PMHNP
✦ ✦
Walden University
LANIF
6635 PMHNP Program · NRNP 6635
A HIGHER DEGREE OF NURSING
WALDEN
NRNP 6635 Final Exam - Schizophrenia
PAT H O P H YS I O LO G Y · C L I N I C A L P R E S E N TAT I O N · P H A R M A CO LO G I C A L T R E AT M E N T · E P S · N M S ·
DIFFERENTIAL DIAGNOSIS
INSTITUTION Walden University · PMHNP Program COURSE CODE NRNP 6635
PROGRAM PMHNP (Psychiatric Mental Health Nurse ACADEMIC YEAR
Practitioner)
EXAM TITLE NRNP 6635 — Final Exam: Schizophrenia TOTAL QUESTIONS 30 Questions
SUBJECT AREAS Schizophrenia · Antipsychotics · EPS · NMS FORMAT Multiple Choice — Select the Single Best
· DDx Answer
FINAL EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content covers: schizophrenia pathophysiology, clinical presentation, pharmacological treatment (FGAs vs. SGAs),
extrapyramidal symptoms, neuroleptic malignant syndrome, and differential diagnosis.
▸ Each question includes the correct answer with a detailed clinical rationale.
SECTION I — SCHIZOPHRENIA: COMPREHENSIVE FINAL EXAM Questions 1 – 30
1. Schizophrenia is best defined as:
A. A mood disorder characterized by alternating episodes of depression and mania
B. A chronic serious mental disorder characterized by loss of contact with reality, manifested by hallucinations and
delusions
C. An anxiety disorder with intrusive thoughts and compulsive rituals
D. A personality disorder characterized by unstable relationships and identity disturbance
CORRECT ANSWER B — A chronic serious mental disorder characterized by loss of contact with reality, hallucinations, and
delusions
RATIONALE Schizophrenia is a chronic, serious mental disorder characterized by LOSS OF CONTACT WITH REALITY
(psychosis) manifested by two main symptoms: HALLUCINATIONS and DELUSIONS. It is associated with a
decline in both COGNITIVE and SOCIAL functioning that often precedes the development of florid psychosis.
Men and women are equally affected but differ in age of onset: Men = average 23 years; Women = average 26
years. The disorder manifests when a person with a GENETIC PREDISPOSITION is exposed to
ENVIRONMENTAL STRESSORS. No single etiological factor is responsible.
, 2. The signs and symptoms of schizophrenia are traditionally separated into which two groups?
A. Acute and Chronic
B. Positive and Negative
C. Motor and Sensory
D. Affective and Cognitive
CORRECT ANSWER B — Positive and Negative
RATIONALE POSITIVE symptoms (psychotic phase) are easy to recognize: DELUSIONS (false fixed beliefs — grandiose,
paranoid, persecutory, ideas of reference), HALLUCINATIONS (auditory most common, visual, somatic,
gustatory, olfactory), ILLUSIONS (misinterpretation of real stimuli), and DISORGANIZED speech/behavior.
NEGATIVE symptoms (residual phase) may be harder to recognize: FLAT AFFECT, AVOLITION (lack of initiative),
ALOGIA (poverty of speech), POOR ATTENTION, and ANHEDONIA. COGNITIVE symptoms: poor executive
functioning, inattention, impaired memory. Hyperactivity of dopamine D2 receptors in subcortical/limbic
regions contributes to POSITIVE symptoms; hypo functionality of D1 receptors in the prefrontal cortex
contributes to NEGATIVE and COGNITIVE symptoms.
3. The exact etiology of schizophrenia is unknown, although it is thought to be linked to an increase in which
neurotransmitter activity?
A. Serotonergic activity
B. GABAergic activity
C. Dopaminergic activity
D. Glutamatergic activity
CORRECT ANSWER C — Dopaminergic activity
RATIONALE The DOPAMINERGIC THEORY: Almost all drugs with antipsychotic properties block the dopaminergic D2
receptor. However, antipsychotics are only 70% effective, and clozapine (the most effective antipsychotic) is a
WEAK D2 antagonist — suggesting other mechanisms. Other theories: hypofunction of NMDA glutamate
receptors, dysfunctional GABA interneurons, and dysfunctional nicotinic acetylcholine receptors. Physical
brain abnormalities: loss of cortical tissue volume (limbic system, prefrontal cortex, thalamus, hippocampus,
amygdala), ventricular enlargement (third and lateral), decreased symmetry, hypoactivity of frontal lobes,
and hyperactivity of basal ganglia.
4. Which of the following is an environmental stressor believed to be a trigger of schizophrenia?
A. High socioeconomic status
B. Frequent cannabis use in early adolescence
C. Birth in mid-summer
D. Young paternal age at conception
CORRECT ANSWER B — Frequent cannabis use in early adolescence
RATIONALE Environmental stressors are believed to be TRIGGERS rather than true causes. They include: childhood
trauma, residence in an urban area, social isolation, FREQUENT CANNABIS USE IN EARLY ADOLESCENCE,
migration, poverty, stress/psychosocial factors, birth in LATE WINTER or EARLY SPRING, and ADVANCED
paternal age at conception. These factors appear to act via a common pathway of disrupting neurotransmitter
components. Co-existing substance use disorder and dependence is common ("dual diagnosis"). Patients
with schizophrenia often LACK INSIGHT (awareness) about their illness.
✦ ✦
Walden University
LANIF
6635 PMHNP Program · NRNP 6635
A HIGHER DEGREE OF NURSING
WALDEN
NRNP 6635 Final Exam - Schizophrenia
PAT H O P H YS I O LO G Y · C L I N I C A L P R E S E N TAT I O N · P H A R M A CO LO G I C A L T R E AT M E N T · E P S · N M S ·
DIFFERENTIAL DIAGNOSIS
INSTITUTION Walden University · PMHNP Program COURSE CODE NRNP 6635
PROGRAM PMHNP (Psychiatric Mental Health Nurse ACADEMIC YEAR
Practitioner)
EXAM TITLE NRNP 6635 — Final Exam: Schizophrenia TOTAL QUESTIONS 30 Questions
SUBJECT AREAS Schizophrenia · Antipsychotics · EPS · NMS FORMAT Multiple Choice — Select the Single Best
· DDx Answer
FINAL EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content covers: schizophrenia pathophysiology, clinical presentation, pharmacological treatment (FGAs vs. SGAs),
extrapyramidal symptoms, neuroleptic malignant syndrome, and differential diagnosis.
▸ Each question includes the correct answer with a detailed clinical rationale.
SECTION I — SCHIZOPHRENIA: COMPREHENSIVE FINAL EXAM Questions 1 – 30
1. Schizophrenia is best defined as:
A. A mood disorder characterized by alternating episodes of depression and mania
B. A chronic serious mental disorder characterized by loss of contact with reality, manifested by hallucinations and
delusions
C. An anxiety disorder with intrusive thoughts and compulsive rituals
D. A personality disorder characterized by unstable relationships and identity disturbance
CORRECT ANSWER B — A chronic serious mental disorder characterized by loss of contact with reality, hallucinations, and
delusions
RATIONALE Schizophrenia is a chronic, serious mental disorder characterized by LOSS OF CONTACT WITH REALITY
(psychosis) manifested by two main symptoms: HALLUCINATIONS and DELUSIONS. It is associated with a
decline in both COGNITIVE and SOCIAL functioning that often precedes the development of florid psychosis.
Men and women are equally affected but differ in age of onset: Men = average 23 years; Women = average 26
years. The disorder manifests when a person with a GENETIC PREDISPOSITION is exposed to
ENVIRONMENTAL STRESSORS. No single etiological factor is responsible.
, 2. The signs and symptoms of schizophrenia are traditionally separated into which two groups?
A. Acute and Chronic
B. Positive and Negative
C. Motor and Sensory
D. Affective and Cognitive
CORRECT ANSWER B — Positive and Negative
RATIONALE POSITIVE symptoms (psychotic phase) are easy to recognize: DELUSIONS (false fixed beliefs — grandiose,
paranoid, persecutory, ideas of reference), HALLUCINATIONS (auditory most common, visual, somatic,
gustatory, olfactory), ILLUSIONS (misinterpretation of real stimuli), and DISORGANIZED speech/behavior.
NEGATIVE symptoms (residual phase) may be harder to recognize: FLAT AFFECT, AVOLITION (lack of initiative),
ALOGIA (poverty of speech), POOR ATTENTION, and ANHEDONIA. COGNITIVE symptoms: poor executive
functioning, inattention, impaired memory. Hyperactivity of dopamine D2 receptors in subcortical/limbic
regions contributes to POSITIVE symptoms; hypo functionality of D1 receptors in the prefrontal cortex
contributes to NEGATIVE and COGNITIVE symptoms.
3. The exact etiology of schizophrenia is unknown, although it is thought to be linked to an increase in which
neurotransmitter activity?
A. Serotonergic activity
B. GABAergic activity
C. Dopaminergic activity
D. Glutamatergic activity
CORRECT ANSWER C — Dopaminergic activity
RATIONALE The DOPAMINERGIC THEORY: Almost all drugs with antipsychotic properties block the dopaminergic D2
receptor. However, antipsychotics are only 70% effective, and clozapine (the most effective antipsychotic) is a
WEAK D2 antagonist — suggesting other mechanisms. Other theories: hypofunction of NMDA glutamate
receptors, dysfunctional GABA interneurons, and dysfunctional nicotinic acetylcholine receptors. Physical
brain abnormalities: loss of cortical tissue volume (limbic system, prefrontal cortex, thalamus, hippocampus,
amygdala), ventricular enlargement (third and lateral), decreased symmetry, hypoactivity of frontal lobes,
and hyperactivity of basal ganglia.
4. Which of the following is an environmental stressor believed to be a trigger of schizophrenia?
A. High socioeconomic status
B. Frequent cannabis use in early adolescence
C. Birth in mid-summer
D. Young paternal age at conception
CORRECT ANSWER B — Frequent cannabis use in early adolescence
RATIONALE Environmental stressors are believed to be TRIGGERS rather than true causes. They include: childhood
trauma, residence in an urban area, social isolation, FREQUENT CANNABIS USE IN EARLY ADOLESCENCE,
migration, poverty, stress/psychosocial factors, birth in LATE WINTER or EARLY SPRING, and ADVANCED
paternal age at conception. These factors appear to act via a common pathway of disrupting neurotransmitter
components. Co-existing substance use disorder and dependence is common ("dual diagnosis"). Patients
with schizophrenia often LACK INSIGHT (awareness) about their illness.
