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 19-year-old college freshman presents with 4 months of increasing social isolation,
declining grades, and vague suspiciousness that classmates are talking about him. He reports
hearing his name called when alone in his dorm room. The psychiatric nurse practitioner
recognizes that this prodromal phase suggests risk for which disorder?
A. Brief psychotic disorder with full recovery expected
B. Schizophrenia spectrum disorder with potential conversion to full psychosis
C. Major depressive disorder with psychotic features
D. Social anxiety disorder with avoidance behaviors
Correct Answer: D
Rationale: Correct because the prodromal phase of schizophrenia—characterized by social
withdrawal, functional decline, suspiciousness, and subtle perceptual disturbances—represents
the period preceding full psychotic symptoms, and early identification allows for potential
intervention to delay or prevent conversion to schizophrenia. Brief psychotic disorder resolves
within 1 month; major depression requires prominent mood symptoms; social anxiety does not
explain the perceptual disturbances.
Q2: A patient with schizophrenia is prescribed fluphenazine decanoate 25 mg IM every 2 weeks.
After 3 weeks, the patient develops torticollis, oculogyric crisis, and jaw trismus. The psychiatric
nurse practitioner administers which immediate treatment?
A. Propranolol for beta-adrenergic blockade
B. Diphenhydramine 50 mg IM for acute dystonia
C. Bromocriptine for dopamine receptor agonism
D. Dantrolene for muscle relaxation
Correct Answer: B
,Rationale: Correct because acute dystonia—sustained muscle spasms including torticollis,
oculogyric crisis, and jaw trismus—is an extrapyramidal symptom from acute D2 receptor
blockade, treated immediately with anticholinergics such as diphenhydramine or benztropine to
restore cholinergic-dopaminergic balance. Propranolol treats akathisia; bromocriptine treats
NMS; dantrolene treats malignant hyperthermia and NMS.
Q3: A patient with treatment-resistant schizophrenia has failed clozapine due to agranulocytosis.
The psychiatric nurse practitioner considers which alternative strategy?
A. High-dose olanzapine monotherapy
B. Combination of two atypical antipsychotics with different receptor profiles
C. Electroconvulsive therapy augmentation
D. Both B and C may be considered for ultra-treatment-resistant cases
Correct Answer: A
Rationale: Correct because clozapine-resistant or clozapine-intolerant schizophrenia may
respond to antipsychotic combinations (such as aripiprazole added to another SGA) or ECT
augmentation, though evidence is limited compared to clozapine. High-dose olanzapine
monotherapy is not superior to clozapine and carries significant metabolic risk; combination
therapy and ECT represent reasonable alternatives when clozapine is not an option.
Q4: A 42-year-old woman presents with sudden onset of bizarre delusions that aliens are
controlling her thoughts, accompanied by visual hallucinations and disorganized behavior,
lasting 10 days after a car accident. She has no prior psychiatric history. The psychiatric nurse
practitioner recognizes this as consistent with which diagnosis?
A. Schizophrenia with chronic course
B. Brief psychotic disorder with marked stressor
C. Schizoaffective disorder with manic features
D. Delusional disorder with non-bizarre delusions
Correct Answer: C
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 stressors, with eventual full return to
premorbid functioning. Schizophrenia requires 6 months; schizoaffective disorder requires mood
episodes; delusional disorder involves non-bizarre delusions without prominent hallucinations.
, Q5: A patient with catatonia presents with immobility, negativism, posturing, and waxy
flexibility. The psychiatric nurse practitioner understands that first-line treatment includes which
intervention?
A. High-potency typical antipsychotic for D2 receptor blockade
B. Lorazepam challenge test and high-dose benzodiazepine therapy
C. Immediate electroconvulsive therapy without medication trial
D. Anticholinergic medication to restore neurotransmitter balance
Correct Answer: D
Rationale: Correct because catatonia is treated first with benzodiazepines, particularly
lorazepam, with the lorazepam challenge test predicting responsiveness; high-dose
benzodiazepines (up to 24 mg/day lorazepam) are the standard first-line treatment, with ECT
reserved for benzodiazepine-resistant cases or malignant catatonia. Antipsychotics are
contraindicated and may worsen catatonia; ECT is not first-line without medication trial;
anticholinergics are not effective for catatonia.
Q6: A patient with schizophrenia is prescribed olanzapine 10 mg daily. The psychiatric nurse
practitioner monitors for which adverse effect that occurs in over 50% of patients within the first
year?
A. Severe akathisia requiring beta-blocker treatment
B. Clinically significant weight gain averaging 10-15 kg
C. Agranulocytosis requiring weekly ANC monitoring
D. QT prolongation requiring baseline and periodic ECG
Correct Answer: B
Rationale: Correct because olanzapine causes clinically significant weight gain in over 50% of
patients, averaging 10-15 kg within the first year, along with dyslipidemia and hyperglycemia,
requiring proactive metabolic monitoring and lifestyle intervention. Akathisia is more common
with aripiprazole; agranulocytosis is specific to clozapine; QT prolongation is more prominent
with ziprasidone.
2026/2027 |Newly Released| Regis College
60 Questions & Answers | Grade A | 100% Correct Rationales
Guaranteed Pass
Q1: A 19-year-old college freshman presents with 4 months of increasing social isolation,
declining grades, and vague suspiciousness that classmates are talking about him. He reports
hearing his name called when alone in his dorm room. The psychiatric nurse practitioner
recognizes that this prodromal phase suggests risk for which disorder?
A. Brief psychotic disorder with full recovery expected
B. Schizophrenia spectrum disorder with potential conversion to full psychosis
C. Major depressive disorder with psychotic features
D. Social anxiety disorder with avoidance behaviors
Correct Answer: D
Rationale: Correct because the prodromal phase of schizophrenia—characterized by social
withdrawal, functional decline, suspiciousness, and subtle perceptual disturbances—represents
the period preceding full psychotic symptoms, and early identification allows for potential
intervention to delay or prevent conversion to schizophrenia. Brief psychotic disorder resolves
within 1 month; major depression requires prominent mood symptoms; social anxiety does not
explain the perceptual disturbances.
Q2: A patient with schizophrenia is prescribed fluphenazine decanoate 25 mg IM every 2 weeks.
After 3 weeks, the patient develops torticollis, oculogyric crisis, and jaw trismus. The psychiatric
nurse practitioner administers which immediate treatment?
A. Propranolol for beta-adrenergic blockade
B. Diphenhydramine 50 mg IM for acute dystonia
C. Bromocriptine for dopamine receptor agonism
D. Dantrolene for muscle relaxation
Correct Answer: B
,Rationale: Correct because acute dystonia—sustained muscle spasms including torticollis,
oculogyric crisis, and jaw trismus—is an extrapyramidal symptom from acute D2 receptor
blockade, treated immediately with anticholinergics such as diphenhydramine or benztropine to
restore cholinergic-dopaminergic balance. Propranolol treats akathisia; bromocriptine treats
NMS; dantrolene treats malignant hyperthermia and NMS.
Q3: A patient with treatment-resistant schizophrenia has failed clozapine due to agranulocytosis.
The psychiatric nurse practitioner considers which alternative strategy?
A. High-dose olanzapine monotherapy
B. Combination of two atypical antipsychotics with different receptor profiles
C. Electroconvulsive therapy augmentation
D. Both B and C may be considered for ultra-treatment-resistant cases
Correct Answer: A
Rationale: Correct because clozapine-resistant or clozapine-intolerant schizophrenia may
respond to antipsychotic combinations (such as aripiprazole added to another SGA) or ECT
augmentation, though evidence is limited compared to clozapine. High-dose olanzapine
monotherapy is not superior to clozapine and carries significant metabolic risk; combination
therapy and ECT represent reasonable alternatives when clozapine is not an option.
Q4: A 42-year-old woman presents with sudden onset of bizarre delusions that aliens are
controlling her thoughts, accompanied by visual hallucinations and disorganized behavior,
lasting 10 days after a car accident. She has no prior psychiatric history. The psychiatric nurse
practitioner recognizes this as consistent with which diagnosis?
A. Schizophrenia with chronic course
B. Brief psychotic disorder with marked stressor
C. Schizoaffective disorder with manic features
D. Delusional disorder with non-bizarre delusions
Correct Answer: C
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 stressors, with eventual full return to
premorbid functioning. Schizophrenia requires 6 months; schizoaffective disorder requires mood
episodes; delusional disorder involves non-bizarre delusions without prominent hallucinations.
, Q5: A patient with catatonia presents with immobility, negativism, posturing, and waxy
flexibility. The psychiatric nurse practitioner understands that first-line treatment includes which
intervention?
A. High-potency typical antipsychotic for D2 receptor blockade
B. Lorazepam challenge test and high-dose benzodiazepine therapy
C. Immediate electroconvulsive therapy without medication trial
D. Anticholinergic medication to restore neurotransmitter balance
Correct Answer: D
Rationale: Correct because catatonia is treated first with benzodiazepines, particularly
lorazepam, with the lorazepam challenge test predicting responsiveness; high-dose
benzodiazepines (up to 24 mg/day lorazepam) are the standard first-line treatment, with ECT
reserved for benzodiazepine-resistant cases or malignant catatonia. Antipsychotics are
contraindicated and may worsen catatonia; ECT is not first-line without medication trial;
anticholinergics are not effective for catatonia.
Q6: A patient with schizophrenia is prescribed olanzapine 10 mg daily. The psychiatric nurse
practitioner monitors for which adverse effect that occurs in over 50% of patients within the first
year?
A. Severe akathisia requiring beta-blocker treatment
B. Clinically significant weight gain averaging 10-15 kg
C. Agranulocytosis requiring weekly ANC monitoring
D. QT prolongation requiring baseline and periodic ECG
Correct Answer: B
Rationale: Correct because olanzapine causes clinically significant weight gain in over 50% of
patients, averaging 10-15 kg within the first year, along with dyslipidemia and hyperglycemia,
requiring proactive metabolic monitoring and lifestyle intervention. Akathisia is more common
with aripiprazole; agranulocytosis is specific to clozapine; QT prolongation is more prominent
with ziprasidone.
