NR 547 PMHNP 2025 TEST BANK Differential
Diagnosis Across the Lifespan Practicum |
Chamberlain University150 Questions | Verified
Answers with Detailed Rationales | Graded A+
Academic Year: 2025/2026
SECTION 1: MOOD DISORDERS
Questions 1–25
Question 1
A 28-year-old patient presents with 3 weeks of depressed mood, anhedonia, sleep disturbance,
decreased appetite, low energy, difficulty concentrating, and passive thoughts of worthlessness
after losing their job. Which diagnosis is most appropriate?
A) Major Depressive Disorder, single episode, moderate
B) Adjustment Disorder with depressed mood
C) Persistent Depressive Disorder (Dysthymia)
D) Normal bereavement
Correct answer: B
Rationale: Duration (less than 3 months since stressor onset) and temporal relationship to a
psychosocial stressor (job loss) with symptoms not meeting full MDD criteria favor Adjustment
Disorder with depressed mood per DSM-5-TR.
Question 2
,A 45-year-old patient reports having felt depressed nearly every day for the past 3 years. During
this time, they have experienced low energy, poor appetite, and low self-esteem, but no major
episodes of severe depression. What is the most likely diagnosis?
A) Major Depressive Disorder, recurrent
B) Persistent Depressive Disorder (Dysthymia)
C) Bipolar II Disorder
D) Cyclothymic Disorder
Correct answer: B
Rationale: Persistent Depressive Disorder (Dysthymia) requires depressed mood for at least 2
years in adults, with at least two additional symptoms (e.g., appetite change, low energy, low
self-esteem). This patient has 3 years of symptoms without major depressive episodes.
Question 3
A 32-year-old patient presents with a 4-month history of depressed mood, anhedonia, insomnia,
fatigue, feelings of worthlessness, and suicidal ideation without a plan. PHQ-9 score is 22. What
is the most appropriate initial management step?
A) Start fluoxetine 20 mg daily
B) Start bupropion 150 mg daily
C) Emergency psychiatric hospitalization
D) Refer to weekly supportive therapy
Correct answer: C
Rationale: Suicidal ideation, even without a plan, requires immediate safety assessment. While
PHQ-9 score 22 indicates severe depression, the presence of suicidal ideation necessitates
emergency evaluation. Safety first, then medication.
Question 4
A 24-year-old female patient reports episodes of hypomania lasting 4 days, with increased
energy, decreased need for sleep, racing thoughts, and increased goal-directed activity. She
also reports recurrent major depressive episodes lasting 2-3 weeks. What is the most likely
diagnosis?
A) Bipolar I Disorder
,B) Bipolar II Disorder
C) Cyclothymic Disorder
D) Major Depressive Disorder with mixed features
Correct answer: B
Rationale: Bipolar II Disorder requires at least one hypomanic episode (≥4 days) and at least
one major depressive episode. Bipolar I requires a full manic episode (≥7 days or requiring
hospitalization). Cyclothymic Disorder requires 2 years of hypomanic and depressive symptoms
without meeting full episode criteria.
Question 5
A 52-year-old patient with recurrent major depressive disorder has failed trials of fluoxetine,
sertraline, and venlafaxine. What is the most appropriate next step?
A) Add aripiprazole
B) Start phenelzine (MAOI)
C) Refer for electroconvulsive therapy (ECT)
D) Start lithium augmentation
Correct answer: A
Rationale: Aripiprazole is FDA-approved as adjunctive treatment for treatment-resistant
depression. ECT is typically reserved for severe, treatment-refractory cases or when rapid
response is needed. MAOIs are third-line due to dietary restrictions and side effects.
Question 6
A 38-year-old patient with major depressive disorder is started on duloxetine. What is the most
important teaching point regarding this medication?
A) Take with a full glass of water and remain upright for 30 minutes
B) Monitor for orthostatic hypotension, especially at bedtime
C) Discontinue immediately if headache or visual changes occur
D) Avoid stopping abruptly due to discontinuation syndrome risk
Correct answer: D
, Rationale: Duloxetine (an SNRI) can cause discontinuation syndrome (dizziness, nausea,
headache, paresthesias) if stopped abruptly. The dose should be tapered. Option A applies to
bisphosphonates. Option B applies to alpha-blockers and some antidepressants but is less
critical than discontinuation syndrome. Option C is for triptans.
Question 7
A 65-year-old patient with major depressive disorder presents with hyponatremia (sodium 128
mEq/L). Which antidepressant is most likely to have contributed to this finding?
A) Bupropion
B) Mirtazapine
C) Sertraline
D) Trazodone
Correct answer: C
Rationale: SSRIs (including sertraline) are the antidepressants most strongly associated with
hyponatremia, particularly in older adults, due to syndrome of inappropriate antidiuretic hormone
(SIADH). Bupropion has lower risk. Mirtazapine and trazodone also have relatively lower risk.
Question 8
A 29-year-old patient with bipolar II disorder is prescribed lamotrigine. What is the most
important safety teaching regarding this medication?
A) Report any rash immediately, especially in the first 8 weeks
B) Monitor serum levels monthly
C) Avoid grapefruit juice
D) Take with food to prevent nausea
Correct answer: A
Rationale: Lamotrigine carries a black box warning for Stevens-Johnson syndrome (SJS) and
toxic epidermal necrolysis (TEN). Rash is a medical emergency, especially during the first 8
weeks of treatment or rapid dose titration.
Question 9
Diagnosis Across the Lifespan Practicum |
Chamberlain University150 Questions | Verified
Answers with Detailed Rationales | Graded A+
Academic Year: 2025/2026
SECTION 1: MOOD DISORDERS
Questions 1–25
Question 1
A 28-year-old patient presents with 3 weeks of depressed mood, anhedonia, sleep disturbance,
decreased appetite, low energy, difficulty concentrating, and passive thoughts of worthlessness
after losing their job. Which diagnosis is most appropriate?
A) Major Depressive Disorder, single episode, moderate
B) Adjustment Disorder with depressed mood
C) Persistent Depressive Disorder (Dysthymia)
D) Normal bereavement
Correct answer: B
Rationale: Duration (less than 3 months since stressor onset) and temporal relationship to a
psychosocial stressor (job loss) with symptoms not meeting full MDD criteria favor Adjustment
Disorder with depressed mood per DSM-5-TR.
Question 2
,A 45-year-old patient reports having felt depressed nearly every day for the past 3 years. During
this time, they have experienced low energy, poor appetite, and low self-esteem, but no major
episodes of severe depression. What is the most likely diagnosis?
A) Major Depressive Disorder, recurrent
B) Persistent Depressive Disorder (Dysthymia)
C) Bipolar II Disorder
D) Cyclothymic Disorder
Correct answer: B
Rationale: Persistent Depressive Disorder (Dysthymia) requires depressed mood for at least 2
years in adults, with at least two additional symptoms (e.g., appetite change, low energy, low
self-esteem). This patient has 3 years of symptoms without major depressive episodes.
Question 3
A 32-year-old patient presents with a 4-month history of depressed mood, anhedonia, insomnia,
fatigue, feelings of worthlessness, and suicidal ideation without a plan. PHQ-9 score is 22. What
is the most appropriate initial management step?
A) Start fluoxetine 20 mg daily
B) Start bupropion 150 mg daily
C) Emergency psychiatric hospitalization
D) Refer to weekly supportive therapy
Correct answer: C
Rationale: Suicidal ideation, even without a plan, requires immediate safety assessment. While
PHQ-9 score 22 indicates severe depression, the presence of suicidal ideation necessitates
emergency evaluation. Safety first, then medication.
Question 4
A 24-year-old female patient reports episodes of hypomania lasting 4 days, with increased
energy, decreased need for sleep, racing thoughts, and increased goal-directed activity. She
also reports recurrent major depressive episodes lasting 2-3 weeks. What is the most likely
diagnosis?
A) Bipolar I Disorder
,B) Bipolar II Disorder
C) Cyclothymic Disorder
D) Major Depressive Disorder with mixed features
Correct answer: B
Rationale: Bipolar II Disorder requires at least one hypomanic episode (≥4 days) and at least
one major depressive episode. Bipolar I requires a full manic episode (≥7 days or requiring
hospitalization). Cyclothymic Disorder requires 2 years of hypomanic and depressive symptoms
without meeting full episode criteria.
Question 5
A 52-year-old patient with recurrent major depressive disorder has failed trials of fluoxetine,
sertraline, and venlafaxine. What is the most appropriate next step?
A) Add aripiprazole
B) Start phenelzine (MAOI)
C) Refer for electroconvulsive therapy (ECT)
D) Start lithium augmentation
Correct answer: A
Rationale: Aripiprazole is FDA-approved as adjunctive treatment for treatment-resistant
depression. ECT is typically reserved for severe, treatment-refractory cases or when rapid
response is needed. MAOIs are third-line due to dietary restrictions and side effects.
Question 6
A 38-year-old patient with major depressive disorder is started on duloxetine. What is the most
important teaching point regarding this medication?
A) Take with a full glass of water and remain upright for 30 minutes
B) Monitor for orthostatic hypotension, especially at bedtime
C) Discontinue immediately if headache or visual changes occur
D) Avoid stopping abruptly due to discontinuation syndrome risk
Correct answer: D
, Rationale: Duloxetine (an SNRI) can cause discontinuation syndrome (dizziness, nausea,
headache, paresthesias) if stopped abruptly. The dose should be tapered. Option A applies to
bisphosphonates. Option B applies to alpha-blockers and some antidepressants but is less
critical than discontinuation syndrome. Option C is for triptans.
Question 7
A 65-year-old patient with major depressive disorder presents with hyponatremia (sodium 128
mEq/L). Which antidepressant is most likely to have contributed to this finding?
A) Bupropion
B) Mirtazapine
C) Sertraline
D) Trazodone
Correct answer: C
Rationale: SSRIs (including sertraline) are the antidepressants most strongly associated with
hyponatremia, particularly in older adults, due to syndrome of inappropriate antidiuretic hormone
(SIADH). Bupropion has lower risk. Mirtazapine and trazodone also have relatively lower risk.
Question 8
A 29-year-old patient with bipolar II disorder is prescribed lamotrigine. What is the most
important safety teaching regarding this medication?
A) Report any rash immediately, especially in the first 8 weeks
B) Monitor serum levels monthly
C) Avoid grapefruit juice
D) Take with food to prevent nausea
Correct answer: A
Rationale: Lamotrigine carries a black box warning for Stevens-Johnson syndrome (SJS) and
toxic epidermal necrolysis (TEN). Rash is a medical emergency, especially during the first 8
weeks of treatment or rapid dose titration.
Question 9
