NR547 /NR 547: Midterm Exam
Differential Diagnosis in Psychiatric-Mental Health
across the Lifespan Practicum
2026-2028 Testing Cycle | Complete Guide
75 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Chamberlain
Q1: A 30-year-old patient with no current physical complaints reports persistent preoccupation
with having a serious heart condition despite repeated negative cardiac workups. He checks his
pulse hourly and seeks frequent reassurance from emergency departments. What is the most
likely diagnosis?
A. Somatic Symptom Disorder
B. Conversion Disorder
C. Factitious Disorder
D. Illness Anxiety Disorder
Correct Answer: D
Rationale: Correct because Illness Anxiety Disorder is defined by a preoccupation with having
or acquiring a serious illness in the absence of significant somatic symptoms, accompanied by
excessive health-related behaviors such as repeated checking and reassurance-seeking that persist
for more than 6 months. This patient's absence of current physical complaints alongside
persistent cardiac concerns and maladaptive health behaviors fits the diagnostic criteria precisely.
Somatic symptom disorder is incorrect because that diagnosis requires distressing somatic
symptoms as the primary focus, while conversion disorder and factitious disorder involve
neurological symptom patterns or intentional production of symptoms not present here.
,Q2: A PMHNP is formulating a differential diagnosis for a new patient presenting with
psychiatric symptoms. Which step of the 6-step differential diagnosis process should be
completed first according to DSM-5-TR framework?
A. Rule out malingering and factitious disorder
B. Rule out substance-induced etiologies
C. Rule out general medical conditions
D. Determine the primary psychiatric disorder
Correct Answer: A
Rationale: Correct because Step 1 of the 6-step differential diagnosis process requires the
clinician to rule out malingering and factitious disorder before proceeding to other diagnostic
considerations, as these represent intentional production of symptoms for external gain or
psychological need. This foundational step ensures that subsequent diagnostic efforts are directed
toward genuine clinical presentations rather than manufactured symptomatology. Ruling out
substance-induced etiologies constitutes Step 2, general medical conditions constitute Step 3, and
determining the primary psychiatric disorder occurs at Step 4, making all other options reflect
incorrect sequencing.
Q3: A 28-year-old patient presents with new-onset anxiety, palpitations, and weight loss. Which
laboratory tests should the PMHNP prioritize to rule out medical mimics of anxiety? Select all
that apply.
A. TSH and Free T4
B. Complete Blood Count
C. Comprehensive Metabolic Panel
D. Lumbar puncture for cerebrospinal fluid analysis
Correct Answer(s): A, B, C
Rationale: Correct because TSH and Free T4 are essential to evaluate for hyperthyroidism,
which frequently mimics anxiety disorders through tachycardia, weight loss, and heat
intolerance. The Complete Blood Count is necessary to identify anemias such as B12 or iron
deficiency that present with fatigue and cognitive symptoms resembling psychiatric disorders.
The Comprehensive Metabolic Panel detects electrolyte imbalances, hepatic encephalopathy, and
renal impairment that can manifest as anxiety or altered mental status. Lumbar puncture is
incorrect because it is not indicated as a routine screening test for anxiety mimics and should
only be performed when specific neurological signs or infectious concerns are present.
,Q4: A 29-year-old woman presents 6 weeks after a sexual assault. She reports recurrent intrusive
memories, avoids walking alone at night, feels detached from friends, and experiences
exaggerated startle responses when hearing sudden noises. According to DSM-5-TR, which
statement about her diagnostic classification is most accurate?
A. She meets criteria for Acute Stress Disorder because symptoms began after a traumatic event.
B. She cannot meet criteria for PTSD because less than 3 months have passed since the trauma.
C. She meets criteria for Adjustment Disorder with anxiety because the stressor is identifiable.
D. She meets criteria for PTSD because symptoms have persisted for more than 1 month
following trauma exposure.
Correct Answer: D
Rationale: Correct because DSM-5-TR specifies that Post-Traumatic Stress Disorder requires
symptoms persisting for more than 1 month after trauma exposure, and this patient presents at 6
weeks with characteristic intrusion, avoidance, negative alterations in cognition and mood, and
marked arousal symptoms. Acute Stress Disorder is incorrect because that diagnosis applies only
to symptom duration between 3 days and 1 month post-trauma, which this patient has exceeded.
Adjustment disorder is incorrect because the symptom pattern reflects the full criteria for PTSD
rather than the less specific emotional or behavioral responses characteristic of adjustment
reactions.
Q5: A 41-year-old patient reports sudden episodes of intense fear accompanied by palpitations,
sweating, chest pain, and fear of dying that peak within minutes. She has been avoiding grocery
stores for 2 months fearing an attack. What is the primary diagnosis?
A. Generalized Anxiety Disorder
B. Panic Disorder with agoraphobia
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: B
Rationale: Correct because this presentation demonstrates recurrent unexpected panic attacks
with persistent concern about additional attacks and avoidance of grocery stores, meeting DSM-
5-TR criteria for Panic Disorder with comorbid agoraphobia. The presence of four or more
physical symptoms peaking within minutes alongside maladaptive avoidance behavior
distinguishes this from other anxiety disorders. Generalized anxiety disorder is incorrect because
the worry is episodic and acute rather than chronic and generalized, while social anxiety disorder
and specific phobia are incorrect because the fear centers on panic attack recurrence rather than
scrutiny or specific phobic objects.
, Q6: A PMHNP is evaluating a 19-year-old college student who reports feeling "on edge" and
having difficulty sleeping for 3 weeks during finals. The student requests medication for anxiety.
Which initial assessment approach is most appropriate?
A. Initiate a comprehensive psychiatric evaluation including full developmental history
B. Prescribe a benzodiazepine for short-term relief of anxiety symptoms
C. Administer the GAD-7 brief screening tool and conduct focused follow-up assessment
D. Order thyroid function tests and comprehensive metabolic panel immediately
Correct Answer: C
Rationale: Correct because the GAD-7 is a validated brief screening instrument appropriate for
initial anxiety assessment in primary care and psychiatric settings, providing a baseline severity
measure that guides further focused evaluation. For a 3-week stress-related presentation in a
college student, beginning with a brief screening tool followed by targeted assessment aligns
with evidence-based stepped care principles. Comprehensive evaluation may follow if indicated,
but immediate benzodiazepine prescribing is inappropriate due to dependence risks, and routine
laboratory ordering without clinical indication for medical mimics is premature in this acute
stress context.
Q7: A 34-year-old woman presents with excessive worry about work, finances, and health for the
past 8 months, occurring more days than not. She reports muscle tension, fatigue, difficulty
concentrating, and restless sleep. She denies substance use and has normal TSH. What is the
most likely diagnosis?
A. Panic Disorder
B. Social Anxiety Disorder
C. Generalized Anxiety Disorder
D. Specific Phobia
Correct Answer: C
Rationale: Correct because this presentation aligns with DSM-5-TR criteria for Generalized
Anxiety Disorder, which requires excessive anxiety and worry occurring more days than not for
at least 6 months accompanied by physical symptoms such as muscle tension, fatigue, and sleep
disturbance. The patient meets the duration criterion and demonstrates multiple associated
symptoms from the required list of six physical manifestations. Panic disorder is incorrect
because there are no reported recurrent unexpected panic attacks, while social anxiety disorder
Differential Diagnosis in Psychiatric-Mental Health
across the Lifespan Practicum
2026-2028 Testing Cycle | Complete Guide
75 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Chamberlain
Q1: A 30-year-old patient with no current physical complaints reports persistent preoccupation
with having a serious heart condition despite repeated negative cardiac workups. He checks his
pulse hourly and seeks frequent reassurance from emergency departments. What is the most
likely diagnosis?
A. Somatic Symptom Disorder
B. Conversion Disorder
C. Factitious Disorder
D. Illness Anxiety Disorder
Correct Answer: D
Rationale: Correct because Illness Anxiety Disorder is defined by a preoccupation with having
or acquiring a serious illness in the absence of significant somatic symptoms, accompanied by
excessive health-related behaviors such as repeated checking and reassurance-seeking that persist
for more than 6 months. This patient's absence of current physical complaints alongside
persistent cardiac concerns and maladaptive health behaviors fits the diagnostic criteria precisely.
Somatic symptom disorder is incorrect because that diagnosis requires distressing somatic
symptoms as the primary focus, while conversion disorder and factitious disorder involve
neurological symptom patterns or intentional production of symptoms not present here.
,Q2: A PMHNP is formulating a differential diagnosis for a new patient presenting with
psychiatric symptoms. Which step of the 6-step differential diagnosis process should be
completed first according to DSM-5-TR framework?
A. Rule out malingering and factitious disorder
B. Rule out substance-induced etiologies
C. Rule out general medical conditions
D. Determine the primary psychiatric disorder
Correct Answer: A
Rationale: Correct because Step 1 of the 6-step differential diagnosis process requires the
clinician to rule out malingering and factitious disorder before proceeding to other diagnostic
considerations, as these represent intentional production of symptoms for external gain or
psychological need. This foundational step ensures that subsequent diagnostic efforts are directed
toward genuine clinical presentations rather than manufactured symptomatology. Ruling out
substance-induced etiologies constitutes Step 2, general medical conditions constitute Step 3, and
determining the primary psychiatric disorder occurs at Step 4, making all other options reflect
incorrect sequencing.
Q3: A 28-year-old patient presents with new-onset anxiety, palpitations, and weight loss. Which
laboratory tests should the PMHNP prioritize to rule out medical mimics of anxiety? Select all
that apply.
A. TSH and Free T4
B. Complete Blood Count
C. Comprehensive Metabolic Panel
D. Lumbar puncture for cerebrospinal fluid analysis
Correct Answer(s): A, B, C
Rationale: Correct because TSH and Free T4 are essential to evaluate for hyperthyroidism,
which frequently mimics anxiety disorders through tachycardia, weight loss, and heat
intolerance. The Complete Blood Count is necessary to identify anemias such as B12 or iron
deficiency that present with fatigue and cognitive symptoms resembling psychiatric disorders.
The Comprehensive Metabolic Panel detects electrolyte imbalances, hepatic encephalopathy, and
renal impairment that can manifest as anxiety or altered mental status. Lumbar puncture is
incorrect because it is not indicated as a routine screening test for anxiety mimics and should
only be performed when specific neurological signs or infectious concerns are present.
,Q4: A 29-year-old woman presents 6 weeks after a sexual assault. She reports recurrent intrusive
memories, avoids walking alone at night, feels detached from friends, and experiences
exaggerated startle responses when hearing sudden noises. According to DSM-5-TR, which
statement about her diagnostic classification is most accurate?
A. She meets criteria for Acute Stress Disorder because symptoms began after a traumatic event.
B. She cannot meet criteria for PTSD because less than 3 months have passed since the trauma.
C. She meets criteria for Adjustment Disorder with anxiety because the stressor is identifiable.
D. She meets criteria for PTSD because symptoms have persisted for more than 1 month
following trauma exposure.
Correct Answer: D
Rationale: Correct because DSM-5-TR specifies that Post-Traumatic Stress Disorder requires
symptoms persisting for more than 1 month after trauma exposure, and this patient presents at 6
weeks with characteristic intrusion, avoidance, negative alterations in cognition and mood, and
marked arousal symptoms. Acute Stress Disorder is incorrect because that diagnosis applies only
to symptom duration between 3 days and 1 month post-trauma, which this patient has exceeded.
Adjustment disorder is incorrect because the symptom pattern reflects the full criteria for PTSD
rather than the less specific emotional or behavioral responses characteristic of adjustment
reactions.
Q5: A 41-year-old patient reports sudden episodes of intense fear accompanied by palpitations,
sweating, chest pain, and fear of dying that peak within minutes. She has been avoiding grocery
stores for 2 months fearing an attack. What is the primary diagnosis?
A. Generalized Anxiety Disorder
B. Panic Disorder with agoraphobia
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: B
Rationale: Correct because this presentation demonstrates recurrent unexpected panic attacks
with persistent concern about additional attacks and avoidance of grocery stores, meeting DSM-
5-TR criteria for Panic Disorder with comorbid agoraphobia. The presence of four or more
physical symptoms peaking within minutes alongside maladaptive avoidance behavior
distinguishes this from other anxiety disorders. Generalized anxiety disorder is incorrect because
the worry is episodic and acute rather than chronic and generalized, while social anxiety disorder
and specific phobia are incorrect because the fear centers on panic attack recurrence rather than
scrutiny or specific phobic objects.
, Q6: A PMHNP is evaluating a 19-year-old college student who reports feeling "on edge" and
having difficulty sleeping for 3 weeks during finals. The student requests medication for anxiety.
Which initial assessment approach is most appropriate?
A. Initiate a comprehensive psychiatric evaluation including full developmental history
B. Prescribe a benzodiazepine for short-term relief of anxiety symptoms
C. Administer the GAD-7 brief screening tool and conduct focused follow-up assessment
D. Order thyroid function tests and comprehensive metabolic panel immediately
Correct Answer: C
Rationale: Correct because the GAD-7 is a validated brief screening instrument appropriate for
initial anxiety assessment in primary care and psychiatric settings, providing a baseline severity
measure that guides further focused evaluation. For a 3-week stress-related presentation in a
college student, beginning with a brief screening tool followed by targeted assessment aligns
with evidence-based stepped care principles. Comprehensive evaluation may follow if indicated,
but immediate benzodiazepine prescribing is inappropriate due to dependence risks, and routine
laboratory ordering without clinical indication for medical mimics is premature in this acute
stress context.
Q7: A 34-year-old woman presents with excessive worry about work, finances, and health for the
past 8 months, occurring more days than not. She reports muscle tension, fatigue, difficulty
concentrating, and restless sleep. She denies substance use and has normal TSH. What is the
most likely diagnosis?
A. Panic Disorder
B. Social Anxiety Disorder
C. Generalized Anxiety Disorder
D. Specific Phobia
Correct Answer: C
Rationale: Correct because this presentation aligns with DSM-5-TR criteria for Generalized
Anxiety Disorder, which requires excessive anxiety and worry occurring more days than not for
at least 6 months accompanied by physical symptoms such as muscle tension, fatigue, and sleep
disturbance. The patient meets the duration criterion and demonstrates multiple associated
symptoms from the required list of six physical manifestations. Panic disorder is incorrect
because there are no reported recurrent unexpected panic attacks, while social anxiety disorder
