NRNP 6635 Final Exam Questions and Answers|
Updated| Pass Guaranteed| Walden
1. A 22-year-old college student has had auditory hallucinations and
disorganized speech for 3 weeks, with a clear decline in functioning.
There is no mood episode and urine toxicology is negative. Which
diagnosis is most consistent with the DSM-5-TR?
A. Brief psychotic disorder
B. Schizoaffective disorder
C. Schizophreniform disorder
D. Schizophrenia
Answer: C. Schizophreniform disorder
Rationale: Schizophreniform disorder requires Criterion A symptoms for at
least 1 month but less than 6 months. Brief psychotic disorder lasts at least 1
day but less than 1 month. Schizophrenia requires continuous signs of
disturbance for at least 6 months, and schizoaffective disorder requires a
concurrent major mood episode.
2. A 26-year-old man has had delusions, disorganized speech, flat affect,
and declining work and self-care for 8 months. Which DSM-5-TR
requirement is MET by this presentation?
A. Symptoms lasting less than 1 month with full return to baseline
B. Continuous signs of disturbance for at least 6 months, including at
least 1 month of active-phase symptoms
C. Presence of a concurrent major depressive episode
D. Onset after age 45
Answer: B. Continuous signs of disturbance for at least 6 months,
including at least 1 month of active-phase symptoms
NRNP 6635 Exam | Page 1
,Rationale: Schizophrenia requires 2 or more Criterion A symptoms (at least
one being delusions, hallucinations, or disorganized speech) for a significant
portion of 1 month, with continuous signs of disturbance for at least 6 months.
Prodromal and residual periods count toward the 6 months.
3. Criterion A for schizophrenia requires two or more characteristic
symptoms. Which combination alone is INSUFFICIENT to meet Criterion
A?
A. Grossly disorganized behavior and negative symptoms
B. Delusions and hallucinations
C. Hallucinations and disorganized speech
D. Delusions and negative symptoms
Answer: A. Grossly disorganized behavior and negative symptoms
Rationale: At least one of the two or more symptoms must be delusions,
hallucinations, or disorganized speech. Grossly disorganized or catatonic
behavior combined with negative symptoms does not meet this requirement.
4. A 38-year-old woman suddenly develops delusions and hallucinations
after a stressful event. Symptoms last 5 days and she then returns fully
to her baseline. What is the most likely diagnosis?
A. Schizophreniform disorder
B. Substance-induced psychotic disorder
C. Delusional disorder
D. Brief psychotic disorder
Answer: D. Brief psychotic disorder
Rationale: Brief psychotic disorder involves delusions, hallucinations,
disorganized speech, or grossly disorganized or catatonic behavior lasting at
least 1 day but less than 1 month, with eventual full return to the premorbid
level of functioning.
NRNP 6635 Exam | Page 2
,5. A 45-year-old woman has believed for 4 months that her neighbor is
poisoning her food. She has no hallucinations, her behavior is otherwise
appropriate, and she works full time. What is the most likely diagnosis?
A. Schizophrenia, paranoid type
B. Delusional disorder, persecutory type
C. Paranoid personality disorder
D. Brief psychotic disorder
Answer: B. Delusional disorder, persecutory type
Rationale: Delusional disorder requires one or more delusions for at least 1
month, with functioning not markedly impaired apart from the delusion's
effects and no prominent hallucinations. The persecutory type is specified by
the delusional theme. DSM-5-TR no longer uses the paranoid subtype of
schizophrenia.
6. A 30-year-old man has had delusions and hallucinations for 2 months
in the absence of any major mood episode. Over the course of his
illness he has also had several major depressive episodes that were
present for most of the total illness duration. What is the most likely
diagnosis?
A. Schizophrenia
B. Major depressive disorder with psychotic features
C. Schizoaffective disorder, depressive type
D. Bipolar I disorder with psychotic features
Answer: C. Schizoaffective disorder, depressive type
Rationale: Schizoaffective disorder requires delusions or hallucinations for 2
or more weeks in the absence of a major mood episode, while mood
symptoms are present for the majority of the total illness duration. In mood
disorders with psychotic features, psychosis occurs only during mood
episodes.
NRNP 6635 Exam | Page 3
, 7. Which patient is the best candidate for clozapine?
A. A patient with schizophrenia and a baseline ANC of 400/µL
B. A patient with schizophrenia who has failed two adequate trials of
other antipsychotics
C. A patient with schizophrenia who is well controlled on risperidone
D. A patient with a first episode of psychosis who has not yet been
treated
Answer: B. A patient with schizophrenia who has failed two adequate
trials of other antipsychotics
Rationale: Clozapine is indicated for treatment-resistant schizophrenia
(inadequate response to at least two adequate antipsychotic trials) and for
reducing recurrent suicidal behavior in schizophrenia or schizoaffective
disorder. It is not first-line because of its adverse-effect burden and monitoring
needs.
8. Clozapine REMS and prescribing information have required routine
absolute neutrophil count (ANC) monitoring. For a patient with a normal
baseline ANC, what is the standard monitoring schedule? (Note: the FDA
announced in 2025 that it no longer requires the clozapine REMS, but
the label still advises ANC monitoring, and many courses still test this
schedule.)
A. Weekly for the first year, then no further monitoring
B. Every 2 weeks for 12 months, then every 6 months
C. Weekly for 6 months, every 2 weeks for months 6 to 12, then monthly
D. Monthly for the first 6 months, then yearly
Answer: C. Weekly for 6 months, every 2 weeks for months 6 to 12, then
monthly
Rationale: The labeled ANC schedule is weekly for the first 6 months, every 2
weeks for the next 6 months (months 6 to 12), and monthly thereafter, for as
long as the patient is on treatment. Severe neutropenia can be fatal.
NRNP 6635 Exam | Page 4
Updated| Pass Guaranteed| Walden
1. A 22-year-old college student has had auditory hallucinations and
disorganized speech for 3 weeks, with a clear decline in functioning.
There is no mood episode and urine toxicology is negative. Which
diagnosis is most consistent with the DSM-5-TR?
A. Brief psychotic disorder
B. Schizoaffective disorder
C. Schizophreniform disorder
D. Schizophrenia
Answer: C. Schizophreniform disorder
Rationale: Schizophreniform disorder requires Criterion A symptoms for at
least 1 month but less than 6 months. Brief psychotic disorder lasts at least 1
day but less than 1 month. Schizophrenia requires continuous signs of
disturbance for at least 6 months, and schizoaffective disorder requires a
concurrent major mood episode.
2. A 26-year-old man has had delusions, disorganized speech, flat affect,
and declining work and self-care for 8 months. Which DSM-5-TR
requirement is MET by this presentation?
A. Symptoms lasting less than 1 month with full return to baseline
B. Continuous signs of disturbance for at least 6 months, including at
least 1 month of active-phase symptoms
C. Presence of a concurrent major depressive episode
D. Onset after age 45
Answer: B. Continuous signs of disturbance for at least 6 months,
including at least 1 month of active-phase symptoms
NRNP 6635 Exam | Page 1
,Rationale: Schizophrenia requires 2 or more Criterion A symptoms (at least
one being delusions, hallucinations, or disorganized speech) for a significant
portion of 1 month, with continuous signs of disturbance for at least 6 months.
Prodromal and residual periods count toward the 6 months.
3. Criterion A for schizophrenia requires two or more characteristic
symptoms. Which combination alone is INSUFFICIENT to meet Criterion
A?
A. Grossly disorganized behavior and negative symptoms
B. Delusions and hallucinations
C. Hallucinations and disorganized speech
D. Delusions and negative symptoms
Answer: A. Grossly disorganized behavior and negative symptoms
Rationale: At least one of the two or more symptoms must be delusions,
hallucinations, or disorganized speech. Grossly disorganized or catatonic
behavior combined with negative symptoms does not meet this requirement.
4. A 38-year-old woman suddenly develops delusions and hallucinations
after a stressful event. Symptoms last 5 days and she then returns fully
to her baseline. What is the most likely diagnosis?
A. Schizophreniform disorder
B. Substance-induced psychotic disorder
C. Delusional disorder
D. Brief psychotic disorder
Answer: D. Brief psychotic disorder
Rationale: Brief psychotic disorder involves delusions, hallucinations,
disorganized speech, or grossly disorganized or catatonic behavior lasting at
least 1 day but less than 1 month, with eventual full return to the premorbid
level of functioning.
NRNP 6635 Exam | Page 2
,5. A 45-year-old woman has believed for 4 months that her neighbor is
poisoning her food. She has no hallucinations, her behavior is otherwise
appropriate, and she works full time. What is the most likely diagnosis?
A. Schizophrenia, paranoid type
B. Delusional disorder, persecutory type
C. Paranoid personality disorder
D. Brief psychotic disorder
Answer: B. Delusional disorder, persecutory type
Rationale: Delusional disorder requires one or more delusions for at least 1
month, with functioning not markedly impaired apart from the delusion's
effects and no prominent hallucinations. The persecutory type is specified by
the delusional theme. DSM-5-TR no longer uses the paranoid subtype of
schizophrenia.
6. A 30-year-old man has had delusions and hallucinations for 2 months
in the absence of any major mood episode. Over the course of his
illness he has also had several major depressive episodes that were
present for most of the total illness duration. What is the most likely
diagnosis?
A. Schizophrenia
B. Major depressive disorder with psychotic features
C. Schizoaffective disorder, depressive type
D. Bipolar I disorder with psychotic features
Answer: C. Schizoaffective disorder, depressive type
Rationale: Schizoaffective disorder requires delusions or hallucinations for 2
or more weeks in the absence of a major mood episode, while mood
symptoms are present for the majority of the total illness duration. In mood
disorders with psychotic features, psychosis occurs only during mood
episodes.
NRNP 6635 Exam | Page 3
, 7. Which patient is the best candidate for clozapine?
A. A patient with schizophrenia and a baseline ANC of 400/µL
B. A patient with schizophrenia who has failed two adequate trials of
other antipsychotics
C. A patient with schizophrenia who is well controlled on risperidone
D. A patient with a first episode of psychosis who has not yet been
treated
Answer: B. A patient with schizophrenia who has failed two adequate
trials of other antipsychotics
Rationale: Clozapine is indicated for treatment-resistant schizophrenia
(inadequate response to at least two adequate antipsychotic trials) and for
reducing recurrent suicidal behavior in schizophrenia or schizoaffective
disorder. It is not first-line because of its adverse-effect burden and monitoring
needs.
8. Clozapine REMS and prescribing information have required routine
absolute neutrophil count (ANC) monitoring. For a patient with a normal
baseline ANC, what is the standard monitoring schedule? (Note: the FDA
announced in 2025 that it no longer requires the clozapine REMS, but
the label still advises ANC monitoring, and many courses still test this
schedule.)
A. Weekly for the first year, then no further monitoring
B. Every 2 weeks for 12 months, then every 6 months
C. Weekly for 6 months, every 2 weeks for months 6 to 12, then monthly
D. Monthly for the first 6 months, then yearly
Answer: C. Weekly for 6 months, every 2 weeks for months 6 to 12, then
monthly
Rationale: The labeled ANC schedule is weekly for the first 6 months, every 2
weeks for the next 6 months (months 6 to 12), and monthly thereafter, for as
long as the patient is on treatment. Severe neutropenia can be fatal.
NRNP 6635 Exam | Page 4
