NU 664C Family Psychiatric Mental Health I Exam 1 Questions
and Answers | Verified Solutions with Detailed Rationales
(2026/2027 Edition)
Family Psychiatric Mental Health I Examination
Regis College
NU 664C – Exam 1
2026/2027 Edition
SECTION 1: Psychiatric Assessment and Mental Status Examination
(8 questions)
Question 1
A 34-year-old male presents to the psychiatric clinic for an initial evaluation. During the
interview, the PMHNP observes that the patient frequently drifts from the original topic,
introducing loosely related ideas that never return to the initial question. The patient's
speech is fluent but difficult to follow. Which of the following best describes this pattern
of thought?
A. Tangential thinking
B. Circumstantial thinking
C. Loose associations
D. Flight of ideas
Correct Answer: C
Rationale: Loose associations (derailment) describe a thought process in which the
patient shifts from one topic to another with no logical or meaningful connection
between ideas; the patient never returns to the original point. Tangential thinking (A)
involves digressing from the topic but eventually reaching a point that is somewhat
related to the original question. Circumstantial thinking (B) includes excessive
unnecessary detail but eventually returns to the original point. Flight of ideas (D) is
characterized by rapid, continuous speech with abrupt shifts between topics, often
based on clang associations or environmental stimuli, and is typically seen in manic
,episodes. The key distinguishing feature in this scenario is that the patient never returns
to the original topic, which is pathognomonic for loose associations.
Question 2
During a mental status examination, a PMHNP assesses a 67-year-old woman with
schizophrenia. The patient demonstrates minimal spontaneous movement, maintains a
fixed gaze, and shows no emotional reactivity to pleasant or unpleasant stimuli. Her
posture is rigid and she resists passive movement. Which cluster of symptoms is most
consistent with this presentation?
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Mood symptoms
Correct Answer: B
Rationale: Negative symptoms represent the absence or diminution of normal functions
and include affective flattening (lack of emotional reactivity), alogia (poverty of speech),
avolition (lack of motivation), anhedonia (inability to experience pleasure), and catatonia
(marked psychomotor abnormalities including rigidity and waxy flexibility). The
presentation described—minimal movement, fixed gaze, flat affect, and rigidity—is
classic for negative symptoms, specifically catatonia and affective flattening. Positive
symptoms (A) include hallucinations, delusions, and disorganized speech. Cognitive
symptoms (C) include impaired attention, memory, and executive function. Mood
symptoms (D) refer to disturbances in emotional state such as depression or mania.
Question 3
A 22-year-old college student is brought to the emergency department by campus
security after being found wandering outside in freezing temperatures wearing only a
t-shirt. The patient is disoriented, responds to internal stimuli, and laughs spontaneously
without apparent external cause. During the MSE, the PMHNP notes that the patient's
affect changes rapidly from euphoria to irritability within minutes. Which term best
describes this affective presentation?
A. Blunted affect
B. Labile affect
C. Inappropriate affect
,D. Constricted affect
Correct Answer: B
Rationale: Labile affect describes rapid, abrupt, and frequent shifts in emotional
expression that are often exaggerated and unrelated to external stimuli or content of
speech. The patient's rapid oscillation from euphoria to irritability within minutes is
characteristic of labile affect, commonly seen in mania, certain neurological conditions,
and schizophrenia. Blunted affect (A) refers to a significant reduction in the intensity of
emotional expression. Inappropriate affect (C) occurs when emotional expression is
discordant with the context or content (e.g., laughing when discussing a traumatic
event). Constricted affect (D) indicates a mild reduction in the range and intensity of
emotional expression. The rapid shifts described distinguish labile affect from the other
options.
Question 4
A PMHNP is conducting an initial psychiatric evaluation of a 45-year-old man who was
involuntarily hospitalized after threatening to harm his neighbor. The patient has a
history of bipolar I disorder and is currently manic. He insists he does not need
medication and wants to leave the hospital immediately. The PMHNP must determine
whether the patient has the capacity to make informed decisions about his treatment.
Which of the following is the most accurate statement regarding capacity in this
context?
A. Capacity is a global, all-or-nothing determination made by a judge
B. Capacity is decision-specific and can be assessed by a trained clinician at the
bedside
C. Capacity requires the patient to agree with the treatment team's recommendations
D. Capacity is determined by the patient's ability to understand only the risks of
treatment
Correct Answer: B
Rationale: Capacity is a clinical determination that is decision-specific and task-specific,
meaning a patient may have capacity for some decisions but not others. It is assessed
by the treating clinician (physician, PMHNP, or other trained healthcare provider) at the
, bedside based on the patient's ability to understand relevant information, appreciate the
situation and its consequences, reason about treatment options, and communicate a
choice. Competency (A) is a legal determination made by a court and is global in nature.
Capacity does not require agreement with the treatment team (C); a patient can refuse
treatment and still have capacity if they understand the consequences. Capacity
requires understanding of risks, benefits, and alternatives (D), not just risks.
Question 5
A 19-year-old female presents to the clinic with a two-week history of depressed mood,
anhedonia, hypersomnia, and psychomotor retardation. During the suicide risk
assessment, she denies current suicidal ideation but reports that she attempted suicide
by overdose two years ago. She has a supportive family, no access to firearms, and is
willing to engage in treatment. Which of the following is the strongest protective factor
against suicide in this patient?
A. Female gender
B. History of previous suicide attempt
C. Strong social support system
D. Absence of current suicidal ideation
Correct Answer: C
Rationale: Protective factors are characteristics or conditions that reduce the likelihood
of suicide. A strong social support system is one of the most robust protective factors,
as it provides emotional support, practical assistance, and connectedness that buffer
against suicidal behavior. Female gender (A) is actually a risk factor for suicide
attempts (though males have higher completion rates). A history of previous suicide
attempt (B) is one of the strongest risk factors for future suicide, not a protective factor.
Absence of current suicidal ideation (D) is reassuring but is a transient clinical finding
rather than a stable protective factor; ideation can fluctuate rapidly. The Columbia
Suicide Severity Rating Scale (C-SRSS) and other evidence-based tools emphasize that
protective factors like social support, engagement in treatment, and restricted access to
lethal means are critical in comprehensive risk assessment.
and Answers | Verified Solutions with Detailed Rationales
(2026/2027 Edition)
Family Psychiatric Mental Health I Examination
Regis College
NU 664C – Exam 1
2026/2027 Edition
SECTION 1: Psychiatric Assessment and Mental Status Examination
(8 questions)
Question 1
A 34-year-old male presents to the psychiatric clinic for an initial evaluation. During the
interview, the PMHNP observes that the patient frequently drifts from the original topic,
introducing loosely related ideas that never return to the initial question. The patient's
speech is fluent but difficult to follow. Which of the following best describes this pattern
of thought?
A. Tangential thinking
B. Circumstantial thinking
C. Loose associations
D. Flight of ideas
Correct Answer: C
Rationale: Loose associations (derailment) describe a thought process in which the
patient shifts from one topic to another with no logical or meaningful connection
between ideas; the patient never returns to the original point. Tangential thinking (A)
involves digressing from the topic but eventually reaching a point that is somewhat
related to the original question. Circumstantial thinking (B) includes excessive
unnecessary detail but eventually returns to the original point. Flight of ideas (D) is
characterized by rapid, continuous speech with abrupt shifts between topics, often
based on clang associations or environmental stimuli, and is typically seen in manic
,episodes. The key distinguishing feature in this scenario is that the patient never returns
to the original topic, which is pathognomonic for loose associations.
Question 2
During a mental status examination, a PMHNP assesses a 67-year-old woman with
schizophrenia. The patient demonstrates minimal spontaneous movement, maintains a
fixed gaze, and shows no emotional reactivity to pleasant or unpleasant stimuli. Her
posture is rigid and she resists passive movement. Which cluster of symptoms is most
consistent with this presentation?
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Mood symptoms
Correct Answer: B
Rationale: Negative symptoms represent the absence or diminution of normal functions
and include affective flattening (lack of emotional reactivity), alogia (poverty of speech),
avolition (lack of motivation), anhedonia (inability to experience pleasure), and catatonia
(marked psychomotor abnormalities including rigidity and waxy flexibility). The
presentation described—minimal movement, fixed gaze, flat affect, and rigidity—is
classic for negative symptoms, specifically catatonia and affective flattening. Positive
symptoms (A) include hallucinations, delusions, and disorganized speech. Cognitive
symptoms (C) include impaired attention, memory, and executive function. Mood
symptoms (D) refer to disturbances in emotional state such as depression or mania.
Question 3
A 22-year-old college student is brought to the emergency department by campus
security after being found wandering outside in freezing temperatures wearing only a
t-shirt. The patient is disoriented, responds to internal stimuli, and laughs spontaneously
without apparent external cause. During the MSE, the PMHNP notes that the patient's
affect changes rapidly from euphoria to irritability within minutes. Which term best
describes this affective presentation?
A. Blunted affect
B. Labile affect
C. Inappropriate affect
,D. Constricted affect
Correct Answer: B
Rationale: Labile affect describes rapid, abrupt, and frequent shifts in emotional
expression that are often exaggerated and unrelated to external stimuli or content of
speech. The patient's rapid oscillation from euphoria to irritability within minutes is
characteristic of labile affect, commonly seen in mania, certain neurological conditions,
and schizophrenia. Blunted affect (A) refers to a significant reduction in the intensity of
emotional expression. Inappropriate affect (C) occurs when emotional expression is
discordant with the context or content (e.g., laughing when discussing a traumatic
event). Constricted affect (D) indicates a mild reduction in the range and intensity of
emotional expression. The rapid shifts described distinguish labile affect from the other
options.
Question 4
A PMHNP is conducting an initial psychiatric evaluation of a 45-year-old man who was
involuntarily hospitalized after threatening to harm his neighbor. The patient has a
history of bipolar I disorder and is currently manic. He insists he does not need
medication and wants to leave the hospital immediately. The PMHNP must determine
whether the patient has the capacity to make informed decisions about his treatment.
Which of the following is the most accurate statement regarding capacity in this
context?
A. Capacity is a global, all-or-nothing determination made by a judge
B. Capacity is decision-specific and can be assessed by a trained clinician at the
bedside
C. Capacity requires the patient to agree with the treatment team's recommendations
D. Capacity is determined by the patient's ability to understand only the risks of
treatment
Correct Answer: B
Rationale: Capacity is a clinical determination that is decision-specific and task-specific,
meaning a patient may have capacity for some decisions but not others. It is assessed
by the treating clinician (physician, PMHNP, or other trained healthcare provider) at the
, bedside based on the patient's ability to understand relevant information, appreciate the
situation and its consequences, reason about treatment options, and communicate a
choice. Competency (A) is a legal determination made by a court and is global in nature.
Capacity does not require agreement with the treatment team (C); a patient can refuse
treatment and still have capacity if they understand the consequences. Capacity
requires understanding of risks, benefits, and alternatives (D), not just risks.
Question 5
A 19-year-old female presents to the clinic with a two-week history of depressed mood,
anhedonia, hypersomnia, and psychomotor retardation. During the suicide risk
assessment, she denies current suicidal ideation but reports that she attempted suicide
by overdose two years ago. She has a supportive family, no access to firearms, and is
willing to engage in treatment. Which of the following is the strongest protective factor
against suicide in this patient?
A. Female gender
B. History of previous suicide attempt
C. Strong social support system
D. Absence of current suicidal ideation
Correct Answer: C
Rationale: Protective factors are characteristics or conditions that reduce the likelihood
of suicide. A strong social support system is one of the most robust protective factors,
as it provides emotional support, practical assistance, and connectedness that buffer
against suicidal behavior. Female gender (A) is actually a risk factor for suicide
attempts (though males have higher completion rates). A history of previous suicide
attempt (B) is one of the strongest risk factors for future suicide, not a protective factor.
Absence of current suicidal ideation (D) is reassuring but is a transient clinical finding
rather than a stable protective factor; ideation can fluctuate rapidly. The Columbia
Suicide Severity Rating Scale (C-SRSS) and other evidence-based tools emphasize that
protective factors like social support, engagement in treatment, and restricted access to
lethal means are critical in comprehensive risk assessment.
