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 29-year-old patient presents with anxiety and depression. During the interview, the
PMHNP learns the patient was evicted last month, lacks reliable transportation, and has missed
three psychiatric appointments due to work schedule conflicts. Which factor should the PMHNP
identify as the primary barrier to care?
A. Social determinants of mental health
B. Neurotransmitter dysregulation
C. Genetic predisposition to mood disorders
D. Maladaptive cognitive schema
Correct Answer: A
Rationale: Correct because social determinants of mental health encompass environmental,
economic, and structural barriers such as housing instability, transportation limitations, and
occupational constraints that directly impede access to psychiatric care and exacerbate
psychological distress. These modifiable external factors must be identified and addressed
through case management and resource linkage to improve treatment engagement.
Neurotransmitter dysregulation, genetic predisposition, and cognitive schemas represent internal
mechanisms that do not explain the immediate access barriers described.
,Q2: A 38-year-old woman presents with panic-like episodes, heat intolerance, and 15-pound
weight loss over 2 months. Vital signs show tachycardia and mild hypertension. Which
laboratory finding would most likely confirm a medical mimic of her anxiety symptoms?
A. Elevated BUN and creatinine
B. Macrocytic anemia with low hemoglobin
C. Elevated ammonia level
D. Suppressed TSH with elevated Free T4
Correct Answer: D
Rationale: Correct because suppressed TSH with elevated Free T4 confirms hyperthyroidism,
which classically mimics panic disorder and generalized anxiety disorder through excessive
thyroid hormone production causing tachycardia, heat intolerance, and weight loss. This
endocrine disorder must be ruled out before assigning a primary anxiety diagnosis. Elevated
BUN and creatinine indicate renal dysfunction, macrocytic anemia suggests B12 deficiency
typically associated with depressive symptoms, and elevated ammonia indicates hepatic
encephalopathy, none of which align with this patient's hypermetabolic presentation.
Q3: A 31-year-old man reports recurrent unexpected panic attacks characterized by palpitations,
sweating, trembling, shortness of breath, and fear of losing control. For the past 6 weeks, he has
worried persistently about having additional attacks and avoids exercise for fear it will trigger an
episode. Which diagnosis best fits this presentation?
A. Generalized Anxiety Disorder
B. Panic Disorder
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: B
Rationale: Correct because Panic Disorder requires recurrent unexpected panic attacks followed
by at least 1 month of persistent concern about additional attacks or maladaptive behavioral
changes related to the attacks, which this patient demonstrates through his worry and exercise
avoidance. The presence of four or more physical symptoms peaking within minutes meets the
panic attack criteria. Generalized Anxiety Disorder is incorrect because the worry is focused on
panic recurrence rather than multiple domains, while Social Anxiety Disorder and Specific
Phobia are incorrect because the fear is not tied to social scrutiny or specific phobic stimuli.
,Q4: A 25-year-old man was in a serious motor vehicle collision 10 days ago. Since then, he
experiences recurrent intrusive images of the crash, avoids driving, reports feeling emotionally
numb, and has difficulty falling asleep due to hypervigilance. Which diagnosis is most accurate?
A. Post-Traumatic Stress Disorder
B. Adjustment Disorder with Anxiety
C. Acute Stress Disorder
D. Brief Psychotic Disorder
Correct Answer: C
Rationale: Correct because Acute Stress Disorder is characterized by intrusion, negative mood,
dissociative, avoidance, and arousal symptoms occurring between 3 days and 1 month after
trauma exposure, and this patient at 10 days falls within this diagnostic window. Post-Traumatic
Stress Disorder is incorrect because the duration criterion requires symptoms persisting beyond 1
month. Adjustment Disorder is incorrect because the symptom pattern reflects specific trauma-
related phenomena rather than a non-specific stress response, and Brief Psychotic Disorder
requires psychotic features not present here.
Q5: A PMHNP evaluates a patient who intentionally feigns auditory hallucinations and suicidal
ideation to avoid criminal prosecution. The patient admits he is fabricating symptoms when
confronted. According to the 6-step differential diagnosis process, which condition has been
identified?
A. Malingering
B. Factitious Disorder
C. Somatic Symptom Disorder
D. Conversion Disorder
Correct Answer: A
Rationale: Correct because malingering involves the intentional production of symptoms
motivated by external incentives such as avoiding criminal prosecution, financial gain, or legal
advantages, which this patient admits when confronted. This represents Step 1 of the differential
diagnosis process. Factitious Disorder is incorrect because that diagnosis requires assuming the
sick role without external incentives, Somatic Symptom Disorder involves genuine distress
without intentional production, and Conversion Disorder features unconscious neurological
symptoms rather than intentional fabrication.
, Q6: A 45-year-old patient presents with new-onset depression, fatigue, and cognitive slowing.
The PMHNP suspects a medical mimic. Which laboratory tests are essential to rule out general
medical conditions before diagnosing a primary psychiatric disorder? Select all that apply.
A. Thyroid function tests (TSH and Free T4)
B. Complete Blood Count
C. Comprehensive Metabolic Panel
D. Lumbar puncture with cerebrospinal fluid analysis
Correct Answer(s): A, B, C
Rationale: Correct because thyroid function tests identify hypothyroidism that mimics
depression, the Complete Blood Count detects anemias causing fatigue and cognitive symptoms,
and the Comprehensive Metabolic Panel reveals electrolyte imbalances, hepatic dysfunction, and
renal impairment that can present with psychiatric symptoms. These three tests form the core
medical workup aligned with Step 3 of the differential diagnosis process. Lumbar puncture is
incorrect because it is not indicated as a routine screening test for depressive symptoms and
should be reserved for suspected central nervous system infection or inflammation.
Q7: A 22-year-old student spends 5 hours daily washing her hands until they bleed, driven by
intrusive thoughts about contamination. She recognizes the behavior is excessive but feels unable
to resist the urge. Which term best describes the hand-washing behavior?
A. Obsession
B. Delusion
C. Tic
D. Compulsion
Correct Answer: D
Rationale: Correct because compulsions are repetitive behaviors that an individual feels driven
to perform in response to an obsession, aimed at reducing anxiety or preventing a feared event,
and this patient's excessive hand-washing fits this definition precisely. The behavior is time-
consuming, causes physical injury, and is recognized as excessive yet irresistible. Obsession
refers to intrusive thoughts rather than behaviors, delusion represents a fixed false belief, and tics
are sudden non-purposeful movements distinct from ritualistic anxiety-reduction behaviors.
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 29-year-old patient presents with anxiety and depression. During the interview, the
PMHNP learns the patient was evicted last month, lacks reliable transportation, and has missed
three psychiatric appointments due to work schedule conflicts. Which factor should the PMHNP
identify as the primary barrier to care?
A. Social determinants of mental health
B. Neurotransmitter dysregulation
C. Genetic predisposition to mood disorders
D. Maladaptive cognitive schema
Correct Answer: A
Rationale: Correct because social determinants of mental health encompass environmental,
economic, and structural barriers such as housing instability, transportation limitations, and
occupational constraints that directly impede access to psychiatric care and exacerbate
psychological distress. These modifiable external factors must be identified and addressed
through case management and resource linkage to improve treatment engagement.
Neurotransmitter dysregulation, genetic predisposition, and cognitive schemas represent internal
mechanisms that do not explain the immediate access barriers described.
,Q2: A 38-year-old woman presents with panic-like episodes, heat intolerance, and 15-pound
weight loss over 2 months. Vital signs show tachycardia and mild hypertension. Which
laboratory finding would most likely confirm a medical mimic of her anxiety symptoms?
A. Elevated BUN and creatinine
B. Macrocytic anemia with low hemoglobin
C. Elevated ammonia level
D. Suppressed TSH with elevated Free T4
Correct Answer: D
Rationale: Correct because suppressed TSH with elevated Free T4 confirms hyperthyroidism,
which classically mimics panic disorder and generalized anxiety disorder through excessive
thyroid hormone production causing tachycardia, heat intolerance, and weight loss. This
endocrine disorder must be ruled out before assigning a primary anxiety diagnosis. Elevated
BUN and creatinine indicate renal dysfunction, macrocytic anemia suggests B12 deficiency
typically associated with depressive symptoms, and elevated ammonia indicates hepatic
encephalopathy, none of which align with this patient's hypermetabolic presentation.
Q3: A 31-year-old man reports recurrent unexpected panic attacks characterized by palpitations,
sweating, trembling, shortness of breath, and fear of losing control. For the past 6 weeks, he has
worried persistently about having additional attacks and avoids exercise for fear it will trigger an
episode. Which diagnosis best fits this presentation?
A. Generalized Anxiety Disorder
B. Panic Disorder
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: B
Rationale: Correct because Panic Disorder requires recurrent unexpected panic attacks followed
by at least 1 month of persistent concern about additional attacks or maladaptive behavioral
changes related to the attacks, which this patient demonstrates through his worry and exercise
avoidance. The presence of four or more physical symptoms peaking within minutes meets the
panic attack criteria. Generalized Anxiety Disorder is incorrect because the worry is focused on
panic recurrence rather than multiple domains, while Social Anxiety Disorder and Specific
Phobia are incorrect because the fear is not tied to social scrutiny or specific phobic stimuli.
,Q4: A 25-year-old man was in a serious motor vehicle collision 10 days ago. Since then, he
experiences recurrent intrusive images of the crash, avoids driving, reports feeling emotionally
numb, and has difficulty falling asleep due to hypervigilance. Which diagnosis is most accurate?
A. Post-Traumatic Stress Disorder
B. Adjustment Disorder with Anxiety
C. Acute Stress Disorder
D. Brief Psychotic Disorder
Correct Answer: C
Rationale: Correct because Acute Stress Disorder is characterized by intrusion, negative mood,
dissociative, avoidance, and arousal symptoms occurring between 3 days and 1 month after
trauma exposure, and this patient at 10 days falls within this diagnostic window. Post-Traumatic
Stress Disorder is incorrect because the duration criterion requires symptoms persisting beyond 1
month. Adjustment Disorder is incorrect because the symptom pattern reflects specific trauma-
related phenomena rather than a non-specific stress response, and Brief Psychotic Disorder
requires psychotic features not present here.
Q5: A PMHNP evaluates a patient who intentionally feigns auditory hallucinations and suicidal
ideation to avoid criminal prosecution. The patient admits he is fabricating symptoms when
confronted. According to the 6-step differential diagnosis process, which condition has been
identified?
A. Malingering
B. Factitious Disorder
C. Somatic Symptom Disorder
D. Conversion Disorder
Correct Answer: A
Rationale: Correct because malingering involves the intentional production of symptoms
motivated by external incentives such as avoiding criminal prosecution, financial gain, or legal
advantages, which this patient admits when confronted. This represents Step 1 of the differential
diagnosis process. Factitious Disorder is incorrect because that diagnosis requires assuming the
sick role without external incentives, Somatic Symptom Disorder involves genuine distress
without intentional production, and Conversion Disorder features unconscious neurological
symptoms rather than intentional fabrication.
, Q6: A 45-year-old patient presents with new-onset depression, fatigue, and cognitive slowing.
The PMHNP suspects a medical mimic. Which laboratory tests are essential to rule out general
medical conditions before diagnosing a primary psychiatric disorder? Select all that apply.
A. Thyroid function tests (TSH and Free T4)
B. Complete Blood Count
C. Comprehensive Metabolic Panel
D. Lumbar puncture with cerebrospinal fluid analysis
Correct Answer(s): A, B, C
Rationale: Correct because thyroid function tests identify hypothyroidism that mimics
depression, the Complete Blood Count detects anemias causing fatigue and cognitive symptoms,
and the Comprehensive Metabolic Panel reveals electrolyte imbalances, hepatic dysfunction, and
renal impairment that can present with psychiatric symptoms. These three tests form the core
medical workup aligned with Step 3 of the differential diagnosis process. Lumbar puncture is
incorrect because it is not indicated as a routine screening test for depressive symptoms and
should be reserved for suspected central nervous system infection or inflammation.
Q7: A 22-year-old student spends 5 hours daily washing her hands until they bleed, driven by
intrusive thoughts about contamination. She recognizes the behavior is excessive but feels unable
to resist the urge. Which term best describes the hand-washing behavior?
A. Obsession
B. Delusion
C. Tic
D. Compulsion
Correct Answer: D
Rationale: Correct because compulsions are repetitive behaviors that an individual feels driven
to perform in response to an obsession, aimed at reducing anxiety or preventing a feared event,
and this patient's excessive hand-washing fits this definition precisely. The behavior is time-
consuming, causes physical injury, and is recognized as excessive yet irresistible. Obsession
refers to intrusive thoughts rather than behaviors, delusion represents a fixed false belief, and tics
are sudden non-purposeful movements distinct from ritualistic anxiety-reduction behaviors.
