PMHNP CERTIFICATION EXAM REVIEW (2026/2027) – 250+
QUESTIONS & ANSWERS FOR PSYCHIATRIC MENTAL
HEALTH NURSE PRACTITIONER LMR EXAM PREP (PDF)
NR 547 Differential Diagnosis Practicum – Comprehensive Exam
PMHNP Certification Exam Review 2026/2027
Course Code and Name: NR 547 – Differential Diagnosis in Psychiatric-Mental
Health Across the Lifespan Practicum
Institution: Chamberlain University
Author/Creator: Prepared by [EDU NURSE PRO]
Exam Format: 250 Questions
Question Types: Multiple Choice and Short Answer
Focus: Psychiatric differential diagnosis, DSM-5-TR diagnostic reasoning,
lifespan considerations, medical and substance-induced mimics, psychiatric
emergencies, and clinical formulation
Academic Study Resource
Table of Contents
1. Psychiatric Diagnostic Foundations and Clinical Reasoning — Questions 1–20
2. Neurocognitive and Delirium Disorders — Questions 21–35
3. Depressive Disorders — Questions 36–55
4. Bipolar and Related Disorders — Questions 56–75
5. Schizophrenia Spectrum and Other Psychotic Disorders — Questions 76–95
6. Anxiety Disorders — Questions 96–115
7. Obsessive-Compulsive and Related Disorders — Questions 116–130
8. Trauma- and Stressor-Related Disorders — Questions 131–145
9. Personality Disorders — Questions 146–160
10. Substance-Related and Addictive Disorders — Questions 161–180
11. Child and Adolescent Differential Diagnosis — Questions 181–195
, 12. Older Adults, Medical Mimics, and Special Populations — Questions 196–210
13. Answer-Key Summary
Section 1 — Psychiatric Diagnostic Foundations and Clinical Reasoning
Question 1
Type: Multiple Choice
A patient reports depressed mood, insomnia, fatigue, and impaired concentration for three weeks.
Which diagnostic principle should the PMHNP apply first?
A. Determine whether symptoms are severe enough for hospitalization
B. Establish the symptom pattern, duration, severity, impairment, and possible causes
C. Start an antidepressant immediately
D. Diagnose major depressive disorder based on depressed mood alone
Correct Answer: B
Rationale: Psychiatric diagnosis requires a systematic assessment of symptoms, duration,
functional impairment, associated features, medical causes, medications, and substances. A
single symptom is insufficient for diagnosis. The clinician must also consider safety and
differential diagnoses before selecting treatment.
Question 2
Type: Short Answer
What is the purpose of a differential diagnosis?
Correct Answer: A differential diagnosis identifies the plausible conditions that could explain a
patient's presenting symptoms and guides the clinician in distinguishing among them.
Rationale: Psychiatric symptoms frequently overlap across disorders. For example, insomnia
may occur with depression, mania, anxiety, substance use, PTSD, medical illness, or medication
effects. Differential diagnosis prevents premature diagnostic closure and promotes evidence-
based assessment.
Question 3
Type: Multiple Choice
,Which finding most strongly supports a psychiatric symptom having a possible medical
etiology?
A. Symptoms began after a stressful breakup
B. Symptoms have been present intermittently for years
C. New-onset psychosis develops in a 72-year-old without psychiatric history
D. The patient reports a family history of depression
Correct Answer: C
Rationale: New-onset psychiatric symptoms later in life, particularly psychosis, require careful
evaluation for neurological, endocrine, metabolic, infectious, medication-related, and other
medical causes. Age at onset is an important diagnostic clue.
Question 4
Type: Multiple Choice
Which history element is particularly important when evaluating a patient with new psychiatric
symptoms?
A. Favorite foods
B. Medication and substance exposure
C. Preferred television programs
D. Childhood hobbies only
Correct Answer: B
Rationale: Prescription medications, over-the-counter products, supplements, alcohol, cannabis,
stimulants, sedatives, and other substances can produce psychiatric symptoms or exacerbate
existing disorders. Medication and substance review is therefore central to differential diagnosis.
Question 5
Type: Short Answer
Define diagnostic overshadowing.
Correct Answer: Diagnostic overshadowing occurs when a clinician attributes new symptoms to
an existing psychiatric or developmental diagnosis and fails to recognize another medical,
psychiatric, or substance-related condition.
, Rationale: A patient with schizophrenia can still develop delirium, thyroid disease, medication
toxicity, infection, or depression. Existing diagnoses should never eliminate consideration of new
causes.
Question 6
Type: Multiple Choice
Which assessment domain is essential when determining the clinical significance of psychiatric
symptoms?
A. Functional impairment
B. Favorite hobbies
C. Educational level only
D. Preferred communication method only
Correct Answer: A
Rationale: Psychiatric disorders generally involve clinically significant distress, impairment, or
dysfunction, depending on the disorder. Assessing occupational, academic, interpersonal, self-
care, and social functioning helps establish severity and clinical significance.
Question 7
Type: Multiple Choice
A patient reports hearing voices but remains fully oriented, has intact attention, and has no
fluctuating consciousness. Which diagnosis should remain prominent in the differential?
A. Delirium
B. Psychotic disorder
C. Panic disorder
D. Somatic symptom disorder
Correct Answer: B
Rationale: Hallucinations can occur in many conditions, but persistent hallucinations with
preserved attention and consciousness raise concern for a primary psychotic disorder, mood
disorder with psychotic features, substance-related disorder, or medical condition rather than
delirium.
Question 8
QUESTIONS & ANSWERS FOR PSYCHIATRIC MENTAL
HEALTH NURSE PRACTITIONER LMR EXAM PREP (PDF)
NR 547 Differential Diagnosis Practicum – Comprehensive Exam
PMHNP Certification Exam Review 2026/2027
Course Code and Name: NR 547 – Differential Diagnosis in Psychiatric-Mental
Health Across the Lifespan Practicum
Institution: Chamberlain University
Author/Creator: Prepared by [EDU NURSE PRO]
Exam Format: 250 Questions
Question Types: Multiple Choice and Short Answer
Focus: Psychiatric differential diagnosis, DSM-5-TR diagnostic reasoning,
lifespan considerations, medical and substance-induced mimics, psychiatric
emergencies, and clinical formulation
Academic Study Resource
Table of Contents
1. Psychiatric Diagnostic Foundations and Clinical Reasoning — Questions 1–20
2. Neurocognitive and Delirium Disorders — Questions 21–35
3. Depressive Disorders — Questions 36–55
4. Bipolar and Related Disorders — Questions 56–75
5. Schizophrenia Spectrum and Other Psychotic Disorders — Questions 76–95
6. Anxiety Disorders — Questions 96–115
7. Obsessive-Compulsive and Related Disorders — Questions 116–130
8. Trauma- and Stressor-Related Disorders — Questions 131–145
9. Personality Disorders — Questions 146–160
10. Substance-Related and Addictive Disorders — Questions 161–180
11. Child and Adolescent Differential Diagnosis — Questions 181–195
, 12. Older Adults, Medical Mimics, and Special Populations — Questions 196–210
13. Answer-Key Summary
Section 1 — Psychiatric Diagnostic Foundations and Clinical Reasoning
Question 1
Type: Multiple Choice
A patient reports depressed mood, insomnia, fatigue, and impaired concentration for three weeks.
Which diagnostic principle should the PMHNP apply first?
A. Determine whether symptoms are severe enough for hospitalization
B. Establish the symptom pattern, duration, severity, impairment, and possible causes
C. Start an antidepressant immediately
D. Diagnose major depressive disorder based on depressed mood alone
Correct Answer: B
Rationale: Psychiatric diagnosis requires a systematic assessment of symptoms, duration,
functional impairment, associated features, medical causes, medications, and substances. A
single symptom is insufficient for diagnosis. The clinician must also consider safety and
differential diagnoses before selecting treatment.
Question 2
Type: Short Answer
What is the purpose of a differential diagnosis?
Correct Answer: A differential diagnosis identifies the plausible conditions that could explain a
patient's presenting symptoms and guides the clinician in distinguishing among them.
Rationale: Psychiatric symptoms frequently overlap across disorders. For example, insomnia
may occur with depression, mania, anxiety, substance use, PTSD, medical illness, or medication
effects. Differential diagnosis prevents premature diagnostic closure and promotes evidence-
based assessment.
Question 3
Type: Multiple Choice
,Which finding most strongly supports a psychiatric symptom having a possible medical
etiology?
A. Symptoms began after a stressful breakup
B. Symptoms have been present intermittently for years
C. New-onset psychosis develops in a 72-year-old without psychiatric history
D. The patient reports a family history of depression
Correct Answer: C
Rationale: New-onset psychiatric symptoms later in life, particularly psychosis, require careful
evaluation for neurological, endocrine, metabolic, infectious, medication-related, and other
medical causes. Age at onset is an important diagnostic clue.
Question 4
Type: Multiple Choice
Which history element is particularly important when evaluating a patient with new psychiatric
symptoms?
A. Favorite foods
B. Medication and substance exposure
C. Preferred television programs
D. Childhood hobbies only
Correct Answer: B
Rationale: Prescription medications, over-the-counter products, supplements, alcohol, cannabis,
stimulants, sedatives, and other substances can produce psychiatric symptoms or exacerbate
existing disorders. Medication and substance review is therefore central to differential diagnosis.
Question 5
Type: Short Answer
Define diagnostic overshadowing.
Correct Answer: Diagnostic overshadowing occurs when a clinician attributes new symptoms to
an existing psychiatric or developmental diagnosis and fails to recognize another medical,
psychiatric, or substance-related condition.
, Rationale: A patient with schizophrenia can still develop delirium, thyroid disease, medication
toxicity, infection, or depression. Existing diagnoses should never eliminate consideration of new
causes.
Question 6
Type: Multiple Choice
Which assessment domain is essential when determining the clinical significance of psychiatric
symptoms?
A. Functional impairment
B. Favorite hobbies
C. Educational level only
D. Preferred communication method only
Correct Answer: A
Rationale: Psychiatric disorders generally involve clinically significant distress, impairment, or
dysfunction, depending on the disorder. Assessing occupational, academic, interpersonal, self-
care, and social functioning helps establish severity and clinical significance.
Question 7
Type: Multiple Choice
A patient reports hearing voices but remains fully oriented, has intact attention, and has no
fluctuating consciousness. Which diagnosis should remain prominent in the differential?
A. Delirium
B. Psychotic disorder
C. Panic disorder
D. Somatic symptom disorder
Correct Answer: B
Rationale: Hallucinations can occur in many conditions, but persistent hallucinations with
preserved attention and consciousness raise concern for a primary psychotic disorder, mood
disorder with psychotic features, substance-related disorder, or medical condition rather than
delirium.
Question 8
