DNE 114 [DEC. 2025]
Psychiatric Nursing, Pharmacology & Counselling
SECTION A: OBJECTIVE QUESTIONS
30 Marks
1. Aims of occupational therapy in acute mental illness include
In acute phases, occupational therapy primarily aims to provide distraction/diversion from hallucinations or overwhelming anxiety rather than vocational training.
2. The nurse checks the circulatory function for the mentally ill patient who is restrained every ......... hour(s).
Standard psychiatric nursing protocol mandates checking neurovascular/circulatory function every 15 to 30 minutes (half an hour) to prevent limb ischemia.
3. The urgency order for admitting a patient to a mental hospital is signed by the
Under the Uganda Mental Treatment Act, an urgency order can be issued by a medical practitioner (medical officer), a chief, or a police officer not below the rank of assistant inspector.
4. The onset of catatonic stupor is
Catatonic stupor (characterized by immobility and mutism) generally presents with a rapid, acute onset, often constituting a psychiatric emergency.
5. A form of psychotherapy based on theories of operant conditioning is
Behavioural therapy relies on B.F. Skinner's principles of operant conditioning, using reinforcement and punishment to modify behaviour.
6. The major causes of panic anxiety disorders are
While genetics and stress play roles, the exact etiology of primary Panic Disorder remains idiopathic/unknown in psychiatric literature.
7. Which of the following disorders is characterised by change in intellectual functioning?
Mental retardation (now termed Intellectual Disability) is explicitly defined by significant limitations in intellectual functioning and adaptive behaviour.
8. The illness which tends to coexist with attention deficit hyperactivity disorder is
Conduct Disorder and Oppositional Defiant Disorder (ODD) are the most common psychiatric comorbidities associated with ADHD in children.
9. Which of the following is NOT a psychogenic factor related to suicide?
Serotonin imbalance is a biological/neurochemical factor, whereas the others are psychogenic (psychological) or cognitive factors.
10. The total maximum number of ECT shocks given at a single course of treatment is:
A standard acute course of Electroconvulsive Therapy (ECT) typically consists of 6 to 12 treatments given 2-3 times a week.
11. Which of the following is NOT the most appropriate measure of managing a violent patient?
Using an angry or scary tone will only escalate the patient's aggression. De-escalation requires a calm, firm, and non-threatening approach.
12. Which of the following is the most appropriate maintenance goal set at hospital discharge of a patient suffering from chronic anxiety?
Eliminating or suppressing anxiety is unrealistic and harmful. The primary goal is teaching the patient to identify triggers so they can apply coping mechanisms.
13. Which of the following is NOT a correct approach to managing psychiatric emergencies?
During a psychiatric emergency, immediate stabilization, safety, and rapid assessment take precedence. Detailed history-taking is deferred until the crisis is resolved.
14. Which of the following are warning signs of post-ictal confusion state?
The post-ictal state (after a seizure) classically presents with extreme sleepiness/drowsiness, unfamiliarity (disorientation), and sometimes agitation or combativeness (violence) as the brain recovers.
15. Which of the following chromosomal abnormalities causes mental retardation?
Down syndrome (Trisomy 21) is the most common genetic chromosomal abnormality associated with mild to moderate intellectual disability.
16. Which section in the mental treatment act deals with a hospital staff who aids patients to escape?
In the historical Uganda Mental Treatment Act (Cap 279), Section 30 dictates offenses relating to "Assisting escape of person of unsound mind from a mental hospital".
17. Which of the following is NOT an antidepressant?
Correction Note: Technically all are antidepressants. However, in some classical curricula, Fluoxetine (an SSRI) is isolated when examining classic Tricyclic Antidepressants (TCAs), which make up options b, c, and d.
18. Which of the following anxiolytic drugs is also administered in the treatment of convulsions in children?
Diazepam (often given rectally or IV) is the first-line benzodiazepine used to abort status epilepticus and severe febrile convulsions in pediatric settings.
19. Which of the following interventions is key in the management of epileptic fits?
Placing the actively seizing or post-ictal patient in the lateral recovery position maintains airway patency and prevents the aspiration of saliva or vomitus.
20. Which of the following drugs is used to boost fertility?
Bromocriptine is a dopamine agonist used to treat hyperprolactinemia, thereby restoring normal ovulatory cycles and boosting fertility in affected women.
21. Side effects of methotrexate exclude:
Contextual Note: While high-dose methotrexate causes alopecia, in the low doses used for rheumatology/autoimmune conditions, alopecia is relatively rare compared to the highly prevalent GI side effects (nausea, diarrhea, anorexia).
22. Which of the following is a mechanism of action for hypnotic drugs?
By definition, a "hypnotic" is a class of psychoactive drugs whose primary function is to induce sleep and treat insomnia by depressing the CNS.
23. Which of the following is an example of serotonin reuptake inhibitors?
Fluoxetine (Prozac) is a classic Selective Serotonin Reuptake Inhibitor (SSRI) used for depression and anxiety.
24. Which of the following is an antidote for antipsychotic drugs?
Artane (Trihexyphenidyl) is an anticholinergic drug used as an "antidote" to treat the extrapyramidal symptoms (EPS) and drug-induced parkinsonism caused by antipsychotics.
25. In which of the following psychotic disorders does the nurse NOT administer Olanzapine?
Delirium Tremens (alcohol withdrawal psychosis) is treated with high-dose benzodiazepines (like Diazepam). Antipsychotics lower the seizure threshold and are generally avoided.
26. Which of the following is a contra indication to gabapentin?
Options a, b, and c are clinical indications for gabapentin. A known allergy or hypersensitivity to the drug is its absolute contraindication.
27. Which of the following drugs is commonly used in auto-immune skin disorders?
Methotrexate is a powerful immunosuppressant used extensively in severe autoimmune skin disorders like severe Psoriasis and pemphigus.
28. Patients taking carbamezapine are at a risk of
Carbamazepine carries a black-box warning for serious blood dyscrasias, specifically Agranulocytosis and aplastic anemia, requiring routine CBC monitoring.
29. Drugs that induce sleep by depressing the central nervous system are
While barbiturates can induce sleep, "hypnotics" is the exact functional pharmacological classification for drugs used specifically to induce and maintain sleep.
30. The commonest side effect of sildenafil is
Sildenafil (Viagra) is a PDE5 inhibitor that causes widespread vasodilation. Facial flushing and headaches are its most common side effects.
SECTION B: SHORT ESSAY QUESTIONS
10 Marks
Question 31: Clofarabine Contraindications
(5 Marks)
State five (5) contraindications to clofarabine use:
Clofarabine is a potent purine nucleoside antimetabolite used in pediatric acute lymphoblastic leukemia. It is contraindicated in the following situations:
- Hypersensitivity: Patients with a known allergy or severe hypersensitivity reaction to clofarabine or any of its excipients.
- Severe Renal Impairment: Because the drug is primarily excreted by the kidneys, severe renal failure increases toxicity risks.
- Severe Hepatic Impairment: It is hepatotoxic and must be avoided in patients with existing severe liver disease.
- Pregnancy and Lactation: It is highly teratogenic and can cause fetal harm; breastfeeding is contraindicated due to potential severe adverse reactions in the infant.
- Active Severe Infections: It induces profound immunosuppression (myelosuppression), making it dangerous to administer if a patient currently has an active, uncontrolled systemic infection.
Question 32: Effects of Intellectual Disability on the Family
(5 Marks)
Outline five (5) effects of having a mentally retarded child on the family:
- Severe Financial Strain: Families often face exorbitant costs related to continuous medical care, specialized therapies, and specialized educational programs.
- Chronic Emotional Stress: Parents may experience prolonged grief, parental guilt, anxiety, and depression regarding the child's delayed milestones and future independence.
- Social Isolation: Due to societal stigma, lack of understanding, and the demanding nature of caregiving, families often withdraw from social gatherings and public outings.
- Marital Conflict: The overwhelming stress, sleep deprivation, and disagreement over care strategies can lead to severe marital discord or breakdown.
- Sibling Resentment and Neglect: Healthy siblings may feel neglected, angry, or burdened with early caregiving responsibilities due to the disproportionate attention required by the affected child.
SECTION C: LONG ESSAY QUESTIONS
60 Marks
Question 33: Panic Disorders and Mental State Examination (20 Marks)
(a) Describe five (5) spheres the nurse focuses on during mental state examination of a client suspected of panic disorder (10 marks):
- Appearance and Behaviour: The nurse observes for signs of extreme psychomotor agitation, restlessness, pacing, sweating, tremors, and hyperventilation which indicate an acute autonomic nervous system surge.
- Mood and Affect: The nurse evaluates the patient's emotional state. The subjective mood is typically described as terrified, overwhelmed, or anxious, and the observable affect is highly congruent, appearing intensely fearful.
- Thought Process and Content: The nurse screens for specific catastrophic thoughts. Content often revolves around an intense fear of dying, having a heart attack, or an overwhelming fear of "going crazy" and losing control.
- Perceptual Disturbances: The nurse asks about distortions in reality testing. It is common to find experiences of derealization (the environment feels fake or dream-like) and depersonalization (feeling detached from one's own body).
- Cognition and Sensorium: The nurse assesses focus and memory. During a panic attack, the patient's attention span and concentration are typically severely impaired due to the overwhelming "fight or flight" response.
(b) Outline ten (10) predisposing factors to panic disorders (10 marks):
- Genetic Predisposition: A strong family history of anxiety disorders significantly increases vulnerability.
- Neurochemical Imbalances: Dysregulation of brain neurotransmitters, particularly serotonin, GABA, and norepinephrine.
- Severe Stressful Life Events: Experiencing traumatic events, such as accidents, sudden bereavement, or violence (leading to PTSD overlap).
- Childhood Trauma: A history of physical, emotional, or sexual abuse during early developmental years.
- Substance Abuse: Misuse of stimulants (cocaine, amphetamines) or withdrawal from central nervous system depressants (alcohol, benzodiazepines).
- Major Life Transitions: High-stress milestones such as divorce, having a baby, or sudden job loss.
- Chronic Medical Illnesses: Underlying physiological conditions like hyperthyroidism, asthma, or cardiac arrhythmias that mimic or trigger panic.
- Excessive Caffeine or Nicotine: High intake of stimulants that artificially trigger sympathetic nervous system arousal.
- Psychological Vulnerability: Personality traits such as high neuroticism, perfectionism, and anxiety sensitivity.
- Co-existing Mental Health Issues: A pre-existing history of major depressive disorder or generalized anxiety disorder.
Question 34: Group Therapy and Ethical Counselling (20 Marks)
(a) Explain five (5) ethical principles nurses put in consideration while conducting group counselling (10 marks):
- Autonomy: The nurse must respect each member's right to self-determination, meaning participation must be voluntary, and a client has the right to refuse to answer questions or exit the group without coercion.
- Beneficence: The nurse has an ethical duty to act in the best interest of the group. This involves facilitating sessions that actively promote healing, psychological growth, and positive coping strategies.
- Non-maleficence (Do No Harm): The nurse must actively protect vulnerable group members from emotional damage, bullying, or harsh confrontation originating from other group participants.
- Confidentiality: The nurse must enforce strict privacy rules, ensuring that what is discussed in the group stays in the group, protecting members' sensitive disclosures from the outside world.
- Justice and Fairness: The nurse must treat all group participants equally, ensuring fair distribution of speaking time and avoiding any favouritism or discrimination based on background or diagnosis.
(b) Outline ten (10) interventions nurses implement for successful group therapy (10 marks):
- Establishing Ground Rules: Clearly defining expectations regarding confidentiality, punctuality, and respectful communication during the first session.
- Active Empathic Listening: Modeling genuine attention and empathy to build trust and encourage members to open up.
- Facilitating Peer Interaction: Redirecting questions and comments from the leader back to the group to foster peer-to-peer support and cohesion.
- Role-Playing Techniques: Using behavioural rehearsal to allow members to practice new social skills or conflict resolution in a safe environment.
- Providing Psychoeducation: Supplying accurate medical and psychological information to help members understand their illness and medications.
- Managing Disruptive Behaviour: Intervening promptly and therapeutically if a member monopolizes the conversation or acts aggressively.
- Promoting Universality: Highlighting shared experiences among members to reduce feelings of isolation and uniqueness in their suffering.
- Encouraging Positive Reinforcement: Prompting members to acknowledge and celebrate each other's progress and milestones.
- Summarizing Sessions: Condensing the main themes discussed at the end of the meeting to consolidate learning and provide closure.
- Proper Termination: Preparing the group in advance for the end of therapy, allowing time to process feelings of loss and review achievements.
Question 35: Combined Oral Contraceptives (20 Marks)
(a) Explain six (6) mechanisms of action of combined oral contraceptives (12 marks):
- Suppression of Ovulation: Estrogen and progestin provide negative feedback to the hypothalamus and anterior pituitary, inhibiting the release of Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH), preventing the LH surge needed for ovulation.
- Thickening of Cervical Mucus: The progestin component causes cervical mucus to become thick and scanty, creating a physical barrier that prevents sperm penetration and motility into the uterus.
- Alteration of the Endometrium: The hormonal balance prevents normal proliferation of the uterine lining, keeping it thin and unsupportive, thereby inhibiting the implantation of a fertilized blastocyst.
- Alteration of Tubal Motility: The hormones interfere with the normal peristaltic movements and ciliary action of the fallopian tubes, slowing or disrupting the transport of both the ovum and sperm.
- Inhibition of Sperm Capacitation: COCs alter the biochemical environment of the female reproductive tract, interfering with capacitation—the physiological changes sperm must undergo to successfully penetrate and fertilize an egg.
- Suppression of Follicular Development: By keeping FSH levels constantly suppressed, the ovaries remain dormant, and no dominant ovarian follicle is allowed to develop and mature.
(b) Outline eight (8) measures of improving user-compliance to combined oral contraceptives (8 marks):
- Comprehensive Initial Education: Providing detailed, easy-to-understand information on how the pill works, when to take it, and why timing matters.
- Linking to Daily Routines: Advising the user to take the pill simultaneously with a fixed daily habit, such as brushing teeth or eating breakfast.
- Utilizing 28-Day Packs: Dispensing pill packs that include 7 placebo (iron) pills so the physical habit of taking a daily pill is never broken during menstruation.
- Implementing Reminder Systems: Encouraging the use of mobile phone alarms, fertility tracking apps, or marked calendars to trigger daily memory.
- Proactive Side-Effect Counseling: Demystifying minor expected side effects (e.g., mild nausea, spotting) so the user does not panic and abruptly abandon the method.
- Clear Missed-Pill Instructions: Providing concrete, written protocols on exactly what to do if one or two pills are forgotten, to prevent anxiety and unintended pregnancy.
- Ensuring Easy Access: Structuring clinic appointments to ensure the client always gets refills before running out, reducing structural barriers to compliance.
- Partner Involvement: Educating the client's partner (with permission) so they can provide supportive reminders and share responsibility for contraceptive adherence.