A patient with borderline personality disorder tells one nurse, 'You are the only one who understands me; the others are cruel.' The most appropriate nursing approach is to:

Keep firm limits that the whole team applies the same way

Report the other nurses' behaviour to the ward in-charge

Avoid talking to her so as not to encourage this

Become her single assigned nurse so that she feels secure

A patient starting lithium asks about diet. Which advice is correct?

Keep a normal salt intake and drink 2-3 litres of fluid a day

Limit fluids to 1 litre a day so the drug is not diluted too much

Avoid all milk products while taking the drug

Follow a strict low-salt diet to protect the kidneys

Which drug group is the first choice to prevent seizures and delirium during alcohol withdrawal?

Selective serotonin reuptake inhibitors

Psychiatric disorders and their care

28 AIIMS NORCET (Nursing Officer) practice questions on Psychiatric disorders and their care, part of Mental Health Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A patient with borderline personality disorder tells one nurse, 'You are the only one who understands me; the others are cruel.' The most appropriate nursing approach is to:
1. AReport the other nurses' behaviour to the ward in-charge
2. BAvoid talking to her so as not to encourage this
3. CBecome her single assigned nurse so that she feels secure
4. DKeep firm limits that the whole team applies the same way
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Answer: D · Keep firm limits that the whole team applies the same way
Idealising one staff member and devaluing others is splitting, common in borderline personality disorder. It divides the team unless everyone gives the same limits and responses. The nurse does not accept the special role and discusses the pattern in team meetings. Consistency reduces manipulation and builds trust.
- A: Acting on her complaint against colleagues is exactly what splitting provokes.
- B: Withdrawal feels like rejection and can trigger self-harm.
- C: Accepting a special role feeds the splitting.
Question 2 · Medium
A patient starting lithium asks about diet. Which advice is correct?
1. ALimit fluids to 1 litre a day so the drug is not diluted too much
2. BAvoid all milk products while taking the drug
3. CFollow a strict low-salt diet to protect the kidneys
4. DKeep a normal salt intake and drink 2-3 litres of fluid a day
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Answer: D · Keep a normal salt intake and drink 2-3 litres of fluid a day
The kidney handles lithium like sodium. When sodium intake falls or the patient is dehydrated, the kidney holds back more lithium and the level rises towards toxicity. A steady, normal salt intake and 2-3 litres of fluid daily keep the level stable. Fever, vomiting, diarrhoea and heavy sweating need extra care and a level check.
- A: Fluid restriction concentrates lithium and raises the level.
- B: Milk products do not interact with lithium.
- C: A low-salt diet increases lithium retention and can cause toxicity.
Question 3 · Easy
Before an intravenous dextrose infusion is started in a malnourished alcohol-dependent patient, which vitamin should be given to prevent Wernicke encephalopathy?
1. AThiamine
2. BCyanocobalamin
3. CFolic acid
4. DPyridoxine
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Answer: A · Thiamine
Thiamine (vitamin B1) is a cofactor for glucose metabolism, and a glucose load can use up the little thiamine left and bring on Wernicke encephalopathy. The classic triad is confusion, ataxia and ophthalmoplegia. Parenteral thiamine is given before or with dextrose in every at-risk patient. Untreated, it can progress to Korsakoff syndrome with permanent memory loss.
- B: Cyanocobalamin deficiency causes megaloblastic anaemia and subacute combined degeneration.
- C: Folic acid deficiency causes megaloblastic anaemia.
- D: Pyridoxine (B6) deficiency causes neuropathy and seizures, not Wernicke encephalopathy.
Question 4 · Medium
On the fourth day of haloperidol therapy, a patient has a temperature of 40 °C, lead-pipe rigidity, sweating, fluctuating consciousness and a markedly raised CPK. The most likely condition is:
1. ANeuroleptic malignant syndrome
2. BAcute dystonic reaction
3. CSerotonin syndrome
4. DTardive dyskinesia
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Answer: A · Neuroleptic malignant syndrome
High fever, severe 'lead-pipe' rigidity, altered consciousness, autonomic instability and a high CPK after an antipsychotic is neuroleptic malignant syndrome. It is caused by dopamine blockade and can be fatal. The drug is stopped at once, the patient is cooled and hydrated, and dantrolene or bromocriptine may be ordered. Renal failure from rhabdomyolysis is a major risk.
- B: Acute dystonia is a muscle spasm without fever or a high CPK.
- C: Serotonin syndrome follows serotonergic drugs and shows clonus and hyperreflexia rather than lead-pipe rigidity.
- D: Tardive dyskinesia is a late movement disorder without fever.
Question 5 · Easy
Which drug group is the first choice to prevent seizures and delirium during alcohol withdrawal?
1. ASelective serotonin reuptake inhibitors
2. BBenzodiazepines
3. COpioid antagonists
4. DPhenothiazines
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Answer: B · Benzodiazepines
Benzodiazepines such as chlordiazepoxide, diazepam or lorazepam act on the same GABA-A receptors as alcohol and replace its effect. A tapering schedule prevents withdrawal seizures and delirium tremens. Lorazepam is preferred when liver function is poor. The dose is guided by regular withdrawal scoring.
- A: SSRIs have no role in acute withdrawal.
- C: Opioid antagonists such as naltrexone reduce craving later, not acute withdrawal.
- D: Phenothiazines lower the seizure threshold and do not treat withdrawal itself.
Question 6 · Hard
A 45-year-old man on lithium for 3 years was started on hydrochlorothiazide for hypertension 2 weeks ago. He now has coarse hand tremor, vomiting, slurred speech and an unsteady gait. Serum lithium is 2.2 mEq/L (target 0.6-1.2). What is the nurse's priority action?
1. ARestrict fluids and give the next dose
2. BGive the dose with food to reduce vomiting
3. CWithhold lithium and report the level at once
4. DGive propranolol for the tremor and continue
Answer and explanation in LearnFree account
Question 7 · Medium
An elderly woman with Alzheimer disease becomes restless and confused every evening. Which nursing measure helps most?
1. AMove her to a different room every few days
2. BKeep the room well lit and follow a fixed daily routine
3. CApply restraints at night to prevent wandering
4. DGive a sedative routinely at the start of each evening
Answer and explanation in LearnFree account
Question 8 · Medium
Which tool scores the severity of alcohol withdrawal to guide benzodiazepine dosing?
1. ACIWA-Ar
2. BCAGE questionnaire
3. CMini-Mental State Examination
4. DAUDIT
Answer and explanation in LearnFree account
Question 9 · Easy
Delirium tremens in a person dependent on alcohol most often begins how long after the last drink?
1. AWithin 1 hour
2. B1 to 2 weeks
3. C6 to 12 hours
4. D2 to 4 days
Answer and explanation in LearnFree account
Question 10 · Medium
A patient taking disulfiram should be taught to avoid which of the following?
1. ADairy products, eggs and all green leafy vegetables
2. BCough syrups and mouthwashes that contain alcohol
3. CParacetamol taken at the normal dose
4. DFresh fruit juices and coconut water
Answer and explanation in LearnFree account
Question 11 · Hard
A man admitted for fracture fixation drank heavily every day until admission 60 hours ago. He is now disoriented, picking at insects he sees on the sheet, sweating, with pulse 128/min and temperature 38.4 °C. The most likely diagnosis is:
1. AAlcohol withdrawal seizure
2. BWernicke encephalopathy
3. CDelirium tremens
4. DAlcoholic hallucinosis
Answer and explanation in LearnFree account
Question 12 · Easy
Which of the following is a Schneiderian first-rank symptom of schizophrenia?
1. APressure of speech
2. BFlight of ideas
3. CDelusion of guilt and sinfulness
4. DThought broadcasting
Answer and explanation in LearnFree account
Question 13 · Hard
Which of these patients is at the highest risk of suicide?
1. AA girl, 16, who is upset after an argument with her friend
2. BA widowed man, 68, who drinks daily and made an earlier attempt
3. CA married woman, 30, with exam stress and good family support
4. DA man, 40, newly started on an antidepressant for mild depression
Answer and explanation in LearnFree account
Question 14 · Medium
During the first week of refeeding a severely underweight patient with anorexia nervosa, which serum level is watched most closely for refeeding syndrome?
1. AChloride
2. BPhosphate
3. CCalcium
4. DSodium
Answer and explanation in LearnFree account
Question 15 · Hard
A 19-year-old woman with anorexia nervosa weighs 30 kg and is 1.55 m tall. By DSM-5, a BMI below 15 kg/m2 is extreme severity. Her BMI and severity are:
1. A16.8 kg/m2, moderate
2. B15.5 kg/m2, severe
3. C19.4 kg/m2, normal
4. D12.5 kg/m2, extreme
Answer and explanation in LearnFree account
Question 16 · Medium
A man with severe depression who has been withdrawn for weeks suddenly appears calm and cheerful and gives his watch and phone to other patients. The nurse should interpret this as:
1. AA warning sign of a possible suicide plan
2. BA normal wish to make friends on the ward
3. CEvidence that the antidepressant is working
4. DA sign that he is ready for early discharge
Answer and explanation in LearnFree account
Question 17 · Hard
A woman on sertraline for depression was given tramadol for back pain. Within hours she is agitated and has diarrhoea, shivering, temperature 38.5 °C, hyperreflexia and ankle clonus. The most likely cause is:
1. ASerotonin syndrome
2. BLithium toxicity
3. CAnticholinergic toxicity
4. DNeuroleptic malignant syndrome
Answer and explanation in LearnFree account
Question 18 · Easy
Calluses and scars on the back of the knuckles (Russell sign) in a young woman with an eating disorder point to:
1. ASelf-induced vomiting
2. BCompulsive hand washing
3. CExcessive exercise
4. DLaxative misuse
Answer and explanation in LearnFree account
Question 19 · Hard
Six weeks after clozapine was started for resistant schizophrenia, a patient develops a temperature of 38.6 °C and painful mouth ulcers. What is the nurse's first action?
1. AGive paracetamol and continue the dose as scheduled
2. BWithhold clozapine and report for an urgent neutrophil count
3. CGive the dose and recheck the blood counts at the end of the month
4. DAdvise warm saline gargles and review again tomorrow
Answer and explanation in LearnFree account
Question 20 · Easy
The usual target serum lithium level for maintenance therapy in bipolar disorder is:
1. A1.5-2.5 mEq/L
2. B0.1-0.4 mEq/L
3. C2.5-3.5 mEq/L
4. D0.6-1.2 mEq/L
Answer and explanation in LearnFree account
Question 21 · Medium
A depressed patient says, 'Nothing matters any more.' Which response by the nurse is most appropriate?
1. AWhy do you feel that nothing matters?
2. BYou have so much to live for, think of your family.
3. CAre you having thoughts of killing yourself?
4. DDon't worry, things will get better soon.
Answer and explanation in LearnFree account
Question 22 · Hard
A patient taking phenelzine ate a large portion of aged cheese at a family function. An hour later she has a severe occipital headache, palpitations and BP 210/120 mm Hg. The most likely explanation is:
1. ATyramine-induced hypertensive crisis
2. BWithdrawal from her antidepressant
3. CSerotonin syndrome from the cheese
4. DLithium toxicity from dehydration
Answer and explanation in LearnFree account
Question 23 · Medium
A newly admitted patient with OCD washes his hands about 30 times each morning and is always late for breakfast. The best initial nursing approach is to:
1. ALock the washroom between fixed times
2. BPoint out to him that the ritual is irrational and useless
3. CAllow time for the ritual and plan the routine around it
4. DStop the ritual firmly whenever it starts
Answer and explanation in LearnFree account
Question 24 · Easy
The first-line drug group for obsessive-compulsive disorder is:
1. ATypical antipsychotics such as haloperidol
2. BSelective serotonin reuptake inhibitors
3. CBeta-adrenergic blockers
4. DBenzodiazepines
Answer and explanation in LearnFree account
Question 25 · Medium
A day after starting haloperidol, a young man suddenly develops a twisted neck and eyes rolled upwards. Which action should the nurse take?
1. AApply an ice pack to the neck
2. BGive the ordered anticholinergic injection
3. CGive oral propranolol and observe for an hour
4. DIncrease the next haloperidol dose
Answer and explanation in LearnFree account

3 more Psychiatric disorders and their care questions

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Study Mental Health Nursing

Psychiatric disorders and their care

A patient with borderline personality disorder tells one nurse, 'You are the only one who understands me; the others are cruel.' The most appropriate nursing approach is to:

A patient starting lithium asks about diet. Which advice is correct?

Before an intravenous dextrose infusion is started in a malnourished alcohol-dependent patient, which vitamin should be given to prevent Wernicke encephalopathy?

On the fourth day of haloperidol therapy, a patient has a temperature of 40 °C, lead-pipe rigidity, sweating, fluctuating consciousness and a markedly raised CPK. The most likely condition is:

Which drug group is the first choice to prevent seizures and delirium during alcohol withdrawal?

A 45-year-old man on lithium for 3 years was started on hydrochlorothiazide for hypertension 2 weeks ago. He now has coarse hand tremor, vomiting, slurred speech and an unsteady gait. Serum lithium is 2.2 mEq/L (target 0.6-1.2). What is the nurse's priority action?

An elderly woman with Alzheimer disease becomes restless and confused every evening. Which nursing measure helps most?

Which tool scores the severity of alcohol withdrawal to guide benzodiazepine dosing?

Delirium tremens in a person dependent on alcohol most often begins how long after the last drink?

A patient taking disulfiram should be taught to avoid which of the following?

A man admitted for fracture fixation drank heavily every day until admission 60 hours ago. He is now disoriented, picking at insects he sees on the sheet, sweating, with pulse 128/min and temperature 38.4 °C. The most likely diagnosis is:

Which of the following is a Schneiderian first-rank symptom of schizophrenia?

Which of these patients is at the highest risk of suicide?

During the first week of refeeding a severely underweight patient with anorexia nervosa, which serum level is watched most closely for refeeding syndrome?

A 19-year-old woman with anorexia nervosa weighs 30 kg and is 1.55 m tall. By DSM-5, a BMI below 15 kg/m2 is extreme severity. Her BMI and severity are:

A man with severe depression who has been withdrawn for weeks suddenly appears calm and cheerful and gives his watch and phone to other patients. The nurse should interpret this as:

A woman on sertraline for depression was given tramadol for back pain. Within hours she is agitated and has diarrhoea, shivering, temperature 38.5 °C, hyperreflexia and ankle clonus. The most likely cause is:

Calluses and scars on the back of the knuckles (Russell sign) in a young woman with an eating disorder point to:

Six weeks after clozapine was started for resistant schizophrenia, a patient develops a temperature of 38.6 °C and painful mouth ulcers. What is the nurse's first action?

The usual target serum lithium level for maintenance therapy in bipolar disorder is:

A depressed patient says, 'Nothing matters any more.' Which response by the nurse is most appropriate?

A patient taking phenelzine ate a large portion of aged cheese at a family function. An hour later she has a severe occipital headache, palpitations and BP 210/120 mm Hg. The most likely explanation is:

A newly admitted patient with OCD washes his hands about 30 times each morning and is always late for breakfast. The best initial nursing approach is to:

The first-line drug group for obsessive-compulsive disorder is:

A day after starting haloperidol, a young man suddenly develops a twisted neck and eyes rolled upwards. Which action should the nurse take?