NU664C Exam 2: Family Psychiatric Mental Health I
2026/2027 |Newly Released| Regis College
60 Questions & Answers | Grade A | 100% Correct Rationales
Guaranteed Pass
Q1: A 28-year-old male presents with 5 months of auditory hallucinations commenting on his
actions, persecutory delusions about neighbors plotting against him, and disorganized speech. He
has no prominent mood symptoms. The psychiatric nurse practitioner recognizes that the
duration of active-phase symptoms meets criteria for which diagnosis?
A. Brief psychotic disorder with stress-related onset
B. Schizophreniform disorder requiring 6-month total duration
C. Schizophrenia with continuous signs for at least 6 months
D. Schizoaffective disorder with concurrent major depression
Correct Answer: C
Rationale: Correct because schizophrenia requires continuous signs of disturbance for at least 6
months, including at least 1 month of active-phase symptoms (delusions, hallucinations,
disorganized speech, grossly disorganized behavior, or negative symptoms), and this patient's 5
months of active symptoms with functional decline meets the active-phase criterion within the
context of emerging illness. Brief psychotic disorder lasts less than 1 month; schizophreniform
requires 1-6 months total but is provisional; schizoaffective disorder requires prominent mood
episodes concurrent with psychotic symptoms.
Q2: A patient with schizophrenia is prescribed chlorpromazine 400 mg daily. After 2 weeks, the
patient develops resting tremor, cogwheel rigidity, and shuffling gait. The psychiatric nurse
practitioner recognizes these symptoms as indicating which extrapyramidal syndrome?
A. Acute dystonia with sustained muscle spasms
B. Akathisia with subjective restlessness
C. Parkinsonism from nigrostriatal D2 receptor blockade
D. Tardive dyskinesia with choreoathetoid movements
Correct Answer: A
,Rationale: Correct because drug-induced parkinsonism presents with the classic triad of resting
tremor, cogwheel rigidity, and bradykinesia (shuffling gait), resulting from D2 receptor
antagonism in the nigrostriatal pathway that mimics idiopathic Parkinson's disease, typically
emerging within weeks of initiating or increasing typical antipsychotic doses. Acute dystonia
involves sustained spasms; akathisia presents as restlessness; tardive dyskinesia develops after
chronic treatment with involuntary movements.
Q3: A patient with treatment-resistant schizophrenia has failed adequate trials of olanzapine,
risperidone, and ziprasidone. The psychiatric nurse practitioner discusses clozapine initiation.
Which baseline parameter is mandatory before starting clozapine?
A. Thyroid function tests to detect hypothyroidism
B. Absolute neutrophil count through the REMS program
C. Electrocardiogram to assess cardiac conduction
D. Liver function tests for hepatotoxicity screening
Correct Answer: D
Rationale: Correct because clozapine requires mandatory baseline and ongoing absolute
neutrophil count monitoring through the FDA-mandated Risk Evaluation and Mitigation Strategy
(REMS) program due to the risk of agranulocytosis, a potentially fatal drop in neutrophils
occurring in approximately 1% of patients, with weekly monitoring for the first 6 months.
Thyroid monitoring is for lithium; ECG is important for ziprasidone and haloperidol; liver tests
are standard but not clozapine-specific.
Q4: A 35-year-old woman presents with sudden onset of paranoid delusions and auditory
hallucinations 3 weeks after surviving a natural disaster. She has no prior psychiatric history, and
her symptoms are gradually improving with supportive care. The psychiatric nurse practitioner
recognizes this as consistent with which disorder?
A. Schizophrenia with early onset and chronic course
B. Brief psychotic disorder with full return to baseline expected
C. Schizoaffective disorder with depressive features
D. Delusional disorder with non-bizarre delusions
Correct Answer: B
, Rationale: Correct because brief psychotic disorder is characterized by sudden onset of
delusions, hallucinations, disorganized speech, or grossly disorganized behavior lasting at least 1
day but less than 1 month, often triggered by severe psychosocial stressors, with eventual full
return to premorbid functioning, which this patient's post-disaster presentation and gradual
improvement demonstrates. Schizophrenia requires 6 months; schizoaffective disorder requires
mood episodes; delusional disorder involves non-bizarre delusions without prominent
hallucinations or marked impairment.
Q5: A patient with catatonia presents with immobility, mutism, negativism, and waxy flexibility.
The psychiatric nurse practitioner administers lorazepam 2 mg IV. Within 45 minutes, the patient
begins speaking, moves spontaneously, and follows commands. This response indicates which
treatment approach?
A. Resistance to benzodiazepines requiring immediate ECT
B. Positive lorazepam challenge predicting benzodiazepine responsiveness
C. Paradoxical reaction necessitating antipsychotic administration
D. Spontaneous remission unrelated to medication effect
Correct Answer: C
Rationale: Correct because a rapid and dramatic improvement in catatonic symptoms after
lorazepam administration constitutes a positive lorazepam challenge test, which predicts
responsiveness to high-dose benzodiazepine therapy and may allow avoidance of
electroconvulsive therapy unless symptoms recur or fail to sustain improvement. Resistance
would show no change; paradoxical reactions are rare and present with agitation; spontaneous
remission within 45 minutes of IV lorazepam is attributable to the medication.
Q6: A patient with schizophrenia is prescribed quetiapine 600 mg daily. The psychiatric nurse
practitioner explains that quetiapine's pharmacologic profile includes which receptor binding
characteristic?
A. High D2 affinity with minimal serotonergic activity
B. Potent 5-HT2A antagonism and low D2 affinity at therapeutic doses
C. Pure D2 antagonism without other receptor activity
D. NMDA receptor antagonism similar to dissociative anesthetics
Correct Answer: A
2026/2027 |Newly Released| Regis College
60 Questions & Answers | Grade A | 100% Correct Rationales
Guaranteed Pass
Q1: A 28-year-old male presents with 5 months of auditory hallucinations commenting on his
actions, persecutory delusions about neighbors plotting against him, and disorganized speech. He
has no prominent mood symptoms. The psychiatric nurse practitioner recognizes that the
duration of active-phase symptoms meets criteria for which diagnosis?
A. Brief psychotic disorder with stress-related onset
B. Schizophreniform disorder requiring 6-month total duration
C. Schizophrenia with continuous signs for at least 6 months
D. Schizoaffective disorder with concurrent major depression
Correct Answer: C
Rationale: Correct because schizophrenia requires continuous signs of disturbance for at least 6
months, including at least 1 month of active-phase symptoms (delusions, hallucinations,
disorganized speech, grossly disorganized behavior, or negative symptoms), and this patient's 5
months of active symptoms with functional decline meets the active-phase criterion within the
context of emerging illness. Brief psychotic disorder lasts less than 1 month; schizophreniform
requires 1-6 months total but is provisional; schizoaffective disorder requires prominent mood
episodes concurrent with psychotic symptoms.
Q2: A patient with schizophrenia is prescribed chlorpromazine 400 mg daily. After 2 weeks, the
patient develops resting tremor, cogwheel rigidity, and shuffling gait. The psychiatric nurse
practitioner recognizes these symptoms as indicating which extrapyramidal syndrome?
A. Acute dystonia with sustained muscle spasms
B. Akathisia with subjective restlessness
C. Parkinsonism from nigrostriatal D2 receptor blockade
D. Tardive dyskinesia with choreoathetoid movements
Correct Answer: A
,Rationale: Correct because drug-induced parkinsonism presents with the classic triad of resting
tremor, cogwheel rigidity, and bradykinesia (shuffling gait), resulting from D2 receptor
antagonism in the nigrostriatal pathway that mimics idiopathic Parkinson's disease, typically
emerging within weeks of initiating or increasing typical antipsychotic doses. Acute dystonia
involves sustained spasms; akathisia presents as restlessness; tardive dyskinesia develops after
chronic treatment with involuntary movements.
Q3: A patient with treatment-resistant schizophrenia has failed adequate trials of olanzapine,
risperidone, and ziprasidone. The psychiatric nurse practitioner discusses clozapine initiation.
Which baseline parameter is mandatory before starting clozapine?
A. Thyroid function tests to detect hypothyroidism
B. Absolute neutrophil count through the REMS program
C. Electrocardiogram to assess cardiac conduction
D. Liver function tests for hepatotoxicity screening
Correct Answer: D
Rationale: Correct because clozapine requires mandatory baseline and ongoing absolute
neutrophil count monitoring through the FDA-mandated Risk Evaluation and Mitigation Strategy
(REMS) program due to the risk of agranulocytosis, a potentially fatal drop in neutrophils
occurring in approximately 1% of patients, with weekly monitoring for the first 6 months.
Thyroid monitoring is for lithium; ECG is important for ziprasidone and haloperidol; liver tests
are standard but not clozapine-specific.
Q4: A 35-year-old woman presents with sudden onset of paranoid delusions and auditory
hallucinations 3 weeks after surviving a natural disaster. She has no prior psychiatric history, and
her symptoms are gradually improving with supportive care. The psychiatric nurse practitioner
recognizes this as consistent with which disorder?
A. Schizophrenia with early onset and chronic course
B. Brief psychotic disorder with full return to baseline expected
C. Schizoaffective disorder with depressive features
D. Delusional disorder with non-bizarre delusions
Correct Answer: B
, Rationale: Correct because brief psychotic disorder is characterized by sudden onset of
delusions, hallucinations, disorganized speech, or grossly disorganized behavior lasting at least 1
day but less than 1 month, often triggered by severe psychosocial stressors, with eventual full
return to premorbid functioning, which this patient's post-disaster presentation and gradual
improvement demonstrates. Schizophrenia requires 6 months; schizoaffective disorder requires
mood episodes; delusional disorder involves non-bizarre delusions without prominent
hallucinations or marked impairment.
Q5: A patient with catatonia presents with immobility, mutism, negativism, and waxy flexibility.
The psychiatric nurse practitioner administers lorazepam 2 mg IV. Within 45 minutes, the patient
begins speaking, moves spontaneously, and follows commands. This response indicates which
treatment approach?
A. Resistance to benzodiazepines requiring immediate ECT
B. Positive lorazepam challenge predicting benzodiazepine responsiveness
C. Paradoxical reaction necessitating antipsychotic administration
D. Spontaneous remission unrelated to medication effect
Correct Answer: C
Rationale: Correct because a rapid and dramatic improvement in catatonic symptoms after
lorazepam administration constitutes a positive lorazepam challenge test, which predicts
responsiveness to high-dose benzodiazepine therapy and may allow avoidance of
electroconvulsive therapy unless symptoms recur or fail to sustain improvement. Resistance
would show no change; paradoxical reactions are rare and present with agitation; spontaneous
remission within 45 minutes of IV lorazepam is attributable to the medication.
Q6: A patient with schizophrenia is prescribed quetiapine 600 mg daily. The psychiatric nurse
practitioner explains that quetiapine's pharmacologic profile includes which receptor binding
characteristic?
A. High D2 affinity with minimal serotonergic activity
B. Potent 5-HT2A antagonism and low D2 affinity at therapeutic doses
C. Pure D2 antagonism without other receptor activity
D. NMDA receptor antagonism similar to dissociative anesthetics
Correct Answer: A
