MRCPsych Clinical Practice & Ethical Standards 3

Question 1

A psychiatrist develops a romantic attraction to a current patient. What is the most ethical course of action?

Accepted Answer

Seek supervision, consider transferring care, and not act on the feelings

Answer

Professional boundaries require seeking supervision and arranging transfer of care; romantic involvement with current or recent patients is a serious boundary violation.

Question 2

A patient with treatment-resistant depression asks about electroconvulsive therapy (ECT). They have capacity and consent. However, their advance decision refuses ECT. What governs?

Accepted Answer

The current capacitous consent overrides the advance decision

Answer

A current capacitous decision overrides a prior advance decision; the patient's present consent is legally and ethically authoritative.

Question 3

Which ethical principle is primarily invoked when a psychiatrist withholds a patient's address from an aggressive ex-partner who presents at the clinic?

Accepted Answer

Non-maleficence

Answer

Non-maleficence—the duty to avoid harm—justifies protecting confidential information when disclosure could endanger the patient.

Question 4

A newly admitted inpatient with bipolar disorder is prescribed lithium. Which monitoring is mandatory before initiation?

Accepted Answer

Renal function, thyroid function, ECG, and pregnancy test where applicable

Answer

Pre-lithium baseline must include renal function (lithium is renally excreted), thyroid function, ECG, and pregnancy test in women of childbearing age per NICE guidelines.

Question 5

A community psychiatric nurse breaches patient confidentiality by discussing a case with a neighbour. Under which framework is this primarily a regulatory concern?

Accepted Answer

Nursing and Midwifery Council Code

Answer

The NMC Code sets professional standards for nurses including confidentiality; breaches are investigated as fitness-to-practise matters by the NMC.

(MRCPsych) Member of the Royal College of Psychiatrists Practice Test

(MRCPsych) Member of the Royal College of Psychiatrists Practice Test

MRCPsych Clinical Practice & Ethical Standards 3