NU664C Exam 1: Family Psychiatric Mental Health I
2026/2027 |Newly Released| Regis College
55 Questions & Answers | Grade A | 100% Correct Rationales
Guaranteed Pass
Q1: A 34-year-old patient with bipolar I disorder is being started on lithium carbonate for
maintenance therapy. Which baseline laboratory assessments are required before initiating
treatment? Select all that apply.
A. Thyroid function tests (TSH, free T4)
B. Comprehensive metabolic panel including BUN and creatinine
C. Complete blood count with differential
D. Liver function tests (AST, ALT, bilirubin)
Correct Answer: A, B, C
Rationale: Correct because lithium baseline monitoring must include thyroid function tests to
screen for pre-existing hypothyroidism and establish baseline for lithium-induced thyroid
dysfunction, renal function tests including BUN and creatinine because lithium is renally
excreted and nephrotoxicity is a major adverse effect, and CBC to detect baseline leukocyte
count as lithium commonly causes benign leukocytosis. Liver function tests are not required for
lithium initiation because lithium does not cause hepatotoxicity; LFT monitoring is indicated for
valproate or carbamazepine initiation, not lithium.
Q2: A patient is brought to the emergency department by police after threatening to harm a
specific neighbor. The patient is agitated, psychotic, and refuses all treatment. Under
Massachusetts law, which admission status is most appropriate?
A. Section 10 conditional voluntary admission
B. Section 11 voluntary admission
C. Section 12 emergency involuntary admission
D. Rogers Guardianship admission
Correct Answer: C
,Rationale: Correct because Section 12 of Massachusetts General Law allows for emergency
involuntary hospitalization for up to 3 days when an individual poses an immediate danger to
self or others, is gravely disabled, or lacks capacity to make informed decisions about treatment
due to mental illness; this patient presents with imminent violence toward an identifiable victim
and acute psychosis requiring immediate protective intervention. Section 10 requires patient
capacity to provide 3-day written notice, Section 11 requires voluntary consent which this
patient refuses, and Rogers Guardianship is a court-appointed proxy for treatment decisions in
legally incompetent patients, not an emergency admission mechanism.
Q3: A 28-year-old patient presents to the psychiatric clinic with depressed mood, anhedonia,
sleep disturbance, and fatigue lasting 3 weeks. The nurse practitioner administers the PHQ-2
screening tool. Which score indicates a positive screen requiring further evaluation with the
PHQ-9?
A. A total score of 2
B. A total score of 3 or higher
C. A total score of 5 or higher
D. A total score of 1
Correct Answer: B
Rationale: Correct because the PHQ-2 is a two-item first-line depression screening tool scored
0-3 per question for a total of 0-6, and a positive screen is defined as a total score of 3 or
greater, which indicates sufficient symptom burden to warrant comprehensive evaluation with
the PHQ-9; scores below 3 are considered negative and do not require further depression
screening. A score of 2 is below the positive threshold, 5 or higher is positive but the cutoff is 3
not 5, and 1 is clearly negative.
Q4: A patient with bipolar II disorder is experiencing a severe depressive episode. The
psychiatric-mental health nurse practitioner is considering pharmacological options. Which
medication is preferred for bipolar depression to minimize risk of mania switch?
A. Fluoxetine monotherapy
B. Lamotrigine
C. Methylphenidate
D. Bupropion monotherapy
Correct Answer: B
, Rationale: Correct because lamotrigine is the preferred agent for bipolar depression due to its
mood-stabilizing properties and low risk of inducing manic or hypomanic episodes, unlike
antidepressants which carry significant risk of mood elevation in bipolar patients. Fluoxetine
and bupropion are antidepressants contraindicated as monotherapy in bipolar depression due
to high mania switch risk, and methylphenidate is a stimulant that would exacerbate mood
instability and is not indicated for depressive episodes in bipolar disorder.
Q5: A 19-year-old college student is brought to the campus health center by roommates after
staying awake for 72 hours, spending $3,000 on credit cards, and claiming to have a direct line
to God. The student is grandiose, hyperverbal, and physically agitated. Which presentation is
most consistent with this clinical picture?
A. Bipolar II hypomanic episode
B. Bipolar I manic episode
C. Cyclothymic disorder
D. Major depressive disorder with psychotic features
Correct Answer: B
Rationale: Correct because this patient presents with classic symptoms of a manic episode
including markedly decreased need for sleep, excessive spending with poor judgment,
grandiose delusions of a religious nature, pressured speech, and psychomotor agitation lasting
more than 7 days, meeting DSM-5 criteria for bipolar I disorder manic episode. Bipolar II
requires hypomania without full manic episodes or psychosis, cyclothymic disorder involves
subthreshold symptoms without full manic or major depressive episodes, and major depressive
disorder with psychotic features would present with depressive rather than expansive mood.
Q6: A patient with major depressive disorder is being evaluated using the Hamilton Depression
Rating Scale (HAM-D). The patient scores 16 on the 17-item scale. How should the nurse
practitioner interpret this score?
A. Normal, no depression
B. Mild depression
C. Moderate depression
D. Severe depression
Correct Answer: C
2026/2027 |Newly Released| Regis College
55 Questions & Answers | Grade A | 100% Correct Rationales
Guaranteed Pass
Q1: A 34-year-old patient with bipolar I disorder is being started on lithium carbonate for
maintenance therapy. Which baseline laboratory assessments are required before initiating
treatment? Select all that apply.
A. Thyroid function tests (TSH, free T4)
B. Comprehensive metabolic panel including BUN and creatinine
C. Complete blood count with differential
D. Liver function tests (AST, ALT, bilirubin)
Correct Answer: A, B, C
Rationale: Correct because lithium baseline monitoring must include thyroid function tests to
screen for pre-existing hypothyroidism and establish baseline for lithium-induced thyroid
dysfunction, renal function tests including BUN and creatinine because lithium is renally
excreted and nephrotoxicity is a major adverse effect, and CBC to detect baseline leukocyte
count as lithium commonly causes benign leukocytosis. Liver function tests are not required for
lithium initiation because lithium does not cause hepatotoxicity; LFT monitoring is indicated for
valproate or carbamazepine initiation, not lithium.
Q2: A patient is brought to the emergency department by police after threatening to harm a
specific neighbor. The patient is agitated, psychotic, and refuses all treatment. Under
Massachusetts law, which admission status is most appropriate?
A. Section 10 conditional voluntary admission
B. Section 11 voluntary admission
C. Section 12 emergency involuntary admission
D. Rogers Guardianship admission
Correct Answer: C
,Rationale: Correct because Section 12 of Massachusetts General Law allows for emergency
involuntary hospitalization for up to 3 days when an individual poses an immediate danger to
self or others, is gravely disabled, or lacks capacity to make informed decisions about treatment
due to mental illness; this patient presents with imminent violence toward an identifiable victim
and acute psychosis requiring immediate protective intervention. Section 10 requires patient
capacity to provide 3-day written notice, Section 11 requires voluntary consent which this
patient refuses, and Rogers Guardianship is a court-appointed proxy for treatment decisions in
legally incompetent patients, not an emergency admission mechanism.
Q3: A 28-year-old patient presents to the psychiatric clinic with depressed mood, anhedonia,
sleep disturbance, and fatigue lasting 3 weeks. The nurse practitioner administers the PHQ-2
screening tool. Which score indicates a positive screen requiring further evaluation with the
PHQ-9?
A. A total score of 2
B. A total score of 3 or higher
C. A total score of 5 or higher
D. A total score of 1
Correct Answer: B
Rationale: Correct because the PHQ-2 is a two-item first-line depression screening tool scored
0-3 per question for a total of 0-6, and a positive screen is defined as a total score of 3 or
greater, which indicates sufficient symptom burden to warrant comprehensive evaluation with
the PHQ-9; scores below 3 are considered negative and do not require further depression
screening. A score of 2 is below the positive threshold, 5 or higher is positive but the cutoff is 3
not 5, and 1 is clearly negative.
Q4: A patient with bipolar II disorder is experiencing a severe depressive episode. The
psychiatric-mental health nurse practitioner is considering pharmacological options. Which
medication is preferred for bipolar depression to minimize risk of mania switch?
A. Fluoxetine monotherapy
B. Lamotrigine
C. Methylphenidate
D. Bupropion monotherapy
Correct Answer: B
, Rationale: Correct because lamotrigine is the preferred agent for bipolar depression due to its
mood-stabilizing properties and low risk of inducing manic or hypomanic episodes, unlike
antidepressants which carry significant risk of mood elevation in bipolar patients. Fluoxetine
and bupropion are antidepressants contraindicated as monotherapy in bipolar depression due
to high mania switch risk, and methylphenidate is a stimulant that would exacerbate mood
instability and is not indicated for depressive episodes in bipolar disorder.
Q5: A 19-year-old college student is brought to the campus health center by roommates after
staying awake for 72 hours, spending $3,000 on credit cards, and claiming to have a direct line
to God. The student is grandiose, hyperverbal, and physically agitated. Which presentation is
most consistent with this clinical picture?
A. Bipolar II hypomanic episode
B. Bipolar I manic episode
C. Cyclothymic disorder
D. Major depressive disorder with psychotic features
Correct Answer: B
Rationale: Correct because this patient presents with classic symptoms of a manic episode
including markedly decreased need for sleep, excessive spending with poor judgment,
grandiose delusions of a religious nature, pressured speech, and psychomotor agitation lasting
more than 7 days, meeting DSM-5 criteria for bipolar I disorder manic episode. Bipolar II
requires hypomania without full manic episodes or psychosis, cyclothymic disorder involves
subthreshold symptoms without full manic or major depressive episodes, and major depressive
disorder with psychotic features would present with depressive rather than expansive mood.
Q6: A patient with major depressive disorder is being evaluated using the Hamilton Depression
Rating Scale (HAM-D). The patient scores 16 on the 17-item scale. How should the nurse
practitioner interpret this score?
A. Normal, no depression
B. Mild depression
C. Moderate depression
D. Severe depression
Correct Answer: C
