NU664C : Family Psychiatric Mental Health I
Final Comprehensive Exam
2026/2027 |Newly Released| Regis College
100 Questions & Answers |Grade A+ |100% Correct Rationales
Guaranteed Pass
Q1: A 28-year-old patient with bipolar I disorder presents with elevated mood, decreased need
for sleep, pressured speech, and excessive spending over 8 days. The patient is grandiose and
distractible. Which DSM-5-TR criterion is met?
A. Hypomanic episode
B. Manic episode
C. Mixed features specifier
D. Rapid-cycling specifier
Correct Answer: B
Rationale: Correct because this patient meets DSM-5-TR criteria for a manic episode with
elevated mood, decreased need for sleep, pressured speech, flight of ideas via distractibility, and
excessive goal-directed activity with high-risk behavior (spending), lasting 8 days which exceeds
the 7-day minimum for mania. Hypomania requires 4 days without marked impairment, mixed
features require concurrent depressive symptoms, and rapid-cycling requires 4 episodes in 12
months.
Q2: A patient on lithium presents with severe diarrhea, vomiting, coarse tremor, ataxia, and
slurred speech. Serum lithium level is 2.3 mEq/L. Which intervention is the priority?
A. Continue lithium at reduced dose and add antiemetics
B. Administer activated charcoal and observe
C. Discontinue lithium immediately, initiate IV normal saline hydration, and prepare for possible
hemodialysis
D. Increase lithium dose to overcome gastrointestinal symptoms
Correct Answer: D
,Rationale: Correct because a lithium level of 2.3 mEq/L indicates severe toxicity presenting
with gastrointestinal symptoms, neurological signs including coarse tremor and ataxia, and
slurred speech; immediate discontinuation of lithium, aggressive IV hydration with normal saline
to enhance renal excretion, and preparation for hemodialysis if renal impairment or worsening
symptoms occur are the standard of care. Continuing or increasing lithium would be fatal, and
activated charcoal does not bind lithium effectively.
Q3: A patient with major depressive disorder scores 18 on the PHQ-9. The patient reports
passive suicidal ideation without plan or intent. Which level of depression severity and action are
indicated?
A. Moderate depression; initiate antidepressant and safety planning
B. Moderately severe depression; initiate antidepressant with close monitoring and safety
assessment
C. Severe depression; consider hospitalization
D. Mild depression; recommend psychotherapy alone
Correct Answer: A
Rationale: Correct because a PHQ-9 score of 18 falls within the moderately severe range (15-
19), indicating significant functional impairment requiring pharmacological intervention; the
presence of passive suicidal ideation necessitates comprehensive safety assessment, development
of a safety plan, and close monitoring rather than immediate hospitalization given the absence of
plan or intent. Moderate depression would score 10-14, severe depression 20-27, and mild
depression 5-9.
Q4: A patient with schizophrenia on risperidone develops amenorrhea, galactorrhea, and sexual
dysfunction. Which neuroanatomical pathway explains these adverse effects?
A. Mesolimbic pathway hyperactivity
B. Mesocortical pathway hypoactivity
C. Nigrostriatal pathway D2 blockade
D. Tuberoinfundibular pathway dopamine inhibition
Correct Answer: C
Rationale: Correct because risperidone's potent D2 receptor blockade in the tuberoinfundibular
pathway removes dopaminergic inhibition of prolactin secretion from the anterior pituitary,
resulting in hyperprolactinemia that causes amenorrhea, galactorrhea, gynecomastia, and sexual
dysfunction. The mesolimbic pathway mediates positive symptoms, mesocortical hypoactivity
causes negative symptoms, and nigrostriatal blockade causes extrapyramidal symptoms.
,Q5: A patient with OCD spends 3-4 hours daily washing hands due to contamination fears. First-
line SSRI treatment at maximum dose for 14 weeks has provided minimal improvement. Which
augmentation strategy is most evidence-based?
A. Increase SSRI beyond FDA maximum dose
B. Add low-dose risperidone 0.5-2 mg daily
C. Switch to benzodiazepine monotherapy
D. Discontinue SSRI and use exposure therapy alone
Correct Answer: B
Rationale: Correct because augmentation with low-dose atypical antipsychotics, particularly
risperidone, is the most evidence-based strategy for treatment-resistant OCD when SSRIs at
adequate doses and duration have failed; risperidone modulates hyperactive direct CSTC
pathway activity through dopaminergic and serotonergic mechanisms. SSRI doses beyond
maximum lack evidence, benzodiazepines do not treat OCD symptoms, and discontinuing
effective SSRI risks relapse.
Q6: Under Massachusetts mental health law, a patient is brought to the emergency department by
police after threatening to kill a neighbor. The patient is agitated, psychotic, and refuses all
treatment. Which legal mechanism allows for immediate involuntary hospitalization?
A. Section 10 voluntary admission
B. Section 11 one-day hold for evaluation
C. Section 12(a) three-day involuntary hold for imminent danger
D. Section 15 emergency police detention only
Correct Answer: D
Rationale: Correct because Massachusetts Section 12(a) authorizes involuntary admission for up
to 3 days when a patient presents imminent danger to self or others, or is gravely disabled, based
on physician certification; this patient meets criteria with credible threat to an identifiable victim
and acute psychosis. Section 10 requires voluntary consent, Section 11 is for emergency
evaluation by law enforcement or physician, and Section 15 allows police/fire detention but
requires physician evaluation for admission.
Q7: A patient with schizophrenia is prescribed clozapine. Which baseline and ongoing
monitoring is required?
A. Absolute neutrophil count through REMS, fasting glucose, lipids, weight, and blood pressure
B. Thyroid function tests every 3 months
C. Pulmonary function tests annually
D. Electroencephalogram monthly
, Correct Answer: A
Rationale: Correct because clozapine requires mandatory ANC monitoring through the FDA
REMS program due to agranulocytosis risk, baseline and periodic fasting metabolic panel for
glucose and lipids due to metabolic syndrome risk, and regular weight and blood pressure
monitoring. Thyroid monitoring is for lithium, pulmonary function tests are not required, and
EEG is not standard for clozapine though myocarditis monitoring may include troponin.
Q8: A patient presents with confusion, agitation, hyperreflexia, clonus, tachycardia,
hypertension, and hyperthermia after starting sertraline while on phenelzine. Which clinical
features distinguish serotonin syndrome from neuroleptic malignant syndrome? Select all that
apply.
A. Hyperreflexia and myoclonus
B. Lead-pipe muscle rigidity
C. Markedly elevated creatine kinase
D. Abrupt onset after serotonergic agent introduction
Correct Answer: A, D
Rationale: Correct because serotonin syndrome is characterized by hyperreflexia, myoclonus,
and abrupt onset after serotonergic agent introduction or dose increase, distinguishing it from
NMS which presents with lead-pipe rigidity, markedly elevated CK, and gradual onset over days.
The combination of sertraline and phenelzine (SSRI plus MAOI) is a classic trigger for serotonin
syndrome due to excessive 5-HT2A receptor activation.
Q9: A patient with generalized anxiety disorder presents with excessive worry about work,
health, and finances for 8 months, with restlessness, fatigue, muscle tension, and sleep
disturbance. Which neurotransmitter system is primarily targeted by first-line pharmacotherapy?
A. Dopamine
B. Serotonin
C. GABA
D. Glutamate
Correct Answer: C
Rationale: Correct because first-line pharmacotherapy for GAD includes SSRIs and SNRIs
which modulate serotonergic neurotransmission in amygdala-prefrontal circuits regulating worry
and emotional processing; serotonin is manufactured in the raphe nuclei and plays a central role
in mood, anxiety, and impulse control. Dopamine is targeted in schizophrenia and bipolar
disorder, GABA is the target of benzodiazepines which are second-line for GAD, and glutamate
is investigational.
Final Comprehensive Exam
2026/2027 |Newly Released| Regis College
100 Questions & Answers |Grade A+ |100% Correct Rationales
Guaranteed Pass
Q1: A 28-year-old patient with bipolar I disorder presents with elevated mood, decreased need
for sleep, pressured speech, and excessive spending over 8 days. The patient is grandiose and
distractible. Which DSM-5-TR criterion is met?
A. Hypomanic episode
B. Manic episode
C. Mixed features specifier
D. Rapid-cycling specifier
Correct Answer: B
Rationale: Correct because this patient meets DSM-5-TR criteria for a manic episode with
elevated mood, decreased need for sleep, pressured speech, flight of ideas via distractibility, and
excessive goal-directed activity with high-risk behavior (spending), lasting 8 days which exceeds
the 7-day minimum for mania. Hypomania requires 4 days without marked impairment, mixed
features require concurrent depressive symptoms, and rapid-cycling requires 4 episodes in 12
months.
Q2: A patient on lithium presents with severe diarrhea, vomiting, coarse tremor, ataxia, and
slurred speech. Serum lithium level is 2.3 mEq/L. Which intervention is the priority?
A. Continue lithium at reduced dose and add antiemetics
B. Administer activated charcoal and observe
C. Discontinue lithium immediately, initiate IV normal saline hydration, and prepare for possible
hemodialysis
D. Increase lithium dose to overcome gastrointestinal symptoms
Correct Answer: D
,Rationale: Correct because a lithium level of 2.3 mEq/L indicates severe toxicity presenting
with gastrointestinal symptoms, neurological signs including coarse tremor and ataxia, and
slurred speech; immediate discontinuation of lithium, aggressive IV hydration with normal saline
to enhance renal excretion, and preparation for hemodialysis if renal impairment or worsening
symptoms occur are the standard of care. Continuing or increasing lithium would be fatal, and
activated charcoal does not bind lithium effectively.
Q3: A patient with major depressive disorder scores 18 on the PHQ-9. The patient reports
passive suicidal ideation without plan or intent. Which level of depression severity and action are
indicated?
A. Moderate depression; initiate antidepressant and safety planning
B. Moderately severe depression; initiate antidepressant with close monitoring and safety
assessment
C. Severe depression; consider hospitalization
D. Mild depression; recommend psychotherapy alone
Correct Answer: A
Rationale: Correct because a PHQ-9 score of 18 falls within the moderately severe range (15-
19), indicating significant functional impairment requiring pharmacological intervention; the
presence of passive suicidal ideation necessitates comprehensive safety assessment, development
of a safety plan, and close monitoring rather than immediate hospitalization given the absence of
plan or intent. Moderate depression would score 10-14, severe depression 20-27, and mild
depression 5-9.
Q4: A patient with schizophrenia on risperidone develops amenorrhea, galactorrhea, and sexual
dysfunction. Which neuroanatomical pathway explains these adverse effects?
A. Mesolimbic pathway hyperactivity
B. Mesocortical pathway hypoactivity
C. Nigrostriatal pathway D2 blockade
D. Tuberoinfundibular pathway dopamine inhibition
Correct Answer: C
Rationale: Correct because risperidone's potent D2 receptor blockade in the tuberoinfundibular
pathway removes dopaminergic inhibition of prolactin secretion from the anterior pituitary,
resulting in hyperprolactinemia that causes amenorrhea, galactorrhea, gynecomastia, and sexual
dysfunction. The mesolimbic pathway mediates positive symptoms, mesocortical hypoactivity
causes negative symptoms, and nigrostriatal blockade causes extrapyramidal symptoms.
,Q5: A patient with OCD spends 3-4 hours daily washing hands due to contamination fears. First-
line SSRI treatment at maximum dose for 14 weeks has provided minimal improvement. Which
augmentation strategy is most evidence-based?
A. Increase SSRI beyond FDA maximum dose
B. Add low-dose risperidone 0.5-2 mg daily
C. Switch to benzodiazepine monotherapy
D. Discontinue SSRI and use exposure therapy alone
Correct Answer: B
Rationale: Correct because augmentation with low-dose atypical antipsychotics, particularly
risperidone, is the most evidence-based strategy for treatment-resistant OCD when SSRIs at
adequate doses and duration have failed; risperidone modulates hyperactive direct CSTC
pathway activity through dopaminergic and serotonergic mechanisms. SSRI doses beyond
maximum lack evidence, benzodiazepines do not treat OCD symptoms, and discontinuing
effective SSRI risks relapse.
Q6: Under Massachusetts mental health law, a patient is brought to the emergency department by
police after threatening to kill a neighbor. The patient is agitated, psychotic, and refuses all
treatment. Which legal mechanism allows for immediate involuntary hospitalization?
A. Section 10 voluntary admission
B. Section 11 one-day hold for evaluation
C. Section 12(a) three-day involuntary hold for imminent danger
D. Section 15 emergency police detention only
Correct Answer: D
Rationale: Correct because Massachusetts Section 12(a) authorizes involuntary admission for up
to 3 days when a patient presents imminent danger to self or others, or is gravely disabled, based
on physician certification; this patient meets criteria with credible threat to an identifiable victim
and acute psychosis. Section 10 requires voluntary consent, Section 11 is for emergency
evaluation by law enforcement or physician, and Section 15 allows police/fire detention but
requires physician evaluation for admission.
Q7: A patient with schizophrenia is prescribed clozapine. Which baseline and ongoing
monitoring is required?
A. Absolute neutrophil count through REMS, fasting glucose, lipids, weight, and blood pressure
B. Thyroid function tests every 3 months
C. Pulmonary function tests annually
D. Electroencephalogram monthly
, Correct Answer: A
Rationale: Correct because clozapine requires mandatory ANC monitoring through the FDA
REMS program due to agranulocytosis risk, baseline and periodic fasting metabolic panel for
glucose and lipids due to metabolic syndrome risk, and regular weight and blood pressure
monitoring. Thyroid monitoring is for lithium, pulmonary function tests are not required, and
EEG is not standard for clozapine though myocarditis monitoring may include troponin.
Q8: A patient presents with confusion, agitation, hyperreflexia, clonus, tachycardia,
hypertension, and hyperthermia after starting sertraline while on phenelzine. Which clinical
features distinguish serotonin syndrome from neuroleptic malignant syndrome? Select all that
apply.
A. Hyperreflexia and myoclonus
B. Lead-pipe muscle rigidity
C. Markedly elevated creatine kinase
D. Abrupt onset after serotonergic agent introduction
Correct Answer: A, D
Rationale: Correct because serotonin syndrome is characterized by hyperreflexia, myoclonus,
and abrupt onset after serotonergic agent introduction or dose increase, distinguishing it from
NMS which presents with lead-pipe rigidity, markedly elevated CK, and gradual onset over days.
The combination of sertraline and phenelzine (SSRI plus MAOI) is a classic trigger for serotonin
syndrome due to excessive 5-HT2A receptor activation.
Q9: A patient with generalized anxiety disorder presents with excessive worry about work,
health, and finances for 8 months, with restlessness, fatigue, muscle tension, and sleep
disturbance. Which neurotransmitter system is primarily targeted by first-line pharmacotherapy?
A. Dopamine
B. Serotonin
C. GABA
D. Glutamate
Correct Answer: C
Rationale: Correct because first-line pharmacotherapy for GAD includes SSRIs and SNRIs
which modulate serotonergic neurotransmission in amygdala-prefrontal circuits regulating worry
and emotional processing; serotonin is manufactured in the raphe nuclei and plays a central role
in mood, anxiety, and impulse control. Dopamine is targeted in schizophrenia and bipolar
disorder, GABA is the target of benzodiazepines which are second-line for GAD, and glutamate
is investigational.
