A patient with paranoid schizophrenia refuses meals, saying the food is poisoned. The most appropriate nursing action is to:

Offer sealed packaged food and avoid arguing about the belief

Tell him firmly that the belief is false and insist he eats

Explain logically why poisoning on the ward is impossible

Withhold food until he accepts that he is mistaken

The most common side effect of ECT is:

Temporary memory loss and confusion

Compression fracture of the spinal vertebrae

Therapeutic communication, defence mechanisms and therapies

22 AIIMS NORCET (Nursing Officer) practice questions on Therapeutic communication, defence mechanisms and therapies, part of Mental Health Nursing. The first 22 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 paranoid schizophrenia refuses meals, saying the food is poisoned. The most appropriate nursing action is to:
1. AOffer sealed packaged food and avoid arguing about the belief
2. BTell him firmly that the belief is false and insist he eats
3. CExplain logically why poisoning on the ward is impossible
4. DWithhold food until he accepts that he is mistaken
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Answer: A · Offer sealed packaged food and avoid arguing about the belief
A fixed delusion cannot be argued away, and arguing increases suspicion. Meeting the nutritional need in a way the patient trusts, such as sealed packaged food or letting him serve himself, keeps him eating. The nurse focuses on present reality and the patient's feelings rather than the delusion. Intake and weight are monitored.
- B: Insisting the belief is false starts a power struggle.
- C: Logical arguments do not change a delusion and increase mistrust.
- D: Withholding food is punitive and endangers his nutrition.
Question 2 · Easy
Before an ECT session done under general anaesthesia, the patient is usually kept nil by mouth for:
1. A6 to 8 hours
2. B1 to 2 hours
3. C24 hours
4. D30 minutes
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Answer: A · 6 to 8 hours
Modified ECT is given under short general anaesthesia with a muscle relaxant. Nil by mouth for about 6-8 hours, usually from midnight, lowers the risk of aspiration of stomach contents. The nurse also removes dentures, jewellery and hairpins and asks the patient to void. Vital signs are recorded before the session.
- B: One to two hours is not enough before general anaesthesia for solids.
- C: A 24-hour fast is unnecessary and risks dehydration.
- D: Thirty minutes is too short to empty the stomach.
Question 3 · Medium
A student who failed the medical entrance exam says, 'I never really wanted to be a doctor anyway.' This is an example of:
1. ASublimation
2. BProjection
3. CRationalisation
4. DDenial
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Answer: C · Rationalisation
Rationalisation offers a reasonable, acceptable explanation to protect self-esteem after a failure, like the fox's 'sour grapes'. The student admits the failure but explains away its importance. It eases the pain of disappointment but can block real problem-solving. The nurse lets the patient express the disappointment safely.
- A: Sublimation turns impulses into a useful, accepted activity.
- B: Projection would blame others, for example unfair examiners.
- D: Denial would refuse to accept that the failure happened at all.
Question 4 · Easy
The most common side effect of ECT is:
1. ACompression fracture of the spinal vertebrae
2. BPermanent brain damage
3. CTemporary memory loss and confusion
4. DSevere muscle wasting
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Answer: C · Temporary memory loss and confusion
Short-term confusion after waking and memory loss for events around the treatment course are the most common effects of ECT. Memory usually recovers within weeks to months after the course ends. The nurse reorients the patient after each session and reassures the family. Modern anaesthesia and muscle relaxants have made fractures rare.
- A: Fractures were a risk of unmodified ECT and are rare with muscle relaxants.
- B: ECT does not cause permanent brain damage.
- D: ECT does not cause muscle wasting.
Question 5 · Medium
A woman with a fear of dogs is taught deep relaxation, then exposed step by step to a list of dog-related situations, from a picture to touching a dog. This therapy is:
1. AToken economy
2. BFlooding (implosion therapy)
3. CAversion therapy
4. DSystematic desensitisation
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Answer: D · Systematic desensitisation
Systematic desensitisation, described by Wolpe, pairs relaxation with graded exposure along a hierarchy from least to most feared. Relaxation and anxiety cannot exist together, so the fear response weakens at each step. The patient moves on only when the current step causes no anxiety. It is used mainly for specific phobias.
- A: A token economy rewards desired behaviour with tokens.
- B: Flooding exposes the patient to the most feared situation at once, without a graded list.
- C: Aversion therapy pairs an unwanted habit with an unpleasant stimulus.
Question 6 · Hard
While preparing a patient for ECT, which finding should the nurse report to the doctor before the session goes ahead?
1. APregnancy at 20 weeks with severe depression
2. BRegular use of an SSRI for the past month
3. CMorning headaches with papilloedema on fundoscopy
4. DAge 68 years with treatment-resistant depression
Answer and explanation in LearnFree account
Question 7 · Easy
A man scolded by his manager comes home and shouts at his wife over a minor matter. The defence mechanism shown is:
1. ARegression
2. BDisplacement
3. CSublimation
4. DProjection
Answer and explanation in LearnFree account
Question 8 · Easy
In the mental status examination, asking the patient to subtract 7 from 100 repeatedly mainly tests:
1. ALong-term (remote) memory
2. BJudgement
3. CAbstract thinking and reasoning
4. DAttention and concentration
Answer and explanation in LearnFree account
Question 9 · Hard
Two days before planned discharge, a patient who had improved steadily becomes withdrawn and says his old symptoms have returned. What should the nurse do?
1. AIncrease his medicines until the symptoms settle
2. BExplore his feelings about ending the relationship
3. CStop meeting him so he learns to cope alone
4. DAsk the doctor to cancel the discharge at once
Answer and explanation in LearnFree account
Question 10 · Hard
During group therapy, a patient in a manic episode talks loudly, interrupts everyone and will not sit down. What is the nurse's best action?
1. ALet him lead the group to use his high energy
2. BAsk the group members to vote on whether he may stay in the room
3. CTake him to a quieter area and use short, firm statements
4. DArgue with him about each of his ideas in turn
Answer and explanation in LearnFree account
Question 11 · Medium
A patient with schizophrenia says, 'The voices keep telling me I am evil.' Which response by the nurse is most therapeutic?
1. ADo the voices belong to people you know?
2. BThere are no voices there; it is only your illness talking.
3. CI don't hear the voices, but you seem frightened by them.
4. DJust ignore them and they will go away soon.
Answer and explanation in LearnFree account
Question 12 · Medium
A depressed patient is helped to identify thoughts such as 'I always fail' and to test them against evidence. This therapy is:
1. ACognitive behaviour therapy
2. BPsychoanalysis
3. CAversion therapy
4. DSystematic desensitisation therapy
Answer and explanation in LearnFree account
Question 13 · Easy
In Peplau's model of the nurse-patient relationship, the nurse examines her own feelings, fears and biases in which phase?
1. AWorking phase
2. BPre-interaction phase
3. COrientation phase
4. DTermination phase
Answer and explanation in LearnFree account
Question 14 · Easy
Under the Mental Healthcare Act 2017, a person who attempts suicide is:
1. ALiable to a year's prison under the Indian Penal Code
2. BPresumed to have severe stress unless proved otherwise
3. CBarred from voting until declared fit by a Board
4. DAdmitted compulsorily to a mental health establishment
Answer and explanation in LearnFree account
Question 15 · Hard
During an interview, a patient answers a question about his sleep with long details of his job, his journey and his neighbour's dog, but finally says he sleeps well. This thought pattern is:
1. AFlight of ideas
2. BTangentiality
3. CPerseveration
4. DCircumstantiality
Answer and explanation in LearnFree account
Question 16 · Medium
Under the Mental Healthcare Act 2017, a person can choose who will support him in treatment decisions by appointing a:
1. AMental Health Review Board
2. BLegal guardian
3. CNominated representative
4. DMedical officer in charge
Answer and explanation in LearnFree account
Question 17 · Medium
A man who has strong, hidden hostile feelings towards his father behaves in an extremely loving and attentive way towards him. Which defence mechanism is this?
1. ACompensation
2. BRationalisation
3. CDisplacement
4. DReaction formation
Answer and explanation in LearnFree account
Question 18 · Easy
When a patient pauses, the nurse says 'Go on...' and nods. This therapeutic technique is called:
1. AOffering general leads
2. BReflecting the feelings back
3. CRestating
4. DGiving recognition
Answer and explanation in LearnFree account
Question 19 · Hard
A patient tells the nurse, 'I will hang myself tonight, but promise you won't tell anyone.' Which response by the nurse is best?
1. AI promise I won't tell anyone, but please tell me why you feel so.
2. BLet's talk about it tomorrow when you are feeling calmer.
3. CI can't keep this secret; I must tell the team so you stay safe.
4. DYou don't really mean that; you have been doing so well.
Answer and explanation in LearnFree account
Question 20 · Medium
Immediately after a modified ECT session, while the patient is still drowsy, the nurse's priority is to:
1. AGive him breakfast to restore his blood sugar
2. BTest his memory of the events of the morning
3. CWalk him back to the ward to prevent stiffness
4. DKeep the airway clear and nurse him on his side
Answer and explanation in LearnFree account
Question 21 · Medium
Under the Mental Healthcare Act 2017, ECT may be given only:
1. AWithout anaesthesia in an emergency
2. BWith anaesthesia and a muscle relaxant
3. CWhen the patient's family gives consent
4. DOn the order of a magistrate
Answer and explanation in LearnFree account
Question 22 · Hard
A severely disturbed patient needs immediate treatment to prevent harm to himself, without his consent. Under the Mental Healthcare Act 2017, such emergency treatment may last up to:
1. A72 hours
2. B30 days
3. C24 hours
4. D7 days
Answer and explanation in LearnFree account

Therapeutic communication, defence mechanisms and therapies

A patient with paranoid schizophrenia refuses meals, saying the food is poisoned. The most appropriate nursing action is to:

Before an ECT session done under general anaesthesia, the patient is usually kept nil by mouth for:

A student who failed the medical entrance exam says, 'I never really wanted to be a doctor anyway.' This is an example of:

The most common side effect of ECT is:

A woman with a fear of dogs is taught deep relaxation, then exposed step by step to a list of dog-related situations, from a picture to touching a dog. This therapy is:

While preparing a patient for ECT, which finding should the nurse report to the doctor before the session goes ahead?

A man scolded by his manager comes home and shouts at his wife over a minor matter. The defence mechanism shown is:

In the mental status examination, asking the patient to subtract 7 from 100 repeatedly mainly tests:

Two days before planned discharge, a patient who had improved steadily becomes withdrawn and says his old symptoms have returned. What should the nurse do?

During group therapy, a patient in a manic episode talks loudly, interrupts everyone and will not sit down. What is the nurse's best action?

A patient with schizophrenia says, 'The voices keep telling me I am evil.' Which response by the nurse is most therapeutic?

A depressed patient is helped to identify thoughts such as 'I always fail' and to test them against evidence. This therapy is:

In Peplau's model of the nurse-patient relationship, the nurse examines her own feelings, fears and biases in which phase?

Under the Mental Healthcare Act 2017, a person who attempts suicide is:

During an interview, a patient answers a question about his sleep with long details of his job, his journey and his neighbour's dog, but finally says he sleeps well. This thought pattern is:

Under the Mental Healthcare Act 2017, a person can choose who will support him in treatment decisions by appointing a:

A man who has strong, hidden hostile feelings towards his father behaves in an extremely loving and attentive way towards him. Which defence mechanism is this?

When a patient pauses, the nurse says 'Go on...' and nods. This therapeutic technique is called:

A patient tells the nurse, 'I will hang myself tonight, but promise you won't tell anyone.' Which response by the nurse is best?

Immediately after a modified ECT session, while the patient is still drowsy, the nurse's priority is to:

Under the Mental Healthcare Act 2017, ECT may be given only:

A severely disturbed patient needs immediate treatment to prevent harm to himself, without his consent. Under the Mental Healthcare Act 2017, such emergency treatment may last up to: