NURS 6630 WEEK 7 ASSIGNMENT
2026/2027| Assessing & Treating Psychosis &
Schizophrenia | 34-Year-Old
Q1: A 34-year-old Pakistani female, Mrs. Farah Ahmed, presents with an 8-month
history of withdrawal, refusing to cook or care for her children, and arguing with
voices when alone. She believes neighbors are poisoning her food through the
walls. Which cluster of symptoms best represents the positive symptoms of
psychosis?
• Auditory hallucinations and persecutory delusions
• Withdrawal, refusal to care for children, and social isolation
• Impaired working memory and difficulty with executive planning
• Flat affect and reduced spontaneous speech
Rationale: Positive symptoms are “added” experiences not present in healthy
individuals. Auditory hallucinations and persecutory delusions are classic positive
symptoms. Withdrawal and isolation are negative symptoms; cognitive deficits are
not positive symptoms; flat affect is negative.
Q2: Mrs. Ahmed’s family reports she has stopped cooking because she fears the
food is poisoned. This belief persists despite evidence to the contrary. Which term
best describes this symptom?
• Delusion of persecution
• Delusion of reference
• Somatic delusion
• Thought broadcasting
Rationale: A persecutory delusion involves the false belief that one is being
harmed, harassed, or poisoned by others. Delusion of reference involves
interpreting neutral events as personally meaningful; somatic delusions involve
,body function; thought broadcasting is the belief that one’s thoughts are audible to
others.
Q3: During the mental status examination, Mrs. Ahmed speaks very little and
often gives one-word answers. Her facial expressions are flat, and she shows no
pleasure in activities she once enjoyed. These findings are most consistent with:
• Positive symptoms
• Negative symptoms
• Disorganized symptoms
• Catatonic symptoms
Rationale: Negative symptoms include diminished emotional expression (flat
affect), alogia (reduced speech), avolition (lack of motivation), and anhedonia
(inability to feel pleasure). Positive symptoms are hallucinations/delusions;
disorganized symptoms include disorganized speech/behavior; catatonia involves
motor abnormalities.
Q4: Mrs. Ahmed’s family immigrated from Pakistan five years ago. They report
she has become more religiously observant recently, praying for hours each day
and stating that God speaks to her directly. The cultural formulation should
consider:
• That religious experiences are always pathological
• That culturally congruent religious practices must be distinguished
from psychosis
• That any religious statement by a psychotic patient is a delusion
• That she should stop all religious practices to improve
Rationale: In the Cultural Formulation Interview, clinicians distinguish between
culturally normative religious/spiritual experiences and symptoms of psychosis.
Praying for hours and feeling direct communication from God may be within
cultural norms but should be explored in context; not all religious statements are
delusional.
, Q5: Which of the following is the most appropriate first-line pharmacological
treatment for Mrs. Ahmed’s acute psychotic symptoms?
• Second-generation antipsychotic (e.g., risperidone, paliperidone,
aripiprazole)
• First-generation antipsychotic (e.g., haloperidol)
• Benzodiazepine monotherapy
• Selective serotonin reuptake inhibitor (SSRI)
Rationale: Practice guidelines recommend second-generation antipsychotics
(SGAs) as first-line for acute psychosis due to efficacy and lower risk of
extrapyramidal symptoms. First-generation antipsychotics are used but have higher
neurological side effects. Benzodiazepines and SSRIs are not primary treatments
for psychosis.
Q6: Before starting antipsychotic medication for Mrs. Ahmed, the nurse
practitioner should order which baseline assessments?
• Electrocardiogram (ECG), fasting glucose, lipid panel, weight/BMI, and
prolactin level
• Complete blood count and liver function tests only
• Thyroid function tests and urine toxicology
• Brain MRI and lumbar puncture
Rationale: Antipsychotics carry risks of metabolic syndrome (glucose, lipids,
weight), QT prolongation (ECG), and prolactin elevation. Baseline metabolic and
cardiac assessments are standard before initiating therapy. Other tests are not
routinely required without specific indications.
Q7: Mrs. Ahmed’s husband asks why she needs medication when “she was fine
before coming to America.” The nurse practitioner’s best response is:
• “The stress of immigration likely caused her schizophrenia.”
2026/2027| Assessing & Treating Psychosis &
Schizophrenia | 34-Year-Old
Q1: A 34-year-old Pakistani female, Mrs. Farah Ahmed, presents with an 8-month
history of withdrawal, refusing to cook or care for her children, and arguing with
voices when alone. She believes neighbors are poisoning her food through the
walls. Which cluster of symptoms best represents the positive symptoms of
psychosis?
• Auditory hallucinations and persecutory delusions
• Withdrawal, refusal to care for children, and social isolation
• Impaired working memory and difficulty with executive planning
• Flat affect and reduced spontaneous speech
Rationale: Positive symptoms are “added” experiences not present in healthy
individuals. Auditory hallucinations and persecutory delusions are classic positive
symptoms. Withdrawal and isolation are negative symptoms; cognitive deficits are
not positive symptoms; flat affect is negative.
Q2: Mrs. Ahmed’s family reports she has stopped cooking because she fears the
food is poisoned. This belief persists despite evidence to the contrary. Which term
best describes this symptom?
• Delusion of persecution
• Delusion of reference
• Somatic delusion
• Thought broadcasting
Rationale: A persecutory delusion involves the false belief that one is being
harmed, harassed, or poisoned by others. Delusion of reference involves
interpreting neutral events as personally meaningful; somatic delusions involve
,body function; thought broadcasting is the belief that one’s thoughts are audible to
others.
Q3: During the mental status examination, Mrs. Ahmed speaks very little and
often gives one-word answers. Her facial expressions are flat, and she shows no
pleasure in activities she once enjoyed. These findings are most consistent with:
• Positive symptoms
• Negative symptoms
• Disorganized symptoms
• Catatonic symptoms
Rationale: Negative symptoms include diminished emotional expression (flat
affect), alogia (reduced speech), avolition (lack of motivation), and anhedonia
(inability to feel pleasure). Positive symptoms are hallucinations/delusions;
disorganized symptoms include disorganized speech/behavior; catatonia involves
motor abnormalities.
Q4: Mrs. Ahmed’s family immigrated from Pakistan five years ago. They report
she has become more religiously observant recently, praying for hours each day
and stating that God speaks to her directly. The cultural formulation should
consider:
• That religious experiences are always pathological
• That culturally congruent religious practices must be distinguished
from psychosis
• That any religious statement by a psychotic patient is a delusion
• That she should stop all religious practices to improve
Rationale: In the Cultural Formulation Interview, clinicians distinguish between
culturally normative religious/spiritual experiences and symptoms of psychosis.
Praying for hours and feeling direct communication from God may be within
cultural norms but should be explored in context; not all religious statements are
delusional.
, Q5: Which of the following is the most appropriate first-line pharmacological
treatment for Mrs. Ahmed’s acute psychotic symptoms?
• Second-generation antipsychotic (e.g., risperidone, paliperidone,
aripiprazole)
• First-generation antipsychotic (e.g., haloperidol)
• Benzodiazepine monotherapy
• Selective serotonin reuptake inhibitor (SSRI)
Rationale: Practice guidelines recommend second-generation antipsychotics
(SGAs) as first-line for acute psychosis due to efficacy and lower risk of
extrapyramidal symptoms. First-generation antipsychotics are used but have higher
neurological side effects. Benzodiazepines and SSRIs are not primary treatments
for psychosis.
Q6: Before starting antipsychotic medication for Mrs. Ahmed, the nurse
practitioner should order which baseline assessments?
• Electrocardiogram (ECG), fasting glucose, lipid panel, weight/BMI, and
prolactin level
• Complete blood count and liver function tests only
• Thyroid function tests and urine toxicology
• Brain MRI and lumbar puncture
Rationale: Antipsychotics carry risks of metabolic syndrome (glucose, lipids,
weight), QT prolongation (ECG), and prolactin elevation. Baseline metabolic and
cardiac assessments are standard before initiating therapy. Other tests are not
routinely required without specific indications.
Q7: Mrs. Ahmed’s husband asks why she needs medication when “she was fine
before coming to America.” The nurse practitioner’s best response is:
• “The stress of immigration likely caused her schizophrenia.”
