NU664C : Family Psychiatric Mental Health I
Final Comprehensive Exam
2026/2027 |Newly Released| Regis College
100 Questions & Answers |Grade A+ |100% Correct Rationales
Guaranteed Pass
Q1: A 31-year-old patient with bipolar I disorder has not slept in 6 days, has spent $15,000 on
online shopping, and believes they are chosen by God to lead a global movement. The patient's
speech is rapid and difficult to interrupt. Which criterion distinguishes this as mania versus
hypomania?
A. The presence of religious delusions
B. The need for hospitalization due to impaired judgment and functional disruption
C. The duration of 6 days
D. The amount of money spent
Correct Answer: B
Rationale: Correct because the need for hospitalization due to marked impairment in functioning
distinguishes mania from hypomania; while both share symptoms such as decreased sleep,
excessive spending, and grandiosity, mania causes marked impairment, psychosis, or requires
hospitalization, whereas hypomania does not. Religious delusions indicate psychosis but not all
manic episodes have psychosis, duration alone does not distinguish, and spending amount is not
diagnostic.
Q2: A patient on lithium for bipolar disorder presents with persistent thirst, urinating 8-10 times
daily, and diluted urine. Serum lithium is 0.7 mEq/L. Which condition has developed?
A. Lithium toxicity requiring hemodialysis
B. Nephrogenic diabetes insipidus from lithium-induced ADH resistance
C. Syndrome of inappropriate antidiuretic hormone
D. Acute tubular necrosis
Correct Answer: D
,Rationale: Correct because lithium causes nephrogenic diabetes insipidus by inhibiting adenyl
cyclase and aquaporin-2 water channels in the renal collecting duct, impairing the kidney's
response to ADH and resulting in polyuria, polydipsia, and inability to concentrate urine; this is a
common adverse effect at therapeutic lithium levels. Toxicity requires elevated levels, SIADH
causes water retention, and acute tubular necrosis causes oliguria.
Q3: A 45-year-old patient with major depressive disorder scores 14 on the PHQ-9. The patient
reports difficulty sleeping, poor appetite, and trouble concentrating but denies suicidal ideation.
Which level of depression severity and treatment approach are indicated?
A. Minimal depression; watchful waiting
B. Mild depression; psychotherapy alone
C. Moderate depression; antidepressant medication plus psychotherapy
D. Severe depression; consider hospitalization
Correct Answer: A
Rationale: Correct because a PHQ-9 score of 14 falls within the moderate range (10-14),
indicating clinically significant depression requiring active treatment with antidepressant
medication combined with psychotherapy; this approach addresses both biological and
psychosocial factors. Minimal depression scores 0-4, mild depression 5-9 may consider
psychotherapy alone, and severe depression 20-27 may require hospitalization if suicidal.
Q4: A patient with schizophrenia on risperidone 6 mg daily develops restlessness, pacing, and
inability to sit still. The patient describes feeling "like I'm going to jump out of my skin." Which
condition is present, and what is the first-line treatment? Select all that apply.
A. Akathisia from dopamine blockade in the nigrostriatal pathway
B. Treatment with propranolol 20-80 mg daily
C. Treatment with benztropine 2 mg daily
D. Condition characterized by subjective inner restlessness and objective motor movements
Correct Answer: A, B, D
Rationale: Correct because akathisia presents as subjective inner restlessness with objective
motor manifestations including pacing and inability to sit still, resulting from dopamine blockade
in the nigrostriatal pathway; first-line treatment is propranolol 20-80 mg daily, a beta-blocker
that reduces noradrenergic hyperactivity. Benztropine is less effective for akathisia and primarily
treats acute dystonia and parkinsonism.
,Q5: A patient with OCD spends 5 hours daily checking door locks and stove burners due to fears
of causing a fire. The patient recognizes these fears as excessive but cannot resist the urges.
Which neuroanatomical circuit underlies these symptoms?
A. Mesolimbic dopamine pathway hyperactivity
B. Cortico-striato-thalamo-cortical loop hyperactivity in the direct pathway
C. Amygdala-hypothalamic fear circuit
D. Hippocampal-prefrontal memory consolidation circuit
Correct Answer: C
Rationale: Correct because OCD is characterized by hyperactivity in the direct pathway of the
cortico-striato-thalamo-cortical loop, particularly involving the orbitofrontal cortex, caudate
nucleus, and thalamus, generating repetitive thoughts and behaviors through insufficient
inhibitory control. The mesolimbic pathway mediates reward and positive symptoms of
schizophrenia, the amygdala-hypothalamic circuit underlies fear and panic, and hippocampal-
prefrontal circuits are involved in memory consolidation.
Q6: Under Massachusetts mental health law, a patient with schizophrenia refuses antipsychotic
medication, stating "I know I have schizophrenia but I believe the side effects are worse than the
symptoms." The patient articulates risks and benefits clearly. Which determination is most
accurate?
A. The patient lacks capacity due to anosognosia
B. The patient has decision-making capacity and may refuse treatment
C. The patient is legally incompetent and requires a guardian
D. The patient must be involuntarily medicated under Section 12
Correct Answer: D
Rationale: Correct because this patient demonstrates all four elements of decision-making
capacity: understanding the diagnosis, appreciating how treatment applies to their situation,
reasoning through the risk-benefit ratio, and expressing a stable choice; refusal of treatment
based on personal values does not constitute incapacity. Anosognosia is not present as the patient
acknowledges the diagnosis, legal incompetency requires judicial determination, and Section 12
applies to imminent danger, not treatment refusal.
, Q7: A patient with bipolar disorder is started on valproate. Two weeks later, the patient develops
nausea, vomiting, and abdominal pain. Liver enzymes are elevated 3 times normal. Which action
is the priority?
A. Continue valproate and add antiemetics
B. Discontinue valproate immediately and monitor liver function
C. Reduce valproate dose by 50%
D. Add carbamazepine for liver protection
Correct Answer: A
Rationale: Correct because elevated liver enzymes 3 times normal with gastrointestinal
symptoms indicates valproate-induced hepatotoxicity, requiring immediate discontinuation of the
drug and close monitoring of liver function; this is a potentially life-threatening adverse effect
that can progress to fulminant hepatic failure. Continuing valproate worsens liver damage, dose
reduction is insufficient, and carbamazepine is also hepatotoxic and contraindicated.
Q8: A patient presents with confusion, agitation, myoclonus, hyperreflexia, tachycardia, and
hyperthermia after starting linezolid while on escitalopram. Which clinical features distinguish
this from neuroleptic malignant syndrome? Select all that apply.
A. Hyperreflexia and myoclonus rather than rigidity
B. Normal or mildly elevated creatine kinase
C. History of serotonergic agent introduction
D. Lead-pipe muscle rigidity and markedly elevated CK
Correct Answer: A, B, C
Rationale: Correct because serotonin syndrome is distinguished from NMS by hyperreflexia and
myoclonus rather than lead-pipe rigidity, normal or mildly elevated CK rather than marked
elevation, and association with serotonergic agents such as linezolid combined with
escitalopram; this combination inhibits MAO and blocks serotonin reuptake, causing excessive
5-HT2A activation. Lead-pipe rigidity and markedly elevated CK are characteristic of NMS.
Final Comprehensive Exam
2026/2027 |Newly Released| Regis College
100 Questions & Answers |Grade A+ |100% Correct Rationales
Guaranteed Pass
Q1: A 31-year-old patient with bipolar I disorder has not slept in 6 days, has spent $15,000 on
online shopping, and believes they are chosen by God to lead a global movement. The patient's
speech is rapid and difficult to interrupt. Which criterion distinguishes this as mania versus
hypomania?
A. The presence of religious delusions
B. The need for hospitalization due to impaired judgment and functional disruption
C. The duration of 6 days
D. The amount of money spent
Correct Answer: B
Rationale: Correct because the need for hospitalization due to marked impairment in functioning
distinguishes mania from hypomania; while both share symptoms such as decreased sleep,
excessive spending, and grandiosity, mania causes marked impairment, psychosis, or requires
hospitalization, whereas hypomania does not. Religious delusions indicate psychosis but not all
manic episodes have psychosis, duration alone does not distinguish, and spending amount is not
diagnostic.
Q2: A patient on lithium for bipolar disorder presents with persistent thirst, urinating 8-10 times
daily, and diluted urine. Serum lithium is 0.7 mEq/L. Which condition has developed?
A. Lithium toxicity requiring hemodialysis
B. Nephrogenic diabetes insipidus from lithium-induced ADH resistance
C. Syndrome of inappropriate antidiuretic hormone
D. Acute tubular necrosis
Correct Answer: D
,Rationale: Correct because lithium causes nephrogenic diabetes insipidus by inhibiting adenyl
cyclase and aquaporin-2 water channels in the renal collecting duct, impairing the kidney's
response to ADH and resulting in polyuria, polydipsia, and inability to concentrate urine; this is a
common adverse effect at therapeutic lithium levels. Toxicity requires elevated levels, SIADH
causes water retention, and acute tubular necrosis causes oliguria.
Q3: A 45-year-old patient with major depressive disorder scores 14 on the PHQ-9. The patient
reports difficulty sleeping, poor appetite, and trouble concentrating but denies suicidal ideation.
Which level of depression severity and treatment approach are indicated?
A. Minimal depression; watchful waiting
B. Mild depression; psychotherapy alone
C. Moderate depression; antidepressant medication plus psychotherapy
D. Severe depression; consider hospitalization
Correct Answer: A
Rationale: Correct because a PHQ-9 score of 14 falls within the moderate range (10-14),
indicating clinically significant depression requiring active treatment with antidepressant
medication combined with psychotherapy; this approach addresses both biological and
psychosocial factors. Minimal depression scores 0-4, mild depression 5-9 may consider
psychotherapy alone, and severe depression 20-27 may require hospitalization if suicidal.
Q4: A patient with schizophrenia on risperidone 6 mg daily develops restlessness, pacing, and
inability to sit still. The patient describes feeling "like I'm going to jump out of my skin." Which
condition is present, and what is the first-line treatment? Select all that apply.
A. Akathisia from dopamine blockade in the nigrostriatal pathway
B. Treatment with propranolol 20-80 mg daily
C. Treatment with benztropine 2 mg daily
D. Condition characterized by subjective inner restlessness and objective motor movements
Correct Answer: A, B, D
Rationale: Correct because akathisia presents as subjective inner restlessness with objective
motor manifestations including pacing and inability to sit still, resulting from dopamine blockade
in the nigrostriatal pathway; first-line treatment is propranolol 20-80 mg daily, a beta-blocker
that reduces noradrenergic hyperactivity. Benztropine is less effective for akathisia and primarily
treats acute dystonia and parkinsonism.
,Q5: A patient with OCD spends 5 hours daily checking door locks and stove burners due to fears
of causing a fire. The patient recognizes these fears as excessive but cannot resist the urges.
Which neuroanatomical circuit underlies these symptoms?
A. Mesolimbic dopamine pathway hyperactivity
B. Cortico-striato-thalamo-cortical loop hyperactivity in the direct pathway
C. Amygdala-hypothalamic fear circuit
D. Hippocampal-prefrontal memory consolidation circuit
Correct Answer: C
Rationale: Correct because OCD is characterized by hyperactivity in the direct pathway of the
cortico-striato-thalamo-cortical loop, particularly involving the orbitofrontal cortex, caudate
nucleus, and thalamus, generating repetitive thoughts and behaviors through insufficient
inhibitory control. The mesolimbic pathway mediates reward and positive symptoms of
schizophrenia, the amygdala-hypothalamic circuit underlies fear and panic, and hippocampal-
prefrontal circuits are involved in memory consolidation.
Q6: Under Massachusetts mental health law, a patient with schizophrenia refuses antipsychotic
medication, stating "I know I have schizophrenia but I believe the side effects are worse than the
symptoms." The patient articulates risks and benefits clearly. Which determination is most
accurate?
A. The patient lacks capacity due to anosognosia
B. The patient has decision-making capacity and may refuse treatment
C. The patient is legally incompetent and requires a guardian
D. The patient must be involuntarily medicated under Section 12
Correct Answer: D
Rationale: Correct because this patient demonstrates all four elements of decision-making
capacity: understanding the diagnosis, appreciating how treatment applies to their situation,
reasoning through the risk-benefit ratio, and expressing a stable choice; refusal of treatment
based on personal values does not constitute incapacity. Anosognosia is not present as the patient
acknowledges the diagnosis, legal incompetency requires judicial determination, and Section 12
applies to imminent danger, not treatment refusal.
, Q7: A patient with bipolar disorder is started on valproate. Two weeks later, the patient develops
nausea, vomiting, and abdominal pain. Liver enzymes are elevated 3 times normal. Which action
is the priority?
A. Continue valproate and add antiemetics
B. Discontinue valproate immediately and monitor liver function
C. Reduce valproate dose by 50%
D. Add carbamazepine for liver protection
Correct Answer: A
Rationale: Correct because elevated liver enzymes 3 times normal with gastrointestinal
symptoms indicates valproate-induced hepatotoxicity, requiring immediate discontinuation of the
drug and close monitoring of liver function; this is a potentially life-threatening adverse effect
that can progress to fulminant hepatic failure. Continuing valproate worsens liver damage, dose
reduction is insufficient, and carbamazepine is also hepatotoxic and contraindicated.
Q8: A patient presents with confusion, agitation, myoclonus, hyperreflexia, tachycardia, and
hyperthermia after starting linezolid while on escitalopram. Which clinical features distinguish
this from neuroleptic malignant syndrome? Select all that apply.
A. Hyperreflexia and myoclonus rather than rigidity
B. Normal or mildly elevated creatine kinase
C. History of serotonergic agent introduction
D. Lead-pipe muscle rigidity and markedly elevated CK
Correct Answer: A, B, C
Rationale: Correct because serotonin syndrome is distinguished from NMS by hyperreflexia and
myoclonus rather than lead-pipe rigidity, normal or mildly elevated CK rather than marked
elevation, and association with serotonergic agents such as linezolid combined with
escitalopram; this combination inhibits MAO and blocks serotonin reuptake, causing excessive
5-HT2A activation. Lead-pipe rigidity and markedly elevated CK are characteristic of NMS.
