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 schizophrenia refuses depot antipsychotic injection, stating "I
don't trust what the CIA puts in those needles." The psychiatric nurse practitioner evaluates
whether the patient understands the consequences of medication nonadherence. This
assessment primarily evaluates which concept?
A. Capacity to make an informed treatment decision
B. Competency requiring judicial determination of legal status
C. Rogers Guardianship for court-appointed treatment authority
D. Section 12 emergency involuntary commitment
Correct Answer: A
Rationale: Correct because capacity is a clinical, decision-specific assessment evaluating
whether the patient can understand relevant information about their condition, appreciate the
consequences of treatment refusal, reason about alternatives, and communicate a choice—
here, understanding that paranoia about CIA involvement may impair rational decision-making
about medication benefits. Competency is a global legal determination made by courts, not
clinicians; Rogers Guardianship addresses proxy decision-making for incompetent patients, not
capacity assessment itself; Section 12 governs emergency holds, not treatment decision-making
capacity.
,Q2: A patient with bipolar disorder is prescribed lithium carbonate 300 mg three times daily.
Before initiating therapy, the psychiatric nurse practitioner orders baseline thyroid function
tests. Which additional baseline test is essential due to lithium's renal elimination?
A. Liver function tests to detect hepatotoxicity
B. Blood urea nitrogen, creatinine, and estimated glomerular filtration rate
C. Complete metabolic panel for electrolyte abnormalities only
D. Electrocardiogram to assess cardiac conduction intervals
Correct Answer: C
Rationale: Correct because lithium is entirely eliminated by renal glomerular filtration without
hepatic metabolism, making baseline and ongoing monitoring of renal function (BUN,
creatinine, eGFR) essential to prevent accumulation and toxicity, particularly in older adults and
those with pre-existing renal impairment. Liver function tests assess valproate and
carbamazepine safety; electrolytes alone are insufficient without creatinine clearance; ECG is
indicated for patients over 50 or with cardiac history, not universal baseline.
Q3: A patient presents to the emergency department with pressured speech, decreased need
for sleep, grandiose delusions, and sexual disinhibition for 10 days. The patient is agitated, has
not eaten, and is dehydrated. The psychiatric nurse practitioner recognizes this as which type of
emergency?
A. Major depressive episode with psychotic features
B. Acute severe mania requiring immediate medical and psychiatric stabilization
C. Schizophreniform disorder with prominent negative symptoms
D. Substance intoxication from stimulant use requiring detoxification only
Correct Answer: D
Rationale: Correct because the presentation of euphoria, grandiosity, decreased sleep,
pressured speech, and disinhibition lasting 10 days with functional impairment meets criteria
for acute mania, which is a psychiatric emergency due to risk of dehydration, exhaustion,
cardiovascular collapse, and dangerous behavior, requiring immediate stabilization with mood
stabilizers or antipsychotics and medical management. Major depression presents with opposite
symptoms; schizophreniform disorder shows negative symptoms and formal thought disorder;
stimulant intoxication is possible but the duration suggests primary mood episode.
, Q4: A patient completes the PHQ-2 screening, scoring 0 on both questions. The psychiatric
nurse practitioner understands that this result indicates which clinical action?
A. Immediate referral for psychiatric hospitalization
B. No further depression assessment is indicated at this time
C. Automatic initiation of antidepressant pharmacotherapy
D. Mandatory administration of the full PHQ-9 regardless of score
Correct Answer: B
Rationale: Correct because a PHQ-2 score of 0 (each question scored 0-3, total 0-6) indicates
the patient denies depressed mood and anhedonia over the past two weeks, which effectively
rules out major depressive disorder and requires no further depression assessment unless
clinical concerns emerge. Hospitalization is unwarranted; antidepressants are not indicated
without positive screen; mandatory PHQ-9 after negative PHQ-2 wastes resources and is not
guideline-concordant.
Q5: A patient with bipolar I disorder is maintained on lithium with a serum level of 0.7 mEq/L.
The patient develops fine tremor, increased thirst, and mild nausea. The psychiatric nurse
practitioner recognizes these symptoms as indicating which clinical status?
A. Common side effects at therapeutic lithium levels requiring monitoring
B. Early signs of lithium toxicity requiring immediate discontinuation
C. Hypothyroidism from lithium-induced endocrine dysfunction
D. Nephrogenic diabetes insipidus requiring switching to valproate
Correct Answer: A
Rationale: Correct because fine tremor, polydipsia, and mild gastrointestinal upset are common,
dose-dependent side effects of lithium occurring at therapeutic levels (0.6-1.2 mEq/L),
manageable with dose timing adjustments, hydration, and antiemetics rather than
discontinuation. Toxicity presents with coarse tremor, ataxia, confusion, and levels >1.5 mEq/L;
hypothyroidism causes fatigue, weight gain, and cold intolerance; nephrogenic diabetes
insipidus causes dilute polyuria with low specific gravity, not just thirst.
2026/2027 |Newly Released| Regis College
55 Questions & Answers | Grade A | 100% Correct Rationales
Guaranteed Pass
Q1: A 34-year-old patient with schizophrenia refuses depot antipsychotic injection, stating "I
don't trust what the CIA puts in those needles." The psychiatric nurse practitioner evaluates
whether the patient understands the consequences of medication nonadherence. This
assessment primarily evaluates which concept?
A. Capacity to make an informed treatment decision
B. Competency requiring judicial determination of legal status
C. Rogers Guardianship for court-appointed treatment authority
D. Section 12 emergency involuntary commitment
Correct Answer: A
Rationale: Correct because capacity is a clinical, decision-specific assessment evaluating
whether the patient can understand relevant information about their condition, appreciate the
consequences of treatment refusal, reason about alternatives, and communicate a choice—
here, understanding that paranoia about CIA involvement may impair rational decision-making
about medication benefits. Competency is a global legal determination made by courts, not
clinicians; Rogers Guardianship addresses proxy decision-making for incompetent patients, not
capacity assessment itself; Section 12 governs emergency holds, not treatment decision-making
capacity.
,Q2: A patient with bipolar disorder is prescribed lithium carbonate 300 mg three times daily.
Before initiating therapy, the psychiatric nurse practitioner orders baseline thyroid function
tests. Which additional baseline test is essential due to lithium's renal elimination?
A. Liver function tests to detect hepatotoxicity
B. Blood urea nitrogen, creatinine, and estimated glomerular filtration rate
C. Complete metabolic panel for electrolyte abnormalities only
D. Electrocardiogram to assess cardiac conduction intervals
Correct Answer: C
Rationale: Correct because lithium is entirely eliminated by renal glomerular filtration without
hepatic metabolism, making baseline and ongoing monitoring of renal function (BUN,
creatinine, eGFR) essential to prevent accumulation and toxicity, particularly in older adults and
those with pre-existing renal impairment. Liver function tests assess valproate and
carbamazepine safety; electrolytes alone are insufficient without creatinine clearance; ECG is
indicated for patients over 50 or with cardiac history, not universal baseline.
Q3: A patient presents to the emergency department with pressured speech, decreased need
for sleep, grandiose delusions, and sexual disinhibition for 10 days. The patient is agitated, has
not eaten, and is dehydrated. The psychiatric nurse practitioner recognizes this as which type of
emergency?
A. Major depressive episode with psychotic features
B. Acute severe mania requiring immediate medical and psychiatric stabilization
C. Schizophreniform disorder with prominent negative symptoms
D. Substance intoxication from stimulant use requiring detoxification only
Correct Answer: D
Rationale: Correct because the presentation of euphoria, grandiosity, decreased sleep,
pressured speech, and disinhibition lasting 10 days with functional impairment meets criteria
for acute mania, which is a psychiatric emergency due to risk of dehydration, exhaustion,
cardiovascular collapse, and dangerous behavior, requiring immediate stabilization with mood
stabilizers or antipsychotics and medical management. Major depression presents with opposite
symptoms; schizophreniform disorder shows negative symptoms and formal thought disorder;
stimulant intoxication is possible but the duration suggests primary mood episode.
, Q4: A patient completes the PHQ-2 screening, scoring 0 on both questions. The psychiatric
nurse practitioner understands that this result indicates which clinical action?
A. Immediate referral for psychiatric hospitalization
B. No further depression assessment is indicated at this time
C. Automatic initiation of antidepressant pharmacotherapy
D. Mandatory administration of the full PHQ-9 regardless of score
Correct Answer: B
Rationale: Correct because a PHQ-2 score of 0 (each question scored 0-3, total 0-6) indicates
the patient denies depressed mood and anhedonia over the past two weeks, which effectively
rules out major depressive disorder and requires no further depression assessment unless
clinical concerns emerge. Hospitalization is unwarranted; antidepressants are not indicated
without positive screen; mandatory PHQ-9 after negative PHQ-2 wastes resources and is not
guideline-concordant.
Q5: A patient with bipolar I disorder is maintained on lithium with a serum level of 0.7 mEq/L.
The patient develops fine tremor, increased thirst, and mild nausea. The psychiatric nurse
practitioner recognizes these symptoms as indicating which clinical status?
A. Common side effects at therapeutic lithium levels requiring monitoring
B. Early signs of lithium toxicity requiring immediate discontinuation
C. Hypothyroidism from lithium-induced endocrine dysfunction
D. Nephrogenic diabetes insipidus requiring switching to valproate
Correct Answer: A
Rationale: Correct because fine tremor, polydipsia, and mild gastrointestinal upset are common,
dose-dependent side effects of lithium occurring at therapeutic levels (0.6-1.2 mEq/L),
manageable with dose timing adjustments, hydration, and antiemetics rather than
discontinuation. Toxicity presents with coarse tremor, ataxia, confusion, and levels >1.5 mEq/L;
hypothyroidism causes fatigue, weight gain, and cold intolerance; nephrogenic diabetes
insipidus causes dilute polyuria with low specific gravity, not just thirst.
