A 40-year-old woman with severe depression is discharged on amitriptyline. She lives alone and still feels hopeless. Which plan for her medicine is safest?

Dispense only a small supply at a time

Give a three-month supply to save visits

Advise her to double the dose if low

Switch to taking it only when needed

ECT is the treatment of choice in which situation?

Severe depression with active suicidal intent

Antisocial personality disorder

Generalised anxiety disorder with insomnia

Obsessive-compulsive disorder with checking

A man with schizophrenia started haloperidol 10 days ago. He paces, cannot sit through meals and says he feels restless inside his legs. The PRN order is haloperidol for agitation. The nurse should:

Report it as a likely drug side effect

Encourage exercise to tire him out

Place him in the seclusion room

Give the PRN haloperidol for agitation

Therapeutic communication and treatment modalities

25 Kerala PSC Staff Nurse Gr II practice questions on Therapeutic communication and treatment modalities, 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
In the Johari window, the part of a nurse's behaviour that colleagues and patients notice but she herself is unaware of is the:
1. AHidden area
2. BOpen area
3. CUnknown area
4. DBlind area
Show answerHide answer
Answer: D · Blind area
Luft and Ingham's Johari window has four areas: open (known to self and others), blind (known to others but not to self), hidden (known to self but kept from others) and unknown (known to no one). Asking for and accepting feedback shrinks the blind area and builds self-awareness. A self-aware nurse can keep her own feelings and habits from affecting the therapeutic relationship.
- A: The hidden area is known to the nurse but kept from others.
- B: The open area is known both to the nurse and to others.
- C: The unknown area is known neither to the nurse nor to others.
Question 2 · Easy
A token economy on a long-stay psychiatric ward is based on which learning principle?
1. AOperant conditioning
2. BClassical conditioning
3. CPsychoanalytic insight
4. DCognitive restructuring
Show answerHide answer
Answer: A · Operant conditioning
In a token economy, desired behaviours such as self-care or attending activities earn tokens that are exchanged for privileges. This is positive reinforcement, the core of Skinner's operant conditioning: behaviour followed by a reward becomes more frequent. It is used for chronic schizophrenia and in children with behaviour problems. Tokens must be given consistently and immediately.
- B: Classical conditioning (Pavlov) pairs two stimuli; it is the basis of aversion therapy and desensitisation.
- C: Psychoanalysis works through unconscious conflicts, not rewards.
- D: Cognitive restructuring changes faulty thoughts rather than rewarding behaviour.
Question 3 · Hard
A 40-year-old woman with severe depression is discharged on amitriptyline. She lives alone and still feels hopeless. Which plan for her medicine is safest?
1. ADispense only a small supply at a time
2. BGive a three-month supply to save visits
3. CAdvise her to double the dose if low
4. DSwitch to taking it only when needed
Show answerHide answer
Answer: A · Dispense only a small supply at a time
Tricyclic antidepressants such as amitriptyline are highly toxic in overdose, causing arrhythmias, seizures and coma, and a few weeks' supply can be fatal. A patient who still feels hopeless and lives alone is at risk, so small amounts (about a week's supply) are given, ideally held by a family member. Close follow-up checks mood and suicidal ideas.
- B: A large supply provides the means for a fatal overdose.
- C: Doubling the dose raises toxicity and does not speed the response.
- D: Antidepressants must be taken daily; as-needed use does not work.
Question 4 · Medium
ECT is the treatment of choice in which situation?
1. AAntisocial personality disorder
2. BGeneralised anxiety disorder with insomnia
3. CSevere depression with active suicidal intent
4. DObsessive-compulsive disorder with checking
Show answerHide answer
Answer: C · Severe depression with active suicidal intent
ECT works faster than antidepressants, so it is preferred when a quick response is life-saving: severe depression with active suicidal intent, refusal of food and fluids, depressive stupor and catatonia. It is also used in drug-resistant mania and schizophrenia. It has little role in anxiety, personality or obsessive disorders.
- A: Personality disorders do not respond to ECT.
- B: Anxiety disorders are treated with psychotherapy and drugs; ECT is not indicated.
- D: OCD is treated with SSRIs and exposure and response prevention, not ECT.
Question 5 · Hard
A man with schizophrenia started haloperidol 10 days ago. He paces, cannot sit through meals and says he feels restless inside his legs. The PRN order is haloperidol for agitation. The nurse should:
1. AEncourage exercise to tire him out
2. BReport it as a likely drug side effect
3. CPlace him in the seclusion room
4. DGive the PRN haloperidol for agitation
Show answerHide answer
Answer: B · Report it as a likely drug side effect
Inner restlessness with an inability to sit still, starting days to weeks after an antipsychotic, is akathisia, an extrapyramidal side effect. It is easily mistaken for psychotic agitation, and giving more haloperidol makes it worse. The nurse reports it so the doctor can lower the dose or add propranolol or a benzodiazepine. Untreated akathisia distresses patients and leads to stopping medicines and even suicide.
- A: Exercise does not relieve akathisia and delays proper treatment.
- C: Seclusion treats the restlessness as behaviour, not as a drug effect.
- D: More haloperidol worsens akathisia.
Question 6 · Medium
A patient is switched from an MAO inhibitor to an SSRI. The minimum drug-free gap before the SSRI is started is:
1. A24 hours
2. B6 months
3. C2 weeks
4. D3 days
Answer and explanation in LearnFree account
Question 7 · Medium
A manic patient says, 'The car is far, a star, a jar, a guitar.' In the mental status examination, this is recorded as:
1. AEcholalia
2. BPerseveration
3. CNeologism
4. DClang association
Answer and explanation in LearnFree account
Question 8 · Easy
In Egan's SOLER guide to attentive listening, the letter 'L' stands for:
1. ALean towards the patient
2. BLook at the patient's face
3. CLower your voice
4. DListen without interrupting
Answer and explanation in LearnFree account
Question 9 · Easy
A nurse asks a patient who refuses his tablets, 'Why are you being so difficult?' This is a non-therapeutic technique called:
1. AExploring
2. BGiving recognition
3. CRequesting an explanation
4. DEncouraging comparison
Answer and explanation in LearnFree account
Question 10 · Medium
Family psychoeducation that lowers 'expressed emotion' in the homes of patients with schizophrenia mainly helps to:
1. APrevent tardive dyskinesia
2. BReduce the rate of relapse
3. CRemove the need for medicines
4. DCure the negative symptoms
Answer and explanation in LearnFree account
Question 11 · Easy
The nurse and patient agree on meeting times, place and goals in which phase of the nurse-patient relationship?
1. AOrientation phase
2. BTermination phase
3. CWorking phase
4. DPre-interaction phase
Answer and explanation in LearnFree account
Question 12 · Easy
Electroconvulsive therapy was first used in 1938 by:
1. AEgas Moniz
2. BLadislas Meduna
3. CCerletti and Bini
4. DManfred Sakel
Answer and explanation in LearnFree account
Question 13 · Easy
A patient says, 'My son never visits me.' The nurse replies, 'You sound hurt by that.' This technique is:
1. AVoicing doubt
2. BGiving information
3. CReflecting feelings
4. DMaking an observation
Answer and explanation in LearnFree account
Question 14 · Medium
Why is a depressed patient watched closely for suicide in the first weeks of antidepressant treatment?
1. AThe drug is most toxic in the first weeks
2. BAntidepressants directly cause suicidal ideas
3. CSleep improves only after several months
4. DEnergy returns before the low mood lifts
Answer and explanation in LearnFree account
Question 15 · Medium
A woman angrily accuses the nurse of being 'bossy, just like my mother'. This reaction is called:
1. ADisplacement
2. BProjection
3. CCountertransference
4. DTransference
Answer and explanation in LearnFree account
Question 16 · Easy
In the mental status examination, hearing voices when no one is present is recorded under:
1. APerception
2. BCognition
3. CThought content
4. DMood and affect
Answer and explanation in LearnFree account
Question 17 · Hard
Fluphenazine decanoate 37.5 mg deep IM is ordered. The ampoule contains 25 mg/mL. How much should the nurse give?
1. A1.5 mL
2. B0.67 mL
3. C3.75 mL
4. D0.15 mL
Answer and explanation in LearnFree account
Question 18 · Easy
In modified ECT, the drug given to prevent violent muscle contractions and fractures is:
1. ANeostigmine
2. BSuccinylcholine
3. CThiopentone
4. DAtropine
Answer and explanation in LearnFree account
Question 19 · Medium
A man with a fear of lifts is made to stay in a lift for a long time until his anxiety settles. This therapy is:
1. ASystematic desensitisation
2. BToken economy
3. CFlooding
4. DAversion therapy
Answer and explanation in LearnFree account
Question 20 · Medium
In group therapy, a patient is relieved to learn that others have the same problems. Yalom calls this curative factor:
1. AAltruism
2. BCatharsis
3. CUniversality
4. DImitative behaviour
Answer and explanation in LearnFree account
Question 21 · Hard
A man with schizophrenia, stable for a year under the District Mental Health Programme clinic, stopped his tablets 2 weeks ago. His family reports poor sleep, irritability and staying in his room. The community nurse should:
1. AArrange an early review at the DMHP clinic
2. BTell the family to double his old dose
3. CWait for his next monthly clinic visit
4. DAdmit him directly to a mental hospital
Answer and explanation in LearnFree account
Question 22 · Easy
Which drug is commonly given with antipsychotics to treat drug-induced parkinsonism?
1. APropranolol
2. BLevodopa
3. CTrihexyphenidyl
4. DLorazepam
Answer and explanation in LearnFree account
Question 23 · Hard
On the day before discharge, a patient asks the nurse for her personal mobile number so they can 'stay friends'. The best response is:
1. APromise to visit him at home after discharge
2. BAvoid him for the rest of the shift
3. CGive the number since he has recovered
4. DKindly decline and explain the relationship is professional
Answer and explanation in LearnFree account
Question 24 · Easy
The concept of the therapeutic community was developed by:
1. AHarry Stack Sullivan
2. BHildegard Peplau
3. CSigmund Freud
4. DMaxwell Jones
Answer and explanation in LearnFree account
Question 25 · Medium
All of the following are therapeutic communication techniques EXCEPT:
1. ASeeking clarification
2. BGiving advice
3. CFocusing
4. DSummarising
Answer and explanation in LearnFree account

Therapeutic communication and treatment modalities

In the Johari window, the part of a nurse's behaviour that colleagues and patients notice but she herself is unaware of is the:

A token economy on a long-stay psychiatric ward is based on which learning principle?

A 40-year-old woman with severe depression is discharged on amitriptyline. She lives alone and still feels hopeless. Which plan for her medicine is safest?

ECT is the treatment of choice in which situation?

A man with schizophrenia started haloperidol 10 days ago. He paces, cannot sit through meals and says he feels restless inside his legs. The PRN order is haloperidol for agitation. The nurse should:

A patient is switched from an MAO inhibitor to an SSRI. The minimum drug-free gap before the SSRI is started is:

A manic patient says, 'The car is far, a star, a jar, a guitar.' In the mental status examination, this is recorded as:

In Egan's SOLER guide to attentive listening, the letter 'L' stands for:

A nurse asks a patient who refuses his tablets, 'Why are you being so difficult?' This is a non-therapeutic technique called:

Family psychoeducation that lowers 'expressed emotion' in the homes of patients with schizophrenia mainly helps to:

The nurse and patient agree on meeting times, place and goals in which phase of the nurse-patient relationship?

Electroconvulsive therapy was first used in 1938 by:

A patient says, 'My son never visits me.' The nurse replies, 'You sound hurt by that.' This technique is:

Why is a depressed patient watched closely for suicide in the first weeks of antidepressant treatment?

A woman angrily accuses the nurse of being 'bossy, just like my mother'. This reaction is called:

In the mental status examination, hearing voices when no one is present is recorded under:

Fluphenazine decanoate 37.5 mg deep IM is ordered. The ampoule contains 25 mg/mL. How much should the nurse give?

In modified ECT, the drug given to prevent violent muscle contractions and fractures is:

A man with a fear of lifts is made to stay in a lift for a long time until his anxiety settles. This therapy is:

In group therapy, a patient is relieved to learn that others have the same problems. Yalom calls this curative factor:

A man with schizophrenia, stable for a year under the District Mental Health Programme clinic, stopped his tablets 2 weeks ago. His family reports poor sleep, irritability and staying in his room. The community nurse should:

Which drug is commonly given with antipsychotics to treat drug-induced parkinsonism?

On the day before discharge, a patient asks the nurse for her personal mobile number so they can 'stay friends'. The best response is:

The concept of the therapeutic community was developed by:

All of the following are therapeutic communication techniques EXCEPT: