NU664C Exam 1: Family Psychiatric Mental Health I
2026/2027 |Newly Released| Regis College
55 Questions & Answers | Grade A | 100% Correct Rationales
Guaranteed Pass
Q1: A 72-year-old patient with schizophrenia is refusing antipsychotic medication, stating "the
pills are poison." The psychiatric nurse practitioner evaluates whether the patient can
understand the risks of refusing treatment. This evaluation assesses which legal concept?
A. Competency, which requires a court hearing to determine legal status
B. Capacity, which is a clinical determination of decision-making ability
C. Guardianship, which appoints a proxy for all future medical decisions
D. Informed consent, which requires the patient to sign a written document
Correct Answer: B
Rationale: Correct because capacity is a clinical, decision-specific determination made by
healthcare providers evaluating whether a patient can understand relevant information,
appreciate their condition, reason about treatment options, and communicate a choice—in this
case, understanding the risks of refusing antipsychotic medication. Competency is a global legal
status determined only by courts, not clinicians; guardianship is a legal remedy when capacity is
absent, not the assessment itself; informed consent is a process, not a determination of mental
ability.
Q2: A patient with bipolar I disorder presents with acute severe mania, psychosis, and
aggressive behavior requiring immediate stabilization. The psychiatric nurse practitioner
anticipates which medication as first-line for rapid control?
A. Lithium carbonate for immediate mood stabilization
B. Lamotrigine for acute manic symptoms
C. Valproate or an atypical antipsychotic for rapid onset of action
D. Carbamazepine for long-term maintenance therapy
,Correct Answer: D
Rationale: Correct because acute severe mania requires medications with rapid onset, and
valproate (particularly intravenous formulation) or atypical antipsychotics such as olanzapine or
risperidone provide faster symptom control than lithium, which has a 7-10 day latency for
therapeutic effect. Lamotrigine is indicated for bipolar depression maintenance, not acute
mania; carbamazepine is a second-line option for maintenance, not first-line for acute
stabilization.
Q3: A patient completes the PHQ-2 screening and scores 4 (positive screen). The psychiatric
nurse practitioner understands that the next appropriate step is which action?
A. Administer the full PHQ-9 to assess severity and suicidal ideation
B. Initiate antidepressant therapy immediately based on the PHQ-2 result
C. Reassure the patient that the score indicates normal mood variation
D. Refer the patient for inpatient psychiatric admission
Correct Answer: A
Rationale: Correct because a PHQ-2 score of 4 (≥3 indicates positive screen) requires follow-up
with the full PHQ-9 to evaluate all nine DSM-5 criteria for major depressive disorder, quantify
severity, and specifically assess suicidal ideation via Question 9, which guides safety planning
and treatment decisions. Initiating medication based solely on PHQ-2 is premature; reassurance
minimizes legitimate symptoms; inpatient referral is unnecessary without further assessment of
severity and safety risk.
Q4: A patient on lithium therapy presents with nausea, coarse tremor, ataxia, and confusion.
The lithium level is 2.1 mEq/L. The psychiatric nurse practitioner recognizes these findings as
indicating which condition?
A. Therapeutic lithium maintenance requiring dose adjustment
B. Lithium toxicity requiring immediate discontinuation and supportive care
C. Expected side effects of lithium initiation that will resolve with time
D. Hypothyroidism from lithium-induced endocrine dysfunction
Correct Answer: C
, Rationale: Correct because a lithium level of 2.1 mEq/L exceeds the therapeutic range (0.6-1.2
mEq/L for maintenance; >1.5 mEq/L indicates toxicity), and the presentation of nausea, coarse
tremor, ataxia, and confusion represents moderate-to-severe lithium toxicity requiring
immediate discontinuation of lithium, supportive care, and possible hemodialysis if levels
exceed 2.5 mEq/L or if renal function is compromised. Therapeutic maintenance levels do not
cause these severe symptoms; expected side effects include fine tremor and mild GI upset, not
ataxia and confusion; hypothyroidism presents with fatigue, weight gain, and cold intolerance,
not acute neurologic symptoms.
Q5: Under Massachusetts law, a patient admitted to a psychiatric facility signs a written request
for discharge. The facility may detain the patient for up to 3 days if the physician determines the
patient remains clinically appropriate for inpatient care. This describes which type of admission?
A. Section 11 voluntary admission with immediate discharge rights
B. Section 10 conditional voluntary admission with 3-day notice requirement
C. Section 12 emergency involuntary admission for danger to self or others
D. Rogers Guardianship with court-appointed proxy decision-making
Correct Answer: B
Rationale: Correct because Section 10 of Massachusetts General Law governs conditional
voluntary admission, wherein a patient may request discharge by providing a written 3-day
notice, and the facility may hold the patient during this period if the physician certifies that
inpatient care remains clinically necessary and appropriate. Section 11 allows immediate
discharge without restriction; Section 12 involves involuntary commitment for patients who are
dangerous or gravely disabled; Rogers Guardianship addresses treatment decisions for
incompetent patients, not admission status.
Q6: A patient with bipolar II disorder reports depressive episodes with periods of increased
energy, decreased sleep, and racing thoughts lasting 4 days without functional impairment. The
psychiatric nurse practitioner recognizes these periods as which type of episode?
A. Manic episodes requiring hospitalization for safety
B. Hypomanic episodes consistent with bipolar II diagnosis
C. Major depressive episodes with mixed features
2026/2027 |Newly Released| Regis College
55 Questions & Answers | Grade A | 100% Correct Rationales
Guaranteed Pass
Q1: A 72-year-old patient with schizophrenia is refusing antipsychotic medication, stating "the
pills are poison." The psychiatric nurse practitioner evaluates whether the patient can
understand the risks of refusing treatment. This evaluation assesses which legal concept?
A. Competency, which requires a court hearing to determine legal status
B. Capacity, which is a clinical determination of decision-making ability
C. Guardianship, which appoints a proxy for all future medical decisions
D. Informed consent, which requires the patient to sign a written document
Correct Answer: B
Rationale: Correct because capacity is a clinical, decision-specific determination made by
healthcare providers evaluating whether a patient can understand relevant information,
appreciate their condition, reason about treatment options, and communicate a choice—in this
case, understanding the risks of refusing antipsychotic medication. Competency is a global legal
status determined only by courts, not clinicians; guardianship is a legal remedy when capacity is
absent, not the assessment itself; informed consent is a process, not a determination of mental
ability.
Q2: A patient with bipolar I disorder presents with acute severe mania, psychosis, and
aggressive behavior requiring immediate stabilization. The psychiatric nurse practitioner
anticipates which medication as first-line for rapid control?
A. Lithium carbonate for immediate mood stabilization
B. Lamotrigine for acute manic symptoms
C. Valproate or an atypical antipsychotic for rapid onset of action
D. Carbamazepine for long-term maintenance therapy
,Correct Answer: D
Rationale: Correct because acute severe mania requires medications with rapid onset, and
valproate (particularly intravenous formulation) or atypical antipsychotics such as olanzapine or
risperidone provide faster symptom control than lithium, which has a 7-10 day latency for
therapeutic effect. Lamotrigine is indicated for bipolar depression maintenance, not acute
mania; carbamazepine is a second-line option for maintenance, not first-line for acute
stabilization.
Q3: A patient completes the PHQ-2 screening and scores 4 (positive screen). The psychiatric
nurse practitioner understands that the next appropriate step is which action?
A. Administer the full PHQ-9 to assess severity and suicidal ideation
B. Initiate antidepressant therapy immediately based on the PHQ-2 result
C. Reassure the patient that the score indicates normal mood variation
D. Refer the patient for inpatient psychiatric admission
Correct Answer: A
Rationale: Correct because a PHQ-2 score of 4 (≥3 indicates positive screen) requires follow-up
with the full PHQ-9 to evaluate all nine DSM-5 criteria for major depressive disorder, quantify
severity, and specifically assess suicidal ideation via Question 9, which guides safety planning
and treatment decisions. Initiating medication based solely on PHQ-2 is premature; reassurance
minimizes legitimate symptoms; inpatient referral is unnecessary without further assessment of
severity and safety risk.
Q4: A patient on lithium therapy presents with nausea, coarse tremor, ataxia, and confusion.
The lithium level is 2.1 mEq/L. The psychiatric nurse practitioner recognizes these findings as
indicating which condition?
A. Therapeutic lithium maintenance requiring dose adjustment
B. Lithium toxicity requiring immediate discontinuation and supportive care
C. Expected side effects of lithium initiation that will resolve with time
D. Hypothyroidism from lithium-induced endocrine dysfunction
Correct Answer: C
, Rationale: Correct because a lithium level of 2.1 mEq/L exceeds the therapeutic range (0.6-1.2
mEq/L for maintenance; >1.5 mEq/L indicates toxicity), and the presentation of nausea, coarse
tremor, ataxia, and confusion represents moderate-to-severe lithium toxicity requiring
immediate discontinuation of lithium, supportive care, and possible hemodialysis if levels
exceed 2.5 mEq/L or if renal function is compromised. Therapeutic maintenance levels do not
cause these severe symptoms; expected side effects include fine tremor and mild GI upset, not
ataxia and confusion; hypothyroidism presents with fatigue, weight gain, and cold intolerance,
not acute neurologic symptoms.
Q5: Under Massachusetts law, a patient admitted to a psychiatric facility signs a written request
for discharge. The facility may detain the patient for up to 3 days if the physician determines the
patient remains clinically appropriate for inpatient care. This describes which type of admission?
A. Section 11 voluntary admission with immediate discharge rights
B. Section 10 conditional voluntary admission with 3-day notice requirement
C. Section 12 emergency involuntary admission for danger to self or others
D. Rogers Guardianship with court-appointed proxy decision-making
Correct Answer: B
Rationale: Correct because Section 10 of Massachusetts General Law governs conditional
voluntary admission, wherein a patient may request discharge by providing a written 3-day
notice, and the facility may hold the patient during this period if the physician certifies that
inpatient care remains clinically necessary and appropriate. Section 11 allows immediate
discharge without restriction; Section 12 involves involuntary commitment for patients who are
dangerous or gravely disabled; Rogers Guardianship addresses treatment decisions for
incompetent patients, not admission status.
Q6: A patient with bipolar II disorder reports depressive episodes with periods of increased
energy, decreased sleep, and racing thoughts lasting 4 days without functional impairment. The
psychiatric nurse practitioner recognizes these periods as which type of episode?
A. Manic episodes requiring hospitalization for safety
B. Hypomanic episodes consistent with bipolar II diagnosis
C. Major depressive episodes with mixed features
