RNP 6675 / NRNP6675 FINAL EXAM
N
2026-2027 | Psychiatric Mental Health Nurse
Practitioner Care Across the Lifespan I |
Verified Q&A | Newly Updated | Pass
Guaranteed - A+ Graded
=======================================================================
=
======== PART A – MULTIPLE CHOICE (Q1‑80)
Q1 (Schizophrenia – diagnostic criteria): A 22-year-old male is brought to the emergency
department by campus police after screaming that the government has implanted tracking
devices in his brain. His roommate reports he has been isolating for 8 months, talking to himself,
and neglecting hygiene. On exam, he displays flat affect, alogia, and poor eye contact. Which
DSM-5-TR criterion is NOT required for a schizophrenia diagnosis?
A. Continuous signs of disturbance for at least 6 months
B. At least two core symptoms present for a significant portion of a 1-month period
C. Marked decline in social/occupational functioning since onset
D. Symptoms must begin before age 25
[CORRECT] D
Rationale: DSM-5-TR Criterion A for schizophrenia requires ≥2 core symptoms (delusions,
hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative
symptoms) for ≥1 month, with continuous signs for ≥6 months total (Criterion B), and marked
functional decline (Criterion C). There is NO age-of-onset requirement in DSM-5-TR—this is a
common student error confusing schizophrenia with early psychosis programs. Clinical pearl:
Age of onset is typically late teens to mid-30s, but not diagnostic.
Q2 (Schizophrenia – differential): A 35-year-old woman presents with 4 weeks of auditory
hallucinations and persecutory delusions following the death of her husband. She has no prior
psychiatric history, and symptoms began 2 weeks after the funeral. She is oriented, sleeps
poorly, and has intermittent suicidal ideation. What is the most likely diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Brief psychotic disorder
D. Delusional disorder
[CORRECT] C
Rationale: DSM-5-TR defines brief psychotic disorder as the sudden onset of ≥1 psychotic
symptoms (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic
behavior) lasting >1 day but <1 month, with eventual full return to premorbid functioning. The
temporal link to bereavement and absence of prodrome support this over schizophrenia (≥6
months). The distractor "schizoaffective" is wrong because there is no mood episode meeting
,full criteria concurrent with psychosis. Clinical pearl: Brief psychotic disorder often follows
stressors and has excellent prognosis.
Q3 (Schizoaffective disorder): A 28-year-old man has a 2-year history of auditory hallucinations
and paranoid delusions. During the past 6 months, he has also experienced major depressive
episodes with anhedonia, psychomotor retardation, and passive suicidal ideation. The mood
episodes have been present for the majority of the total illness duration. What is the correct
diagnosis?
A. Schizophrenia with comorbid MDD
B. Schizoaffective disorder, depressive type
C. Bipolar I disorder with psychotic features
D. Major depressive disorder with psychotic features
[CORRECT] B
Rationale: DSM-5-TR criteria for schizoaffective disorder require (1) an uninterrupted period of
illness with concurrent major mood episode and Criterion A schizophrenia symptoms, (2)
delusions/hallucinations for ≥2 weeks in the absence of prominent mood symptoms, and (3)
mood symptoms present for the majority of the total illness duration. The 6-month mood
predominance and 2-year psychosis history meet these criteria. Distractor A is wrong because
in schizophrenia, mood episodes are brief relative to psychosis duration. Clinical pearl: "Mood
symptoms majority of time" is the key differentiator from schizophrenia.
Q4 (First-generation antipsychotics – EPS): A 45-year-old man on haloperidol 10 mg daily for
schizophrenia develops acute dystonia with torticollis and oculogyric crisis 5 days after initiation.
Which medication is first-line for acute management?
A. Propranolol 40 mg PO
B. Benztropine 2 mg IM/IV
C. Amantadine 100 mg PO BID
D. Diphenhydramine 25 mg PO
[CORRECT] B
Rationale: Acute dystonia is an early-onset extrapyramidal symptom (EPS) caused by
dopamine D2 receptor blockade in the nigrostriatal pathway. Benztropine (anticholinergic) 1-2
mg IM/IV is first-line for acute dystonia due to rapid onset. Propranolol treats akathisia, not
dystonia. Amantadine is used for chronic EPS or Parkinsonism. Diphenhydramine is second-line
and less effective than benztropine for severe acute dystonia. Clinical pearl: Young males are
highest risk for acute dystonia; always have benztropine available when initiating high-potency
FGAs.
Q5 (Tardive dyskinesia): A 62-year-old woman on chlorpromazine for 15 years develops
involuntary, repetitive tongue protrusion and lip smacking. Which medication is FDA-approved
for tardive dyskinesia treatment?
A. Trihexyphenidyl
B. Valbenazine
C. Ropinirole
D. Levodopa
[CORRECT] B
Rationale: Valbenazine (Ingrezza) and deutetrabenazine (Austedo) are FDA-approved VMAT2
inhibitors for tardive dyskinesia (TD), which results from chronic dopamine receptor
, upersensitivity from antipsychotic exposure. Trihexyphenidyl (anticholinergic) worsens TD by
s
worsening cholinergic imbalance. Ropinirole (dopamine agonist) and levodopa are
contraindicated as they may worsen psychosis. Clinical pearl: TD risk increases with age,
duration of antipsychotic use, and FGA exposure; monitor with AIMS every 6 months.
Q6 (Second-generation antipsychotics – metabolic syndrome): A 34-year-old man on
olanzapine 20 mg daily for 6 months has gained 22 lbs, developed fasting glucose 142 mg/dL,
and triglycerides 280 mg/dL. Which metabolic parameter should be monitored most urgently?
A. Hemoglobin A1c
B. Lipid panel
C. Blood pressure
D. Waist circumference
[CORRECT] A
Rationale: Olanzapine carries the highest metabolic risk among SGAs, with rapid onset of
insulin resistance and glucose dysregulation. Fasting glucose >126 mg/dL meets diabetes
threshold per ADA criteria and requires immediate intervention. While all metabolic parameters
matter, glucose abnormalities can precipitate diabetic ketoacidosis (DKA) acutely. The ADA/APA
consensus recommends A1c monitoring every 3-6 months for patients on high-risk
antipsychotics. Clinical pearl: Olanzapine and clozapine have the highest weight gain/metabolic
liability; aripiprazole and ziprasidone have the lowest.
Q7 (Clozapine – absolute neutrophil count): A 28-year-old man with treatment-resistant
schizophrenia is started on clozapine. His baseline ANC is 4,200/mm³. According to the REMS
program, what is the required ANC monitoring frequency during the first 6 months?
A. Weekly
B. Every 2 weeks
C. Monthly
D. Every 3 months
[CORRECT] A
Rationale: The Clozapine Risk Evaluation and Mitigation Strategy (REMS) mandates weekly
ANC monitoring for the first 6 months of therapy due to risk of agranulocytosis (ANC <500/mm³).
After 6 months of stable counts, frequency decreases to every 2 weeks for months 6-12, then
monthly thereafter. ANC 1,000-1,499 requires interruption; <500 requires permanent
discontinuation. Clinical pearl: Clozapine is the only antipsychotic with proven efficacy for
treatment-resistant schizophrenia (30-60% response rate); do not let monitoring burden delay its
use in appropriate candidates.
Q8 (Clozapine – myocarditis): A 25-year-old woman on clozapine for 3 weeks presents with
fever, chest pain, and dyspnea. ECG shows ST elevations; troponin is elevated.
Echocardiogram reveals reduced ejection fraction. What is the most appropriate action?
A. Continue clozapine and add prednisone 40 mg daily
B. Immediately discontinue clozapine and initiate cardiology consultation
C. Reduce clozapine dose by 50% and monitor closely
D. Switch to olanzapine while continuing clozapine taper
[CORRECT] B
Rationale: Clozapine-induced myocarditis occurs in 1-3% of patients, typically within the first 2-8
weeks, and is potentially fatal. The triad of fever, eosinophilia, and cardiac symptoms requires
, immediate discontinuation—there is no safe rechallenge protocol. Continuing or tapering
clozapine risks cardiovascular collapse. Prednisone is used only after discontinuation in
confirmed eosinophilic myocarditis under cardiology guidance. Clinical pearl: Baseline troponin
and BNP are recommended before clozapine initiation; any fever in the first 2 months warrants
immediate evaluation.
Q9 (Schizophreniform disorder): A 19-year-old college student presents with 3 months of
paranoid delusions, auditory hallucinations, and disorganized speech. His parents report
gradual decline in academic performance. He denies mood symptoms. What is the correct
diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Schizophreniform disorder
D. Brief psychotic disorder
[CORRECT] C
Rationale: Schizophreniform disorder requires Criterion A symptoms of schizophrenia (≥2 core
symptoms) for >1 month but <6 months, without the 6-month duration required for
schizophrenia. The 3-month duration here fits perfectly. Good prognostic features (confusing
term) include onset within 4 weeks of psychosis, confusion/perplexity at height of psychosis,
good premorbid function, and absence of blunted/flat affect—this patient has good premorbid
function (college student). Clinical pearl: 1/3 of schizophreniform patients recover completely;
2/3 progress to schizophrenia if symptoms persist >6 months.
Q10 (Delusional disorder): A 58-year-old executive firmly believes his wife is having an affair,
despite no evidence and her repeated denials. He has hired private investigators and
confronted coworkers. He continues to work effectively, maintains social relationships, and has
no hallucinations. What is the most likely diagnosis?
A. Paranoid personality disorder
B. Delusional disorder, jealous type
C. Schizophrenia, paranoid type
D. Obsessive-compulsive disorder
[CORRECT] B
Rationale: DSM-5-TR delusional disorder requires ≥1 delusion(s) for ≥1 month, absence of other
psychotic symptoms (hallucinations are not prominent), preserved functioning outside the
delusion's impact, and behavior not bizarrely odd. The jealous subtype (Othello syndrome)
involves the delusion that one's partner is unfaithful. Paranoid PD involves pervasive distrust
without fixed delusional system. Schizophrenia requires ≥6 months and functional decline. OCD
involves ego-dystonic obsessions, not fixed beliefs. Clinical pearl: Delusional disorder has the
best prognosis among psychotic disorders; antipsychotics have modest efficacy.
Q11 (Borderline personality disorder – diagnostic criteria): A 24-year-old woman presents after
her third suicide attempt (overdose) in 2 years. She reports chronic emptiness, unstable
relationships alternating between idealization and devaluation, impulsive spending, and
transient stress-related paranoid ideation. Which DSM-5-TR criterion is NOT required for
borderline PD?
A. Frantic efforts to avoid real or imagined abandonment
B. Identity disturbance with markedly unstable self-image
N
2026-2027 | Psychiatric Mental Health Nurse
Practitioner Care Across the Lifespan I |
Verified Q&A | Newly Updated | Pass
Guaranteed - A+ Graded
=======================================================================
=
======== PART A – MULTIPLE CHOICE (Q1‑80)
Q1 (Schizophrenia – diagnostic criteria): A 22-year-old male is brought to the emergency
department by campus police after screaming that the government has implanted tracking
devices in his brain. His roommate reports he has been isolating for 8 months, talking to himself,
and neglecting hygiene. On exam, he displays flat affect, alogia, and poor eye contact. Which
DSM-5-TR criterion is NOT required for a schizophrenia diagnosis?
A. Continuous signs of disturbance for at least 6 months
B. At least two core symptoms present for a significant portion of a 1-month period
C. Marked decline in social/occupational functioning since onset
D. Symptoms must begin before age 25
[CORRECT] D
Rationale: DSM-5-TR Criterion A for schizophrenia requires ≥2 core symptoms (delusions,
hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative
symptoms) for ≥1 month, with continuous signs for ≥6 months total (Criterion B), and marked
functional decline (Criterion C). There is NO age-of-onset requirement in DSM-5-TR—this is a
common student error confusing schizophrenia with early psychosis programs. Clinical pearl:
Age of onset is typically late teens to mid-30s, but not diagnostic.
Q2 (Schizophrenia – differential): A 35-year-old woman presents with 4 weeks of auditory
hallucinations and persecutory delusions following the death of her husband. She has no prior
psychiatric history, and symptoms began 2 weeks after the funeral. She is oriented, sleeps
poorly, and has intermittent suicidal ideation. What is the most likely diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Brief psychotic disorder
D. Delusional disorder
[CORRECT] C
Rationale: DSM-5-TR defines brief psychotic disorder as the sudden onset of ≥1 psychotic
symptoms (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic
behavior) lasting >1 day but <1 month, with eventual full return to premorbid functioning. The
temporal link to bereavement and absence of prodrome support this over schizophrenia (≥6
months). The distractor "schizoaffective" is wrong because there is no mood episode meeting
,full criteria concurrent with psychosis. Clinical pearl: Brief psychotic disorder often follows
stressors and has excellent prognosis.
Q3 (Schizoaffective disorder): A 28-year-old man has a 2-year history of auditory hallucinations
and paranoid delusions. During the past 6 months, he has also experienced major depressive
episodes with anhedonia, psychomotor retardation, and passive suicidal ideation. The mood
episodes have been present for the majority of the total illness duration. What is the correct
diagnosis?
A. Schizophrenia with comorbid MDD
B. Schizoaffective disorder, depressive type
C. Bipolar I disorder with psychotic features
D. Major depressive disorder with psychotic features
[CORRECT] B
Rationale: DSM-5-TR criteria for schizoaffective disorder require (1) an uninterrupted period of
illness with concurrent major mood episode and Criterion A schizophrenia symptoms, (2)
delusions/hallucinations for ≥2 weeks in the absence of prominent mood symptoms, and (3)
mood symptoms present for the majority of the total illness duration. The 6-month mood
predominance and 2-year psychosis history meet these criteria. Distractor A is wrong because
in schizophrenia, mood episodes are brief relative to psychosis duration. Clinical pearl: "Mood
symptoms majority of time" is the key differentiator from schizophrenia.
Q4 (First-generation antipsychotics – EPS): A 45-year-old man on haloperidol 10 mg daily for
schizophrenia develops acute dystonia with torticollis and oculogyric crisis 5 days after initiation.
Which medication is first-line for acute management?
A. Propranolol 40 mg PO
B. Benztropine 2 mg IM/IV
C. Amantadine 100 mg PO BID
D. Diphenhydramine 25 mg PO
[CORRECT] B
Rationale: Acute dystonia is an early-onset extrapyramidal symptom (EPS) caused by
dopamine D2 receptor blockade in the nigrostriatal pathway. Benztropine (anticholinergic) 1-2
mg IM/IV is first-line for acute dystonia due to rapid onset. Propranolol treats akathisia, not
dystonia. Amantadine is used for chronic EPS or Parkinsonism. Diphenhydramine is second-line
and less effective than benztropine for severe acute dystonia. Clinical pearl: Young males are
highest risk for acute dystonia; always have benztropine available when initiating high-potency
FGAs.
Q5 (Tardive dyskinesia): A 62-year-old woman on chlorpromazine for 15 years develops
involuntary, repetitive tongue protrusion and lip smacking. Which medication is FDA-approved
for tardive dyskinesia treatment?
A. Trihexyphenidyl
B. Valbenazine
C. Ropinirole
D. Levodopa
[CORRECT] B
Rationale: Valbenazine (Ingrezza) and deutetrabenazine (Austedo) are FDA-approved VMAT2
inhibitors for tardive dyskinesia (TD), which results from chronic dopamine receptor
, upersensitivity from antipsychotic exposure. Trihexyphenidyl (anticholinergic) worsens TD by
s
worsening cholinergic imbalance. Ropinirole (dopamine agonist) and levodopa are
contraindicated as they may worsen psychosis. Clinical pearl: TD risk increases with age,
duration of antipsychotic use, and FGA exposure; monitor with AIMS every 6 months.
Q6 (Second-generation antipsychotics – metabolic syndrome): A 34-year-old man on
olanzapine 20 mg daily for 6 months has gained 22 lbs, developed fasting glucose 142 mg/dL,
and triglycerides 280 mg/dL. Which metabolic parameter should be monitored most urgently?
A. Hemoglobin A1c
B. Lipid panel
C. Blood pressure
D. Waist circumference
[CORRECT] A
Rationale: Olanzapine carries the highest metabolic risk among SGAs, with rapid onset of
insulin resistance and glucose dysregulation. Fasting glucose >126 mg/dL meets diabetes
threshold per ADA criteria and requires immediate intervention. While all metabolic parameters
matter, glucose abnormalities can precipitate diabetic ketoacidosis (DKA) acutely. The ADA/APA
consensus recommends A1c monitoring every 3-6 months for patients on high-risk
antipsychotics. Clinical pearl: Olanzapine and clozapine have the highest weight gain/metabolic
liability; aripiprazole and ziprasidone have the lowest.
Q7 (Clozapine – absolute neutrophil count): A 28-year-old man with treatment-resistant
schizophrenia is started on clozapine. His baseline ANC is 4,200/mm³. According to the REMS
program, what is the required ANC monitoring frequency during the first 6 months?
A. Weekly
B. Every 2 weeks
C. Monthly
D. Every 3 months
[CORRECT] A
Rationale: The Clozapine Risk Evaluation and Mitigation Strategy (REMS) mandates weekly
ANC monitoring for the first 6 months of therapy due to risk of agranulocytosis (ANC <500/mm³).
After 6 months of stable counts, frequency decreases to every 2 weeks for months 6-12, then
monthly thereafter. ANC 1,000-1,499 requires interruption; <500 requires permanent
discontinuation. Clinical pearl: Clozapine is the only antipsychotic with proven efficacy for
treatment-resistant schizophrenia (30-60% response rate); do not let monitoring burden delay its
use in appropriate candidates.
Q8 (Clozapine – myocarditis): A 25-year-old woman on clozapine for 3 weeks presents with
fever, chest pain, and dyspnea. ECG shows ST elevations; troponin is elevated.
Echocardiogram reveals reduced ejection fraction. What is the most appropriate action?
A. Continue clozapine and add prednisone 40 mg daily
B. Immediately discontinue clozapine and initiate cardiology consultation
C. Reduce clozapine dose by 50% and monitor closely
D. Switch to olanzapine while continuing clozapine taper
[CORRECT] B
Rationale: Clozapine-induced myocarditis occurs in 1-3% of patients, typically within the first 2-8
weeks, and is potentially fatal. The triad of fever, eosinophilia, and cardiac symptoms requires
, immediate discontinuation—there is no safe rechallenge protocol. Continuing or tapering
clozapine risks cardiovascular collapse. Prednisone is used only after discontinuation in
confirmed eosinophilic myocarditis under cardiology guidance. Clinical pearl: Baseline troponin
and BNP are recommended before clozapine initiation; any fever in the first 2 months warrants
immediate evaluation.
Q9 (Schizophreniform disorder): A 19-year-old college student presents with 3 months of
paranoid delusions, auditory hallucinations, and disorganized speech. His parents report
gradual decline in academic performance. He denies mood symptoms. What is the correct
diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Schizophreniform disorder
D. Brief psychotic disorder
[CORRECT] C
Rationale: Schizophreniform disorder requires Criterion A symptoms of schizophrenia (≥2 core
symptoms) for >1 month but <6 months, without the 6-month duration required for
schizophrenia. The 3-month duration here fits perfectly. Good prognostic features (confusing
term) include onset within 4 weeks of psychosis, confusion/perplexity at height of psychosis,
good premorbid function, and absence of blunted/flat affect—this patient has good premorbid
function (college student). Clinical pearl: 1/3 of schizophreniform patients recover completely;
2/3 progress to schizophrenia if symptoms persist >6 months.
Q10 (Delusional disorder): A 58-year-old executive firmly believes his wife is having an affair,
despite no evidence and her repeated denials. He has hired private investigators and
confronted coworkers. He continues to work effectively, maintains social relationships, and has
no hallucinations. What is the most likely diagnosis?
A. Paranoid personality disorder
B. Delusional disorder, jealous type
C. Schizophrenia, paranoid type
D. Obsessive-compulsive disorder
[CORRECT] B
Rationale: DSM-5-TR delusional disorder requires ≥1 delusion(s) for ≥1 month, absence of other
psychotic symptoms (hallucinations are not prominent), preserved functioning outside the
delusion's impact, and behavior not bizarrely odd. The jealous subtype (Othello syndrome)
involves the delusion that one's partner is unfaithful. Paranoid PD involves pervasive distrust
without fixed delusional system. Schizophrenia requires ≥6 months and functional decline. OCD
involves ego-dystonic obsessions, not fixed beliefs. Clinical pearl: Delusional disorder has the
best prognosis among psychotic disorders; antipsychotics have modest efficacy.
Q11 (Borderline personality disorder – diagnostic criteria): A 24-year-old woman presents after
her third suicide attempt (overdose) in 2 years. She reports chronic emptiness, unstable
relationships alternating between idealization and devaluation, impulsive spending, and
transient stress-related paranoid ideation. Which DSM-5-TR criterion is NOT required for
borderline PD?
A. Frantic efforts to avoid real or imagined abandonment
B. Identity disturbance with markedly unstable self-image
