning assistance does not address the patient's behavior or the safety of others who may be present or unaware. "Calling for help" is a more comprehensive initial action.
(c) Restrain the patient: Attempting to restrain a violent patient single-handedly is dangerous and generally contraindicated. Physical restraint should only be implemented by a trained team with sufficient numbers to ensure safety for both the patient and staff, and only as a last resort when de-escalation has failed.
(d) Seclude the patient: Seclusion, like restraint, is a restrictive intervention used as a last resort when less restrictive measures are ineffective and the patient poses an ongoing danger to self or others. It requires a team approach and is not the initial action a nurse takes immediately upon encountering aggression.

(b) Intensifying health education talks: Health education is important for raising awareness, but on its own, it often has limited impact on changing widespread substance abuse behaviors without being part of a broader strategy that includes policy and environmental changes.
(c) Hiking alcohol prices: Increasing alcohol prices through taxation is recognized as one of the most effective individual measures (a "best buy" intervention according to WHO). However, this is usually implemented as part of a broader policy framework, not as a standalone approach.
(d) Regulating drinking hours: Restricting the hours during which alcohol can be sold is another specific policy measure that can help reduce alcohol-related harm. Again, this is a component that would fall under a comprehensive policy approach.

(a) Temporary detention order: While this also involves detention, an "Urgency Order" is typically the specific legal instrument for immediate, emergency removal. A temporary detention order might be part of the process following an urgency order, allowing for a short period of assessment.
(b) Order of commitment on detention: This sounds more like a formal, longer-term commitment order made by a court or tribunal after a period of assessment. It's not typically the order for quick initial removal from the community in an emergency.
(d) Warrant order: A warrant is a general legal document authorizing police to make an arrest or search. While a warrant might be used in some circumstances, an "Urgency Order" under mental health law is more specific for the immediate needs of a mentally ill person posing a danger.

(a) Single person: This is too vague. Auditory hallucinations can involve one voice or multiple voices. If it refers to hearing a familiar single person, that's possible in many conditions. The content and nature of the hallucination (like third-person commentary) are more characteristic than just the number of perceived speakers.
(b) Gustatory: These are hallucinations of taste. While they can occur in schizophrenia, they are less common than auditory hallucinations and can also be seen in medical or neurological disorders, not as specifically characteristic as certain types of auditory hallucinations.
(d) Tactile: These are hallucinations of touch (e.g., feeling insects crawling). Tactile hallucinations can occur in schizophrenia but are also commonly associated with substance withdrawal (e.g., alcohol or cocaine withdrawal), delirium, or neurological conditions. They are not as classic for schizophrenia as third-party auditory hallucinations.

(a) Generalised anxiety (Generalized Anxiety Disorder - GAD): GAD is a common anxiety disorder characterized by excessive, uncontrollable, and often irrational worry about everyday things, persisting for at least six months.
(b) Panic disorder: This is an anxiety disorder characterized by recurrent, unexpected panic attacks – sudden periods of intense fear or discomfort that reach a peak within minutes.
(c) Agoraphobia: This is an anxiety disorder characterized by intense fear or anxiety about being in situations from which escape might be difficult or help might not be available, such as public transportation, open spaces, or crowds.

(a) Generalised anxiety disorder (GAD): GAD is characterized by excessive and pervasive worry about various aspects of life, but survivor guilt is not a core diagnostic feature of GAD.
(c) Schizophrenia: Schizophrenia is characterized by psychosis (delusions, hallucinations), disorganized thought and speech, and negative symptoms. While individuals with schizophrenia may experience guilt related to their illness, "survivor guilt" as a specific phenomenon linked to surviving a traumatic event is not a characteristic feature of schizophrenia itself.
(d) Grandmal epilepsy (Tonic-clonic seizure): This is a type of seizure characterized by loss of consciousness and violent muscle contractions. While experiencing seizures can be traumatic, survivor guilt related to others not surviving is not a direct presentation of epilepsy.

(a) Depression (Major Depressive Disorder): This is primarily a mood disorder characterized by persistent sadness, loss of interest or pleasure (anhedonia), and other emotional and physical problems. While anxiety symptoms are common in depression (comorbid anxiety), depression itself is classified as a mood disorder, not an anxiety disorder.
(b) Mania: Mania is a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." It is a key feature of Bipolar I Disorder and is classified as a mood state, not an anxiety disorder.
(c) Bipolar (Bipolar Disorder): This is a mood disorder characterized by shifts in mood, energy, activity levels, and concentration, ranging from periods of intense excitement and energy (manic or hypomanic episodes) to periods of depression.

(b) Schizophrenia: Schizophrenia is a severe mental illness that significantly increases the risk of suicide. Individuals with schizophrenia have a lifetime suicide risk estimated to be around 5-10%. Factors include command hallucinations, depression, hopelessness, substance abuse, and impact of illness on functioning.
(c) Major depression (Major Depressive Disorder - MDD): MDD is one of the most significant risk factors for suicide. A large percentage of individuals who die by suicide have a diagnosable mood disorder at the time of their death. Symptoms like hopelessness, worthlessness, anhedonia, and suicidal ideation are core features.
(d) Substance abuse (Substance Use Disorders - SUDs): SUDs are strongly associated with increased risk of suicidal ideation, attempts, and completion. Substance use can lower inhibitions, impair judgment, increase impulsivity, worsen underlying mental health conditions, and lead to social/occupational problems that contribute to hopelessness.

(b) Chlor-diazepovide (Chlordiazepoxide): This is a benzodiazepine primarily used for anxiety disorders and alcohol withdrawal symptoms. It has a slower onset of action compared to diazepam or lorazepam and is not typically used for the acute treatment of status epilepticus.
(c) Phenytoin: Phenytoin is an anti-epileptic drug often used as a second-line agent if seizures do not stop after initial benzodiazepine administration. It has a slower onset and requires careful administration (slow IV infusion to avoid cardiac side effects), making it unsuitable as the initial drug of choice.
(d) Carbamazepine: Carbamazepine is an anti-epileptic drug used for long-term management of certain seizure types (focal seizures) and also for bipolar disorder. It is an oral medication and is not used for the acute emergency treatment of status epilepticus.

(b) Cervicitis: Cervicitis is inflammation of the cervix, more commonly caused by infections (like STIs) rather than being a direct side effect of COCs. COCs might even offer some protection against pelvic inflammatory disease (PID).
(c) Fibrocystic disease (Fibrocystic breast changes): Combined oral contraceptives have actually been shown to decrease the incidence and symptoms of benign fibrocystic breast changes, not cause them.
(d) Ovarian cyst: COCs work by suppressing ovulation. By preventing ovulation, they can actually reduce the risk of developing functional ovarian cysts (like follicular cysts or corpus luteum cysts), which form as part of the normal ovulatory cycle.

(a) Slows down cardiac contractions: While high doses or rapid IV administration of diazepam can cause cardiovascular side effects like hypotension or bradycardia, slowing cardiac contractions is not its primary mode of action or therapeutic goal for treating convulsions.
(c) Dilates the bronchial structures: Diazepam is not a bronchodilator. Drugs that dilate bronchial structures are typically used for respiratory conditions like asthma. Benzodiazepines can, in fact, cause respiratory depression as a side effect.
(d) Provides amnesia for the convulsive episode: While diazepam is known to cause anterograde amnesia, this is a side effect, not its primary mode of action for stopping the convulsion itself. The question asks for the mode of action, which refers to how it therapeutically stops the seizure.

(a) Furosemide and oral pethidine: Furosemide is a loop diuretic used to treat fluid overload; it has no analgesic properties. Pethidine is an analgesic. This combination doesn't make sense for pain management itself.
(b) Paracetamol and oral diclofenac: This combination can be used for mild to moderate pain, or as an adjunct to opioids. However, for advanced cancer pain, which is often severe, this combination alone might not be sufficient and strong opioids are usually required.
(c) Bisacodyl and oral morphine: Bisacodyl is a stimulant laxative used to treat constipation - a common side effect of opioids. While bisacodyl would be appropriately prescribed alongside morphine to manage this side effect, bisacodyl itself is not for pain management.

(a) Salbutamol: Salbutamol (albuterol) is a short-acting beta2-adrenergic receptor agonist used as a bronchodilator to treat asthma and COPD. It has no role in inhibiting lactation.
(b) Furosemide: Furosemide is a potent loop diuretic used to treat edema and hypertension. It acts on the kidneys to increase urine output and has no direct effect on inhibiting lactation.
(d) Aspirin: Aspirin (acetylsalicylic acid) is a non-steroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and antiplatelet properties. It is used for pain relief and to prevent blood clots. It does not inhibit lactation.

(a) Nicotine (primarily from tobacco): Nicotine is highly addictive, and tobacco use is a major public health concern. While nicotine dependence is very common, alcohol consumption and its associated harms often surpass it in terms of overall prevalence of "abuse" when considering impairment and broader societal impact.
(b) Cannabis (Marijuana): Cannabis is the most commonly used illicit drug in many parts of the world, including Uganda. Its use is significant, but generally, the overall prevalence of alcohol abuse tends to be higher than that of cannabis abuse when population-level data is considered.
(c) Cocaine: Cocaine is a powerful stimulant drug. While its use occurs in Uganda, particularly in certain urban populations, it is generally far less common and less widely abused compared to alcohol or even cannabis, partly due to its higher cost and more limited availability.