NR547 Final Exam
Practice Questions
Psychiatric Mental Health Nurse Practitioner
Differential Diagnosis and Management
Chamberlain University | 2026/2027 Academic Cycle
100 Questions with 100% Verified Answers
Guaranteed A+ Pass | DSM-5-TR Aligned
, Table of Contents
Section 1: Depressive Disorders (Q1-Q8) (8 Q)
Section 2: Bipolar Disorders (Q9-Q16) (8 Q)
Section 3: Anxiety Disorders (Q17-Q19) (3 Q)
Section 4: PTSD & Trauma-Related Disorders (Q20-Q25) (6 Q)
Section 5: OCD & Related Disorders (Q26-Q30) (5 Q)
Section 6: ADHD (Q31-Q37) (7 Q)
Section 7: Eating Disorders (Q38-Q42) (5 Q)
Section 8: Sleep-Wake Disorders (Q43-Q45) (3 Q)
Section 9: Psychopharmacology Principles (Q46-Q50) (5 Q)
Section 10: Schizophrenia Spectrum & Psychotic Disorders (Q51-Q58) (8 Q)
Section 11: Personality Disorders (Q59-Q65) (7 Q)
Section 12: Substance Use Disorders (Q66-Q74) (9 Q)
Section 13: Somatic Symptom & Related Disorders (Q75-Q78) (4 Q)
Section 14: Child & Adolescent Psychiatry (Q79-Q83) (5 Q)
Section 15: Geriatric Psychiatry (Q84-Q86) (3 Q)
Section 16: Perinatal Mental Health (Q87-Q88) (2 Q)
Section 17: Legal & Ethical Issues (Q89-Q95) (7 Q)
Section 18: Psychotherapy Modalities (Q96-Q98) (3 Q)
Section 19: PMHNP Scope of Practice & Collaborative Care (Q99-Q100) (2 Q)
NR547 Final Exam
Practice Questions Study Guide
Part 1: Questions 1–50
Chamberlain University
Psychiatric-Mental Health Nurse Practitioner Program
2026–2027 Academic Year
, Domains Covered in Part 1:
Depressive Disorders (Q1–Q8)
Bipolar Disorders (Q9–Q16)
Anxiety Disorders (Q17–Q19)
PTSD & Trauma-Related Disorders (Q20–Q25)
OCD & Related Disorders (Q26–Q30)
ADHD (Q31–Q37)
Eating Disorders (Q38–Q42)
Sleep-Wake Disorders & Insomnia (Q43–Q45)
Psychopharmacology Principles (Q46–Q50)
DOMAIN 1: DEPRESSIVE DISORDERS (Q1–Q8)
Q1. A 34-year-old woman presents to the psychiatric clinic with a 6-week history of
persistent sadness, anhedonia, significant weight loss, insomnia, fatigue, feelings of
worthlessness, and difficulty concentrating. She states she has been crying daily and
stopped attending her weekly book club. Her medical history is unremarkable and she
takes no medications. According to DSM-5-TR criteria, which combination of symptoms
best confirms a diagnosis of Major Depressive Disorder (MDD)?
A) Depressed mood plus anhedonia lasting 1 week with functional impairment
B) Five or more symptoms including depressed mood or anhedonia present for at least 2 weeks causing
functional impairment
C) Four or more symptoms present for at least 2 weeks with at least one somatic complaint
D) Depressed mood plus three somatic symptoms lasting at least 1 month
✓ Correct Answer: B) Five or more symptoms including depressed mood or anhedonia
present for at least 2 weeks causing functional impairment
Rationale: DSM-5-TR criteria for MDD require five or more of nine symptoms during the same 2-week
period, representing a change from previous functioning. At least one symptom must be either (1)
depressed mood or (2) loss of interest or pleasure (anhedonia). The nine symptoms can be remembered
by the mnemonic SIGECAPS: Sleep disturbance, Interest (anhedonia), Guilt (worthlessness), Energy
(fatigue), Concentration (diminished), Appetite/weight change, Psychomotor changes, and Suicidal
ideation. This patient exhibits at least 7 of 9 criteria for over 2 weeks with functional impairment
(stopped attending book club), meeting full MDD criteria.
Q2. A 28-year-old man reports feeling “down” almost every day for the past 3 years. He
describes a chronic low mood, poor appetite, low energy, low self-esteem, and difficulty
making decisions. He has never had a period completely free of symptoms lasting more
than 2 months. He is able to work but feels he underperforms. There has never been a
manic or hypomanic episode. What is the most appropriate diagnosis?
A) Major Depressive Disorder, recurrent
B) Persistent Depressive Disorder (Dysthymia)
C) Adjustment Disorder with Depressed Mood
D) Depressive Personality Disorder
✓ Correct Answer: B) Persistent Depressive Disorder (Dysthymia)
Rationale: Persistent Depressive Disorder (PDD), formerly called Dysthymic Disorder, is characterized
by a depressed mood that lasts for most of the day, for more days than not, for at least 2 years (1 year in
children/adolescents). The patient must have two or more of the following: poor appetite or overeating,
insomnia or hypersomnia, low energy, low self-esteem, poor concentration, or feelings of hopelessness.
During the 2-year period, the individual has never been without symptoms for more than 2 months at a
time. This patient’s chronic low mood of 3 years with multiple symptoms and no symptom-free period
, exceeding 2 months meets PDD criteria. If MDD criteria are also met concurrently, it is termed “double
depression.”
Q3. A 52-year-old woman with recurrent MDD presents with profound anhedonia,
depression that is distinctly worse in the morning, early morning awakening (3:00 AM),
significant weight loss, and excessive guilt. She describes her mood as qualitatively
different from sadness—more like a complete emptiness. What specifier best describes this
presentation?
A) MDD with atypical features
B) MDD with melancholic features
C) MDD with seasonal pattern
D) MDD with anxious distress
✓ Correct Answer: B) MDD with melancholic features
Rationale: DSM-5-TR melancholic features specifier requires a loss of pleasure in all, or almost all,
activities, or a lack of reactivity to usually pleasurable stimuli, plus three or more of: (1) distinct quality
of depressed mood (often described as qualitatively different from sadness), (2) depression regularly
worse in the morning, (3) early morning awakening (at least 2 hours before usual), (4) marked
psychomotor retardation or agitation, (5) significant anorexia or weight loss, (6) excessive or
inappropriate guilt. This patient presents with classic melancholic features: anhedonia, morning
worsening, early morning awakening, weight loss, and excessive guilt. Melancholic depression tends to
respond better to TCAs and ECT compared to SSRIs.
Q4. A 40-year-old man has experienced three episodes of major depression, each
beginning in October and remitting spontaneously by March. During episodes, he reports
hypersomnia (sleeping 12+ hours/day), increased appetite with carbohydrate craving
(gaining 15–20 lbs), leaden paralysis, and extreme sensitivity to interpersonal rejection. In
the summer months, he functions normally with full energy. He also reports passive
suicidal ideation (“I wish I could just go to sleep and not wake up”) without plan or intent.
What is the most accurate diagnosis and next step for this patient?
A) MDD with seasonal pattern; assess with PHQ-9 item 9 and Columbia Suicide Severity Rating Scale (C-
SSRS)
B) MDD with melancholic features; initiate sertraline and refer for CBT
C) Bipolar II Disorder, seasonal pattern; initiate mood stabilizer
D) Persistent Depressive Disorder; start bupropion
✓ Correct Answer: A) MDD with seasonal pattern; assess with PHQ-9 item 9 and Columbia
Suicide Severity Rating Scale (C-SSRS)
Rationale: This patient meets criteria for MDD with seasonal pattern (formerly Seasonal Affective
Disorder). DSM-5-TR requires a regular temporal relationship between the onset of MDD episodes and
a particular time of year, full remissions at a characteristic time of year, and two episodes meeting
criteria in the last 2 years with no non-seasonal episodes. His symptoms of hypersomnia, increased
appetite with carb craving, leaden paralysis, and rejection sensitivity are hallmark atypical features,
which commonly co-occur with the seasonal pattern. Given passive suicidal ideation, the immediate
next step is a systematic suicide risk assessment using validated tools: PHQ-9 item 9 screens for suicidal
ideation, and the Columbia Suicide Severity Rating Scale (C-SSRS) provides structured assessment of
ideation severity, intensity, and behavior. Light therapy and SSRI (especially fluoxetine or bupropion
XL) are first-line treatments.
Q5. A PMHNP is initiating sertraline for a 20-year-old college student newly diagnosed
with MDD. The patient lives with roommates and has no history of self-harm. What is the
most important counseling point the PMHNP must discuss with the patient and family?
A) Sertraline causes weight gain of at least 10 lbs in the first month
B) FDA black box warning: increased risk of suicidal thoughts and behaviors in patients under age 25,
especially during the first 1–2 months of treatment or dose changes
Practice Questions
Psychiatric Mental Health Nurse Practitioner
Differential Diagnosis and Management
Chamberlain University | 2026/2027 Academic Cycle
100 Questions with 100% Verified Answers
Guaranteed A+ Pass | DSM-5-TR Aligned
, Table of Contents
Section 1: Depressive Disorders (Q1-Q8) (8 Q)
Section 2: Bipolar Disorders (Q9-Q16) (8 Q)
Section 3: Anxiety Disorders (Q17-Q19) (3 Q)
Section 4: PTSD & Trauma-Related Disorders (Q20-Q25) (6 Q)
Section 5: OCD & Related Disorders (Q26-Q30) (5 Q)
Section 6: ADHD (Q31-Q37) (7 Q)
Section 7: Eating Disorders (Q38-Q42) (5 Q)
Section 8: Sleep-Wake Disorders (Q43-Q45) (3 Q)
Section 9: Psychopharmacology Principles (Q46-Q50) (5 Q)
Section 10: Schizophrenia Spectrum & Psychotic Disorders (Q51-Q58) (8 Q)
Section 11: Personality Disorders (Q59-Q65) (7 Q)
Section 12: Substance Use Disorders (Q66-Q74) (9 Q)
Section 13: Somatic Symptom & Related Disorders (Q75-Q78) (4 Q)
Section 14: Child & Adolescent Psychiatry (Q79-Q83) (5 Q)
Section 15: Geriatric Psychiatry (Q84-Q86) (3 Q)
Section 16: Perinatal Mental Health (Q87-Q88) (2 Q)
Section 17: Legal & Ethical Issues (Q89-Q95) (7 Q)
Section 18: Psychotherapy Modalities (Q96-Q98) (3 Q)
Section 19: PMHNP Scope of Practice & Collaborative Care (Q99-Q100) (2 Q)
NR547 Final Exam
Practice Questions Study Guide
Part 1: Questions 1–50
Chamberlain University
Psychiatric-Mental Health Nurse Practitioner Program
2026–2027 Academic Year
, Domains Covered in Part 1:
Depressive Disorders (Q1–Q8)
Bipolar Disorders (Q9–Q16)
Anxiety Disorders (Q17–Q19)
PTSD & Trauma-Related Disorders (Q20–Q25)
OCD & Related Disorders (Q26–Q30)
ADHD (Q31–Q37)
Eating Disorders (Q38–Q42)
Sleep-Wake Disorders & Insomnia (Q43–Q45)
Psychopharmacology Principles (Q46–Q50)
DOMAIN 1: DEPRESSIVE DISORDERS (Q1–Q8)
Q1. A 34-year-old woman presents to the psychiatric clinic with a 6-week history of
persistent sadness, anhedonia, significant weight loss, insomnia, fatigue, feelings of
worthlessness, and difficulty concentrating. She states she has been crying daily and
stopped attending her weekly book club. Her medical history is unremarkable and she
takes no medications. According to DSM-5-TR criteria, which combination of symptoms
best confirms a diagnosis of Major Depressive Disorder (MDD)?
A) Depressed mood plus anhedonia lasting 1 week with functional impairment
B) Five or more symptoms including depressed mood or anhedonia present for at least 2 weeks causing
functional impairment
C) Four or more symptoms present for at least 2 weeks with at least one somatic complaint
D) Depressed mood plus three somatic symptoms lasting at least 1 month
✓ Correct Answer: B) Five or more symptoms including depressed mood or anhedonia
present for at least 2 weeks causing functional impairment
Rationale: DSM-5-TR criteria for MDD require five or more of nine symptoms during the same 2-week
period, representing a change from previous functioning. At least one symptom must be either (1)
depressed mood or (2) loss of interest or pleasure (anhedonia). The nine symptoms can be remembered
by the mnemonic SIGECAPS: Sleep disturbance, Interest (anhedonia), Guilt (worthlessness), Energy
(fatigue), Concentration (diminished), Appetite/weight change, Psychomotor changes, and Suicidal
ideation. This patient exhibits at least 7 of 9 criteria for over 2 weeks with functional impairment
(stopped attending book club), meeting full MDD criteria.
Q2. A 28-year-old man reports feeling “down” almost every day for the past 3 years. He
describes a chronic low mood, poor appetite, low energy, low self-esteem, and difficulty
making decisions. He has never had a period completely free of symptoms lasting more
than 2 months. He is able to work but feels he underperforms. There has never been a
manic or hypomanic episode. What is the most appropriate diagnosis?
A) Major Depressive Disorder, recurrent
B) Persistent Depressive Disorder (Dysthymia)
C) Adjustment Disorder with Depressed Mood
D) Depressive Personality Disorder
✓ Correct Answer: B) Persistent Depressive Disorder (Dysthymia)
Rationale: Persistent Depressive Disorder (PDD), formerly called Dysthymic Disorder, is characterized
by a depressed mood that lasts for most of the day, for more days than not, for at least 2 years (1 year in
children/adolescents). The patient must have two or more of the following: poor appetite or overeating,
insomnia or hypersomnia, low energy, low self-esteem, poor concentration, or feelings of hopelessness.
During the 2-year period, the individual has never been without symptoms for more than 2 months at a
time. This patient’s chronic low mood of 3 years with multiple symptoms and no symptom-free period
, exceeding 2 months meets PDD criteria. If MDD criteria are also met concurrently, it is termed “double
depression.”
Q3. A 52-year-old woman with recurrent MDD presents with profound anhedonia,
depression that is distinctly worse in the morning, early morning awakening (3:00 AM),
significant weight loss, and excessive guilt. She describes her mood as qualitatively
different from sadness—more like a complete emptiness. What specifier best describes this
presentation?
A) MDD with atypical features
B) MDD with melancholic features
C) MDD with seasonal pattern
D) MDD with anxious distress
✓ Correct Answer: B) MDD with melancholic features
Rationale: DSM-5-TR melancholic features specifier requires a loss of pleasure in all, or almost all,
activities, or a lack of reactivity to usually pleasurable stimuli, plus three or more of: (1) distinct quality
of depressed mood (often described as qualitatively different from sadness), (2) depression regularly
worse in the morning, (3) early morning awakening (at least 2 hours before usual), (4) marked
psychomotor retardation or agitation, (5) significant anorexia or weight loss, (6) excessive or
inappropriate guilt. This patient presents with classic melancholic features: anhedonia, morning
worsening, early morning awakening, weight loss, and excessive guilt. Melancholic depression tends to
respond better to TCAs and ECT compared to SSRIs.
Q4. A 40-year-old man has experienced three episodes of major depression, each
beginning in October and remitting spontaneously by March. During episodes, he reports
hypersomnia (sleeping 12+ hours/day), increased appetite with carbohydrate craving
(gaining 15–20 lbs), leaden paralysis, and extreme sensitivity to interpersonal rejection. In
the summer months, he functions normally with full energy. He also reports passive
suicidal ideation (“I wish I could just go to sleep and not wake up”) without plan or intent.
What is the most accurate diagnosis and next step for this patient?
A) MDD with seasonal pattern; assess with PHQ-9 item 9 and Columbia Suicide Severity Rating Scale (C-
SSRS)
B) MDD with melancholic features; initiate sertraline and refer for CBT
C) Bipolar II Disorder, seasonal pattern; initiate mood stabilizer
D) Persistent Depressive Disorder; start bupropion
✓ Correct Answer: A) MDD with seasonal pattern; assess with PHQ-9 item 9 and Columbia
Suicide Severity Rating Scale (C-SSRS)
Rationale: This patient meets criteria for MDD with seasonal pattern (formerly Seasonal Affective
Disorder). DSM-5-TR requires a regular temporal relationship between the onset of MDD episodes and
a particular time of year, full remissions at a characteristic time of year, and two episodes meeting
criteria in the last 2 years with no non-seasonal episodes. His symptoms of hypersomnia, increased
appetite with carb craving, leaden paralysis, and rejection sensitivity are hallmark atypical features,
which commonly co-occur with the seasonal pattern. Given passive suicidal ideation, the immediate
next step is a systematic suicide risk assessment using validated tools: PHQ-9 item 9 screens for suicidal
ideation, and the Columbia Suicide Severity Rating Scale (C-SSRS) provides structured assessment of
ideation severity, intensity, and behavior. Light therapy and SSRI (especially fluoxetine or bupropion
XL) are first-line treatments.
Q5. A PMHNP is initiating sertraline for a 20-year-old college student newly diagnosed
with MDD. The patient lives with roommates and has no history of self-harm. What is the
most important counseling point the PMHNP must discuss with the patient and family?
A) Sertraline causes weight gain of at least 10 lbs in the first month
B) FDA black box warning: increased risk of suicidal thoughts and behaviors in patients under age 25,
especially during the first 1–2 months of treatment or dose changes
