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NURS 665 PSYCHIATRIC MENTAL HEALTH DIAGNOSIS
AND MANAGEMENT III PRACTICE EXAM MARYVILLE
UNIVERSITY — PMHNP PROGRAM 2026/2027 COMPLETE
(100) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PSYCHIATRIC
Prepare for the NURS 665 Exam – Maryville University with a focused study resource
designed to reinforce advanced psychiatric and mental health nursing concepts. It
supports review of psychiatric assessment, diagnostic considerations, mental health
disorders across the lifespan, therapeutic interventions, psychopharmacology, and
patient-centered management. Use the practice material to strengthen clinical
reasoning, apply diagnostic and treatment concepts, and identify areas that may
require additional review before the exam. This resource is best suited for Maryville
University NURS 665 students, PMHNP learners, and graduate nursing students
preparing for Psychiatric Mental Health Diagnosis and Management III assessments.
MULTIPLE CHOICE.
SECTION 1: COMPLEX PSYCHIATRIC DISORDERS — SCHIZOPHRENIA &
PSYCHOTIC DISORDERS
1. A 24-year-old male presents with a 6-month history of auditory
hallucinations, paranoid delusions, and disorganized speech. He has no
history of mood episodes. What is the most likely diagnosis?
A) Schizoaffective disorder
B) Schizophrenia
C) Brief psychotic disorder
D) Substance-induced psychotic disorder
Answer: B) Schizophrenia
Rationale: This patient meets criteria for schizophrenia: at least 6 months
of symptoms including two or more of the following: delusions,
hallucinations, disorganized speech, grossly disorganized or catatonic
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behavior, or negative symptoms. The absence of mood episodes helps
differentiate from schizoaffective disorder. Brief psychotic disorder lasts
1 day to 1 month.
2. A 28-year-old woman with schizophrenia is on clozapine. She reports a
sore throat and fever. What is the priority action?
A) Administer acetaminophen and monitor
B) Hold clozapine and obtain a CBC with differential
C) Prescribe antibiotics
D) Encourage oral fluids
Answer: B) Hold clozapine and obtain a CBC with differential
Rationale: Clozapine carries a risk of agranulocytosis (severe
neutropenia). Fever and sore throat may be early signs of agranulocytosis.
The medication should be held, and a complete blood count with
differential should be obtained immediately. Clozapine requires regular
monitoring through the REMS program.
3. Which of the following is a negative symptom of schizophrenia?
A) Hallucinations
B) Delusions
C) Avolition
D) Disorganized speech
Answer: C) Avolition
Rationale: Negative symptoms of schizophrenia include avolition (lack of
motivation), alogia (poverty of speech), anhedonia, asociality, and flat
affect. Positive symptoms include hallucinations, delusions, and
disorganized speech. Negative symptoms are often more refractory to
antipsychotic treatment and are associated with poorer functional
outcomes.
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4. A 32-year-old man with schizophrenia is on risperidone. He presents
with weight gain, hyperglycemia, and hyperlipidemia. What is the most
appropriate next step?
A) Continue risperidone and monitor
B) Switch to haloperidol
C) Add metformin and counsel on lifestyle modifications
D) Switch to clozapine
Answer: C) Add metformin and counsel on lifestyle modifications
Rationale: Second-generation antipsychotics are associated with
metabolic side effects including weight gain, hyperglycemia, and
hyperlipidemia. Metformin can be used to manage weight gain and insulin
resistance. Lifestyle modifications (diet, exercise) are essential.
Switching to haloperidol may reduce metabolic risk but increases EPS
risk. Clozapine has even higher metabolic risk.
5. A 45-year-old man with schizophrenia is on haloperidol. He develops
involuntary, repetitive movements of the face and tongue. Which of the
following is the most likely diagnosis?
A) Akathisia
B) Tardive dyskinesia
C) Dystonia
D) Parkinsonism
Answer: B) Tardive dyskinesia
Rationale: Tardive dyskinesia is a potentially irreversible movement
disorder characterized by involuntary movements of the face, tongue, and
extremities. It is associated with long-term use of first-generation
antipsychotics. Akathisia is subjective restlessness. Dystonia is muscle
spasms. Parkinsonism is rigidity and bradykinesia.
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6. A 30-year-old woman with schizophrenia is experiencing auditory
hallucinations. She tells the PMHNP, "The voices are telling me I'm
worthless." What is the most therapeutic response?
A) "Those voices are not real."
B) "I understand you are hearing voices. That must be frightening."
C) "Try to ignore the voices."
D) "What are the voices saying to you?"
Answer: B) "I understand you are hearing voices. That must be
frightening."
Rationale: This response acknowledges the client's experience without
reinforcing the hallucination. It validates the emotional impact while
maintaining reality orientation. Telling the client they are hallucinating
can feel dismissive. Asking what the voices are saying may reinforce the
hallucination.
7. A 26-year-old man with a first episode of psychosis is being evaluated.
Which factor is most predictive of a good prognosis?
A) Insidious onset
B) Early age of onset
C) Acute onset with good premorbid functioning
D) Male gender
Answer: C) Acute onset with good premorbid functioning
Rationale: Acute onset and good premorbid functioning are positive
prognostic factors in schizophrenia. Insidious onset, early age of onset,
and male gender are associated with poorer outcomes. Early intervention
in first-episode psychosis improves long-term outcomes.
NURS 665 PSYCHIATRIC MENTAL HEALTH DIAGNOSIS
AND MANAGEMENT III PRACTICE EXAM MARYVILLE
UNIVERSITY — PMHNP PROGRAM 2026/2027 COMPLETE
(100) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PSYCHIATRIC
Prepare for the NURS 665 Exam – Maryville University with a focused study resource
designed to reinforce advanced psychiatric and mental health nursing concepts. It
supports review of psychiatric assessment, diagnostic considerations, mental health
disorders across the lifespan, therapeutic interventions, psychopharmacology, and
patient-centered management. Use the practice material to strengthen clinical
reasoning, apply diagnostic and treatment concepts, and identify areas that may
require additional review before the exam. This resource is best suited for Maryville
University NURS 665 students, PMHNP learners, and graduate nursing students
preparing for Psychiatric Mental Health Diagnosis and Management III assessments.
MULTIPLE CHOICE.
SECTION 1: COMPLEX PSYCHIATRIC DISORDERS — SCHIZOPHRENIA &
PSYCHOTIC DISORDERS
1. A 24-year-old male presents with a 6-month history of auditory
hallucinations, paranoid delusions, and disorganized speech. He has no
history of mood episodes. What is the most likely diagnosis?
A) Schizoaffective disorder
B) Schizophrenia
C) Brief psychotic disorder
D) Substance-induced psychotic disorder
Answer: B) Schizophrenia
Rationale: This patient meets criteria for schizophrenia: at least 6 months
of symptoms including two or more of the following: delusions,
hallucinations, disorganized speech, grossly disorganized or catatonic
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behavior, or negative symptoms. The absence of mood episodes helps
differentiate from schizoaffective disorder. Brief psychotic disorder lasts
1 day to 1 month.
2. A 28-year-old woman with schizophrenia is on clozapine. She reports a
sore throat and fever. What is the priority action?
A) Administer acetaminophen and monitor
B) Hold clozapine and obtain a CBC with differential
C) Prescribe antibiotics
D) Encourage oral fluids
Answer: B) Hold clozapine and obtain a CBC with differential
Rationale: Clozapine carries a risk of agranulocytosis (severe
neutropenia). Fever and sore throat may be early signs of agranulocytosis.
The medication should be held, and a complete blood count with
differential should be obtained immediately. Clozapine requires regular
monitoring through the REMS program.
3. Which of the following is a negative symptom of schizophrenia?
A) Hallucinations
B) Delusions
C) Avolition
D) Disorganized speech
Answer: C) Avolition
Rationale: Negative symptoms of schizophrenia include avolition (lack of
motivation), alogia (poverty of speech), anhedonia, asociality, and flat
affect. Positive symptoms include hallucinations, delusions, and
disorganized speech. Negative symptoms are often more refractory to
antipsychotic treatment and are associated with poorer functional
outcomes.
, Page 3 of 51
4. A 32-year-old man with schizophrenia is on risperidone. He presents
with weight gain, hyperglycemia, and hyperlipidemia. What is the most
appropriate next step?
A) Continue risperidone and monitor
B) Switch to haloperidol
C) Add metformin and counsel on lifestyle modifications
D) Switch to clozapine
Answer: C) Add metformin and counsel on lifestyle modifications
Rationale: Second-generation antipsychotics are associated with
metabolic side effects including weight gain, hyperglycemia, and
hyperlipidemia. Metformin can be used to manage weight gain and insulin
resistance. Lifestyle modifications (diet, exercise) are essential.
Switching to haloperidol may reduce metabolic risk but increases EPS
risk. Clozapine has even higher metabolic risk.
5. A 45-year-old man with schizophrenia is on haloperidol. He develops
involuntary, repetitive movements of the face and tongue. Which of the
following is the most likely diagnosis?
A) Akathisia
B) Tardive dyskinesia
C) Dystonia
D) Parkinsonism
Answer: B) Tardive dyskinesia
Rationale: Tardive dyskinesia is a potentially irreversible movement
disorder characterized by involuntary movements of the face, tongue, and
extremities. It is associated with long-term use of first-generation
antipsychotics. Akathisia is subjective restlessness. Dystonia is muscle
spasms. Parkinsonism is rigidity and bradykinesia.
, Page 4 of 51
6. A 30-year-old woman with schizophrenia is experiencing auditory
hallucinations. She tells the PMHNP, "The voices are telling me I'm
worthless." What is the most therapeutic response?
A) "Those voices are not real."
B) "I understand you are hearing voices. That must be frightening."
C) "Try to ignore the voices."
D) "What are the voices saying to you?"
Answer: B) "I understand you are hearing voices. That must be
frightening."
Rationale: This response acknowledges the client's experience without
reinforcing the hallucination. It validates the emotional impact while
maintaining reality orientation. Telling the client they are hallucinating
can feel dismissive. Asking what the voices are saying may reinforce the
hallucination.
7. A 26-year-old man with a first episode of psychosis is being evaluated.
Which factor is most predictive of a good prognosis?
A) Insidious onset
B) Early age of onset
C) Acute onset with good premorbid functioning
D) Male gender
Answer: C) Acute onset with good premorbid functioning
Rationale: Acute onset and good premorbid functioning are positive
prognostic factors in schizophrenia. Insidious onset, early age of onset,
and male gender are associated with poorer outcomes. Early intervention
in first-episode psychosis improves long-term outcomes.
