NRNP 6675 • Midterm & Final Practice Package
NRNP 6675 MIDTERM EXAM & FINAL EXAM
COMPLETE 250-QUESTION PRACTICE PACKAGE
1. A patient says, “I feel empty, but I cannot explain why.” Which response best demonstrates therapeutic
communication?
“You should try to think more positively.”
“Tell me more about what feeling empty is like for you.”
“Everyone feels empty sometimes.”
“Why do you think you feel that way?”
Rationale: An open invitation to elaborate explores the patient’s experience without judgment.
2. During an initial psychiatric interview, which information is most important to establish first?
Preferred pharmacy
Immediate safety and risk
Childhood grades
Long-term career goals
Rationale: Safety assessment takes priority when beginning a psychiatric evaluation.
3. Which finding is most consistent with a flight of ideas?
One topic is repeated without progression
Rapidly shifting topics with understandable but loose associations
Complete absence of speech
Invented words with no meaning
Rationale: Flight of ideas is rapid topic shifting in which the connections remain understandable.
4. A patient reports hearing a voice when no one is present. This is best documented as:
Delusion
Illusion
Hallucination
Depersonalization
Rationale: A hallucination is a perception without an external stimulus.
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,NRNP 6675 • Midterm & Final Practice Package
REAL IMAGE — Human brain, public-domain NIH/NIA image. Used here as an anatomical visual aid.
5. Which feature most strongly suggests a delusion rather than an overvalued idea?
The belief is strongly held
The belief is culturally shared
The belief remains fixed despite clear contradictory evidence
The belief causes mild worry
Rationale: Delusions are fixed false beliefs not better explained by cultural context.
6. Which negative symptom of schizophrenia is characterized by reduced emotional expression?
Avolition
Alogia
Flat affect
Anhedonia
Rationale: Flat affect refers to markedly reduced emotional expression.
7. A patient with schizophrenia has diminished motivation and difficulty initiating purposeful activity. This is:
Avolition
Echolalia
Neologism
Clang association
Rationale: Avolition is reduced motivation or goal-directed activity.
8. Which dopamine pathway is most associated with positive psychotic symptoms?
Mesolimbic
Nigrostriatal
Tuberoinfundibular
Mesocortical
Rationale: Excess dopamine activity in the mesolimbic pathway is associated with positive symptoms.
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,NRNP 6675 • Midterm & Final Practice Package
9. Blockade of dopamine receptors in the nigrostriatal pathway is most associated with:
Hyperprolactinemia
Extrapyramidal symptoms
Improved cognition
Reduced negative symptoms
Rationale: Nigrostriatal dopamine blockade can produce movement-related adverse effects.
10. Dopamine blockade in the tuberoinfundibular pathway can cause:
Hyperprolactinemia
Agranulocytosis
QT shortening
Severe hypoglycemia
Rationale: Dopamine normally inhibits prolactin release; blockade can increase prolactin.
11. Which antipsychotic adverse effect is particularly concerning for neuroleptic malignant syndrome?
Mild dry mouth
Lead-pipe rigidity with hyperthermia
Increased appetite
Transient headache
Rationale: NMS classically involves hyperthermia, severe rigidity, autonomic instability, and altered mental status.
12. A patient taking an antipsychotic develops fever, severe rigidity, confusion, and autonomic instability. What
is the priority?
Give the next antipsychotic dose
Stop the offending agent and provide emergency medical care
Encourage exercise
Start an SSRI
Rationale: The presentation is consistent with NMS, a medical emergency.
13. Which medication is classically associated with agranulocytosis requiring ANC monitoring?
Clozapine
Buspirone
Lamotrigine
Propranolol
Rationale: Clozapine carries a serious risk of neutropenia/agranulocytosis.
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, NRNP 6675 • Midterm & Final Practice Package
14. Which adverse effect is most characteristic of tardive dyskinesia?
Rhythmic lip smacking and tongue movements
Acute urinary retention
Severe diarrhea
Orthostatic headache
Rationale: Tardive dyskinesia often causes repetitive involuntary orofacial movements.
15. Acute dystonia after an antipsychotic is best treated initially with:
An anticholinergic such as benztropine
A stimulant
An SSRI
Lithium
Rationale: Anticholinergic treatment rapidly reverses acute dystonia.
16. Akathisia is best described as:
Inner restlessness with an urge to move
Complete loss of muscle tone
Repeated involuntary blinking only
Fixed false beliefs
Rationale: Akathisia is a distressing subjective and objective sense of restlessness.
17. A patient taking lithium develops coarse tremor, vomiting, diarrhea, and ataxia. The clinician should
suspect:
Lithium toxicity
Serotonin syndrome
Akathisia
Atypical depression
Rationale: GI symptoms, worsening tremor, and ataxia can indicate lithium toxicity.
18. Which laboratory test is especially important for a patient receiving lithium?
Serum creatinine and renal function
Amylase only
Troponin every week
INR only
Rationale: Lithium is renally cleared and can affect renal and thyroid function.
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NRNP 6675 MIDTERM EXAM & FINAL EXAM
COMPLETE 250-QUESTION PRACTICE PACKAGE
1. A patient says, “I feel empty, but I cannot explain why.” Which response best demonstrates therapeutic
communication?
“You should try to think more positively.”
“Tell me more about what feeling empty is like for you.”
“Everyone feels empty sometimes.”
“Why do you think you feel that way?”
Rationale: An open invitation to elaborate explores the patient’s experience without judgment.
2. During an initial psychiatric interview, which information is most important to establish first?
Preferred pharmacy
Immediate safety and risk
Childhood grades
Long-term career goals
Rationale: Safety assessment takes priority when beginning a psychiatric evaluation.
3. Which finding is most consistent with a flight of ideas?
One topic is repeated without progression
Rapidly shifting topics with understandable but loose associations
Complete absence of speech
Invented words with no meaning
Rationale: Flight of ideas is rapid topic shifting in which the connections remain understandable.
4. A patient reports hearing a voice when no one is present. This is best documented as:
Delusion
Illusion
Hallucination
Depersonalization
Rationale: A hallucination is a perception without an external stimulus.
Page 1
,NRNP 6675 • Midterm & Final Practice Package
REAL IMAGE — Human brain, public-domain NIH/NIA image. Used here as an anatomical visual aid.
5. Which feature most strongly suggests a delusion rather than an overvalued idea?
The belief is strongly held
The belief is culturally shared
The belief remains fixed despite clear contradictory evidence
The belief causes mild worry
Rationale: Delusions are fixed false beliefs not better explained by cultural context.
6. Which negative symptom of schizophrenia is characterized by reduced emotional expression?
Avolition
Alogia
Flat affect
Anhedonia
Rationale: Flat affect refers to markedly reduced emotional expression.
7. A patient with schizophrenia has diminished motivation and difficulty initiating purposeful activity. This is:
Avolition
Echolalia
Neologism
Clang association
Rationale: Avolition is reduced motivation or goal-directed activity.
8. Which dopamine pathway is most associated with positive psychotic symptoms?
Mesolimbic
Nigrostriatal
Tuberoinfundibular
Mesocortical
Rationale: Excess dopamine activity in the mesolimbic pathway is associated with positive symptoms.
Page 2
,NRNP 6675 • Midterm & Final Practice Package
9. Blockade of dopamine receptors in the nigrostriatal pathway is most associated with:
Hyperprolactinemia
Extrapyramidal symptoms
Improved cognition
Reduced negative symptoms
Rationale: Nigrostriatal dopamine blockade can produce movement-related adverse effects.
10. Dopamine blockade in the tuberoinfundibular pathway can cause:
Hyperprolactinemia
Agranulocytosis
QT shortening
Severe hypoglycemia
Rationale: Dopamine normally inhibits prolactin release; blockade can increase prolactin.
11. Which antipsychotic adverse effect is particularly concerning for neuroleptic malignant syndrome?
Mild dry mouth
Lead-pipe rigidity with hyperthermia
Increased appetite
Transient headache
Rationale: NMS classically involves hyperthermia, severe rigidity, autonomic instability, and altered mental status.
12. A patient taking an antipsychotic develops fever, severe rigidity, confusion, and autonomic instability. What
is the priority?
Give the next antipsychotic dose
Stop the offending agent and provide emergency medical care
Encourage exercise
Start an SSRI
Rationale: The presentation is consistent with NMS, a medical emergency.
13. Which medication is classically associated with agranulocytosis requiring ANC monitoring?
Clozapine
Buspirone
Lamotrigine
Propranolol
Rationale: Clozapine carries a serious risk of neutropenia/agranulocytosis.
Page 3
, NRNP 6675 • Midterm & Final Practice Package
14. Which adverse effect is most characteristic of tardive dyskinesia?
Rhythmic lip smacking and tongue movements
Acute urinary retention
Severe diarrhea
Orthostatic headache
Rationale: Tardive dyskinesia often causes repetitive involuntary orofacial movements.
15. Acute dystonia after an antipsychotic is best treated initially with:
An anticholinergic such as benztropine
A stimulant
An SSRI
Lithium
Rationale: Anticholinergic treatment rapidly reverses acute dystonia.
16. Akathisia is best described as:
Inner restlessness with an urge to move
Complete loss of muscle tone
Repeated involuntary blinking only
Fixed false beliefs
Rationale: Akathisia is a distressing subjective and objective sense of restlessness.
17. A patient taking lithium develops coarse tremor, vomiting, diarrhea, and ataxia. The clinician should
suspect:
Lithium toxicity
Serotonin syndrome
Akathisia
Atypical depression
Rationale: GI symptoms, worsening tremor, and ataxia can indicate lithium toxicity.
18. Which laboratory test is especially important for a patient receiving lithium?
Serum creatinine and renal function
Amylase only
Troponin every week
INR only
Rationale: Lithium is renally cleared and can affect renal and thyroid function.
Page 4
