NU664C Exam 1 Family Psychiatric Mental Health I Actual Exam
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
Institution: Regis University
Program: Family Psychiatric Mental Health Nurse Practitioner (PMHNP) Track
Level: Graduate
Time Allotment: 120 minutes
Total Questions: 55 (Multiple-Choice and Select-All-That-Apply)
Instructions
This examination assesses clinical knowledge in family psychiatric mental health care,
including diagnostic reasoning, psychopharmacology, therapeutic interventions, crisis
management, and legal/ethical practice. Select the best answer for each
multiple-choice question. For Select-All-That-Apply (SATA) questions, choose all options
that apply. No partial credit is awarded for SATA items.
Question 1
A 28-year-old female, three weeks postpartum, is brought to the emergency department
by her partner. She has not slept in 72 hours, is extremely agitated, and insists that her
newborn is "possessed by demons." She is oriented to person and place but not
situation. Vital signs are: blood pressure 152/94 mmHg, heart rate 112 bpm, respiratory
,rate 22 breaths/min, temperature 99.1°F (37.3°C). She has no history of psychiatric
illness. Which action is the highest priority?
A. Initiate an SSRI and arrange outpatient follow-up within one week.
B. Admit to an inpatient psychiatric unit and initiate an antipsychotic with
mood-stabilizing properties.
C. Perform a urine drug screen and discharge home if negative, with strict return
precautions.
D. Administer lorazepam 2 mg IM and observe in the emergency department for 4 hours
prior to disposition.
Correct Answer: B
Rationale: The presentation is classic for postpartum psychosis (acute onset insomnia,
delusions, paranoia, agitation in the postpartum period). This is a psychiatric emergency
with high risk for infanticide and suicide. Immediate inpatient admission is required. An
antipsychotic (e.g., olanzapine, quetiapine, risperidone) and potentially a mood stabilizer
(e.g., lithium) should be initiated. SSRIs are inappropriate as monotherapy for psychosis,
and outpatient management is unsafe.
Question 2
A 19-year-old college freshman is brought to the student health center by his roommate.
Over the past week, he has slept only 2–3 hours nightly, purchased $2,400 worth of
electronic equipment he cannot afford, and is speaking rapidly about "solving the energy
crisis." He is distractible and hyperactive. Urine drug screen is negative. Vital signs are
within normal limits except for a heart rate of 104 bpm. He has no prior psychiatric
,history, but his mother has bipolar I disorder. Which is the most appropriate initial
pharmacological intervention?
A. Initiate lithium carbonate 600 mg daily and titrate to a therapeutic level.
B. Start aripiprazole 10 mg daily and obtain baseline metabolic labs.
C. Prescribe lorazepam 1 mg TID for acute agitation and schedule outpatient follow-up.
D. Begin valproic acid 750 mg daily due to the family history of bipolar disorder.
Correct Answer: B
Rationale: The patient presents with a first manic episode (bipolar I disorder).
Second-generation antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone) are
effective for acute mania and work more rapidly than lithium or valproate. While lithium
is a cornerstone maintenance treatment, monotherapy with a mood stabilizer may take
weeks to achieve full effect. Benzodiazepines may be used adjunctively for acute
agitation but are not definitive treatment. Aripiprazole is weight-neutral compared to
other options, making it a reasonable first choice in a young adult.
Question 3 (SATA)
A 45-year-old patient with major depressive disorder (MDD) is starting venlafaxine XR
75 mg daily. Which counseling points are essential for the nurse practitioner to provide?
(Select all that apply.)
A. Discontinue the medication immediately if you experience a mild headache during
the first week.
, B. This medication may cause an increase in blood pressure; home monitoring is
recommended.
C. Do not stop the medication abruptly, as withdrawal symptoms can be significant.
D. Expect improvement in sleep and energy within 24–48 hours, though mood may take
longer.
E. Avoid taking over-the-counter St. John's wort or tryptophan supplements without
consulting the prescriber.
Correct Answer: B, C, E
Rationale: Venlafaxine is an SNRI associated with dose-dependent hypertension,
making home BP monitoring essential (B). Abrupt discontinuation can cause significant
discontinuation syndrome (C). St. John's wort and tryptophan increase serotonin
syndrome risk when combined with serotonergic agents (E). Mild headaches are
common early side effects and do not require immediate discontinuation (A is
incorrect). While some patients experience early changes in energy or sleep, significant
mood improvement typically requires 2–4 weeks, not 24–48 hours (D is incorrect).
Question 4
A 62-year-old male with treatment-resistant schizophrenia has been stable on clozapine
400 mg daily for 18 months. His most recent labs show: WBC 3.2 × 10³/μL, ANC
1,800/μL, hemoglobin 13.5 g/dL, platelets 180,000/μL. He reports mild fatigue but
denies fever, sore throat, or infection. According to the Clozapine Risk Evaluation and
Mitigation Strategy (REMS), which is the appropriate next step?
A. Discontinue clozapine permanently and transition to a different antipsychotic.
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
Institution: Regis University
Program: Family Psychiatric Mental Health Nurse Practitioner (PMHNP) Track
Level: Graduate
Time Allotment: 120 minutes
Total Questions: 55 (Multiple-Choice and Select-All-That-Apply)
Instructions
This examination assesses clinical knowledge in family psychiatric mental health care,
including diagnostic reasoning, psychopharmacology, therapeutic interventions, crisis
management, and legal/ethical practice. Select the best answer for each
multiple-choice question. For Select-All-That-Apply (SATA) questions, choose all options
that apply. No partial credit is awarded for SATA items.
Question 1
A 28-year-old female, three weeks postpartum, is brought to the emergency department
by her partner. She has not slept in 72 hours, is extremely agitated, and insists that her
newborn is "possessed by demons." She is oriented to person and place but not
situation. Vital signs are: blood pressure 152/94 mmHg, heart rate 112 bpm, respiratory
,rate 22 breaths/min, temperature 99.1°F (37.3°C). She has no history of psychiatric
illness. Which action is the highest priority?
A. Initiate an SSRI and arrange outpatient follow-up within one week.
B. Admit to an inpatient psychiatric unit and initiate an antipsychotic with
mood-stabilizing properties.
C. Perform a urine drug screen and discharge home if negative, with strict return
precautions.
D. Administer lorazepam 2 mg IM and observe in the emergency department for 4 hours
prior to disposition.
Correct Answer: B
Rationale: The presentation is classic for postpartum psychosis (acute onset insomnia,
delusions, paranoia, agitation in the postpartum period). This is a psychiatric emergency
with high risk for infanticide and suicide. Immediate inpatient admission is required. An
antipsychotic (e.g., olanzapine, quetiapine, risperidone) and potentially a mood stabilizer
(e.g., lithium) should be initiated. SSRIs are inappropriate as monotherapy for psychosis,
and outpatient management is unsafe.
Question 2
A 19-year-old college freshman is brought to the student health center by his roommate.
Over the past week, he has slept only 2–3 hours nightly, purchased $2,400 worth of
electronic equipment he cannot afford, and is speaking rapidly about "solving the energy
crisis." He is distractible and hyperactive. Urine drug screen is negative. Vital signs are
within normal limits except for a heart rate of 104 bpm. He has no prior psychiatric
,history, but his mother has bipolar I disorder. Which is the most appropriate initial
pharmacological intervention?
A. Initiate lithium carbonate 600 mg daily and titrate to a therapeutic level.
B. Start aripiprazole 10 mg daily and obtain baseline metabolic labs.
C. Prescribe lorazepam 1 mg TID for acute agitation and schedule outpatient follow-up.
D. Begin valproic acid 750 mg daily due to the family history of bipolar disorder.
Correct Answer: B
Rationale: The patient presents with a first manic episode (bipolar I disorder).
Second-generation antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone) are
effective for acute mania and work more rapidly than lithium or valproate. While lithium
is a cornerstone maintenance treatment, monotherapy with a mood stabilizer may take
weeks to achieve full effect. Benzodiazepines may be used adjunctively for acute
agitation but are not definitive treatment. Aripiprazole is weight-neutral compared to
other options, making it a reasonable first choice in a young adult.
Question 3 (SATA)
A 45-year-old patient with major depressive disorder (MDD) is starting venlafaxine XR
75 mg daily. Which counseling points are essential for the nurse practitioner to provide?
(Select all that apply.)
A. Discontinue the medication immediately if you experience a mild headache during
the first week.
, B. This medication may cause an increase in blood pressure; home monitoring is
recommended.
C. Do not stop the medication abruptly, as withdrawal symptoms can be significant.
D. Expect improvement in sleep and energy within 24–48 hours, though mood may take
longer.
E. Avoid taking over-the-counter St. John's wort or tryptophan supplements without
consulting the prescriber.
Correct Answer: B, C, E
Rationale: Venlafaxine is an SNRI associated with dose-dependent hypertension,
making home BP monitoring essential (B). Abrupt discontinuation can cause significant
discontinuation syndrome (C). St. John's wort and tryptophan increase serotonin
syndrome risk when combined with serotonergic agents (E). Mild headaches are
common early side effects and do not require immediate discontinuation (A is
incorrect). While some patients experience early changes in energy or sleep, significant
mood improvement typically requires 2–4 weeks, not 24–48 hours (D is incorrect).
Question 4
A 62-year-old male with treatment-resistant schizophrenia has been stable on clozapine
400 mg daily for 18 months. His most recent labs show: WBC 3.2 × 10³/μL, ANC
1,800/μL, hemoglobin 13.5 g/dL, platelets 180,000/μL. He reports mild fatigue but
denies fever, sore throat, or infection. According to the Clozapine Risk Evaluation and
Mitigation Strategy (REMS), which is the appropriate next step?
A. Discontinue clozapine permanently and transition to a different antipsychotic.
