NRNP 6635 PSYCHOPATHOLOGY AND
DIAGNOSTIC REASONING EXAM 2027
1. Which dopaminergic pathway is primarily responsible for the development of positive
symptoms in schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: Hyperactivity in the mesolimbic pathway is associated with
positive symptoms of schizophrenia, while hypoactivity in the mesocortical pathway is
linked to negative symptoms.
2. A patient taking Clozapine must have their Absolute Neutrophil Count (ANC) monitored
regularly to screen for which life-threatening condition?
A. Agranulocytosis
B. Thrombocytopenia
,C. Metabolic Syndrome
D. Neuroleptic Malignant Syndrome
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis, a
severe reduction in white blood cell count that increases infection risk.
3. What is the minimum duration of symptoms required for a diagnosis of Generalized
Anxiety Disorder (GAD) according to the DSM-5-TR?
A. 2 weeks
B. 6 months
C. 3 months
D. 1 month
Answer: B
Conceptual Explanation: DSM-5-TR requires excessive anxiety and worry occurring more
days than not for at least 6 months for a GAD diagnosis.
4. Which antidepressant is specifically contraindicated in patients with a history of seizures or
eating disorders due to an increased risk of seizure activity?
A. Bupropion
B. Venlafaxine
C. Fluoxetine
, D. Mirtazapine
Answer: A
Conceptual Explanation: Bupropion lowers the seizure threshold, particularly in patients
with electrolyte imbalances common in eating disorders like bulimia or anorexia.
5. A patient presents with a ‘lead pipe’ muscle rigidity, high fever, autonomic instability, and
altered mental status. Which condition should the NP immediately suspect?
A. Serotonin Syndrome
B. Akathisia
C. Neuroleptic Malignant Syndrome (NMS)
D. Tardive Dyskinesia
Answer: C
Conceptual Explanation: NMS is a medical emergency caused by D2 receptor blockade,
characterized by severe rigidity (lead pipe), hyperthermia, and autonomic dysfunction.
6. Which of the following distinguishes Schizoaffective Disorder from Major Depressive
Disorder with Psychotic Features?
A. The severity of the depressive episode
B. Total duration of illness exceeding 6 months
C. The presence of prominent negative symptoms
D. Presence of hallucinations for 2 weeks in the absence of a major mood episode
DIAGNOSTIC REASONING EXAM 2027
1. Which dopaminergic pathway is primarily responsible for the development of positive
symptoms in schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: Hyperactivity in the mesolimbic pathway is associated with
positive symptoms of schizophrenia, while hypoactivity in the mesocortical pathway is
linked to negative symptoms.
2. A patient taking Clozapine must have their Absolute Neutrophil Count (ANC) monitored
regularly to screen for which life-threatening condition?
A. Agranulocytosis
B. Thrombocytopenia
,C. Metabolic Syndrome
D. Neuroleptic Malignant Syndrome
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis, a
severe reduction in white blood cell count that increases infection risk.
3. What is the minimum duration of symptoms required for a diagnosis of Generalized
Anxiety Disorder (GAD) according to the DSM-5-TR?
A. 2 weeks
B. 6 months
C. 3 months
D. 1 month
Answer: B
Conceptual Explanation: DSM-5-TR requires excessive anxiety and worry occurring more
days than not for at least 6 months for a GAD diagnosis.
4. Which antidepressant is specifically contraindicated in patients with a history of seizures or
eating disorders due to an increased risk of seizure activity?
A. Bupropion
B. Venlafaxine
C. Fluoxetine
, D. Mirtazapine
Answer: A
Conceptual Explanation: Bupropion lowers the seizure threshold, particularly in patients
with electrolyte imbalances common in eating disorders like bulimia or anorexia.
5. A patient presents with a ‘lead pipe’ muscle rigidity, high fever, autonomic instability, and
altered mental status. Which condition should the NP immediately suspect?
A. Serotonin Syndrome
B. Akathisia
C. Neuroleptic Malignant Syndrome (NMS)
D. Tardive Dyskinesia
Answer: C
Conceptual Explanation: NMS is a medical emergency caused by D2 receptor blockade,
characterized by severe rigidity (lead pipe), hyperthermia, and autonomic dysfunction.
6. Which of the following distinguishes Schizoaffective Disorder from Major Depressive
Disorder with Psychotic Features?
A. The severity of the depressive episode
B. Total duration of illness exceeding 6 months
C. The presence of prominent negative symptoms
D. Presence of hallucinations for 2 weeks in the absence of a major mood episode
