NR547 / NR 547 FINAL EXAM (LATEST 2026/2027):
DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL HEALTH
ACROSS THE LIFESPAN PRACTICUM | WEEKS 5-8 COVERED |
COMPLETE GUIDE WITH QUESTIONS AND VERIFIED ANSWERS –
CHAMBERLAIN
COMPLETE A+ STUDY GUIDE
SECTION 1: DIFFERENTIAL DIAGNOSIS PROCESS & DSM-5-TR
HIERARCHY (Questions 1–25)
1. According to the DSM-5-TR differential diagnosis hierarchy,
which step should be completed FIRST before determining a
primary mental disorder?
A) Determine the specific primary mental disorder based on
symptom clusters
,B) Rule out malingering and factitious disorder
C) Rule out substance/medication-induced conditions
D) Rule out medical conditions that may explain symptoms
Answer B: Rule out malingering and factitious disorder
Rationale: The DSM-5-TR differential diagnosis hierarchy
prioritizes ruling out malingering and factitious disorder first, as
these involve intentional deception that must be distinguished
from genuine psychopathology. Step 2 rules out
substance/medication-induced conditions, Step 3 rules out
medical conditions, and Step 4 determines the specific primary
mental disorder. ---
2. A 45-year-old patient presents with hallucinations,
delusions, and disorganized speech. The PMHNP should first:
A) Diagnose schizophrenia based on symptom presentation
B) Order a comprehensive metabolic panel and toxicology screen
C) Assess for malingering and factitious disorder
D) Begin antipsychotic medication immediately
Answer C: Assess for malingering and factitious disorder
Rationale: According to the DSM-5-TR hierarchy, ruling out
malingering and factitious disorder is the first step before
,considering other etiologies. Diagnosing schizophrenia is
premature without ruling out other causes. Laboratory testing is
appropriate as Step 2 after ruling out intentional deception.
Medication initiation is clinically inappropriate without a
confirmed diagnosis and proper assessment. ---
3. Which of the following represents the correct sequential
order of the DSM-5-TR differential diagnosis hierarchy?
A) Substance-induced conditions → Medical conditions →
Malingering → Primary disorder
B) Medical conditions → Substance-induced → Malingering →
Primary disorder
C) Malingering/Factitious → Substance/medication-induced →
Medical conditions → Primary disorder
D) Primary disorder → Malingering → Substance-induced →
Medical conditions
Answer C: Malingering/Factitious → Substance/medication-
induced → Medical conditions → Primary disorder
Rationale: The correct hierarchy is: Step 1 - Rule out malingering
and factitious disorder; Step 2 - Rule out substance/medication-
, induced conditions; Step 3 - Rule out medical conditions; Step 4 -
Determine the primary psychiatric disorder. ---
4. What is the primary purpose of the differential diagnosis
process in psychiatric-mental health practice?
A) To confirm the patient's self-reported diagnosis
B) To develop a working list of potential disorders that could
explain the patient's symptoms
C) To rule out all medical causes before considering any mental
health diagnosis
D) To assign a single diagnosis that will guide all future treatment
decisions
Answer B: To develop a working list of potential disorders
that could explain the patient's symptoms
Rationale: The differential diagnosis process involves developing
a working hypothesis or list of potential disorders that could
account for the presenting symptoms. This list is prioritized, and
each potential diagnosis is systematically ruled in or out based on
diagnostic criteria, history, and assessment findings. ---
DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL HEALTH
ACROSS THE LIFESPAN PRACTICUM | WEEKS 5-8 COVERED |
COMPLETE GUIDE WITH QUESTIONS AND VERIFIED ANSWERS –
CHAMBERLAIN
COMPLETE A+ STUDY GUIDE
SECTION 1: DIFFERENTIAL DIAGNOSIS PROCESS & DSM-5-TR
HIERARCHY (Questions 1–25)
1. According to the DSM-5-TR differential diagnosis hierarchy,
which step should be completed FIRST before determining a
primary mental disorder?
A) Determine the specific primary mental disorder based on
symptom clusters
,B) Rule out malingering and factitious disorder
C) Rule out substance/medication-induced conditions
D) Rule out medical conditions that may explain symptoms
Answer B: Rule out malingering and factitious disorder
Rationale: The DSM-5-TR differential diagnosis hierarchy
prioritizes ruling out malingering and factitious disorder first, as
these involve intentional deception that must be distinguished
from genuine psychopathology. Step 2 rules out
substance/medication-induced conditions, Step 3 rules out
medical conditions, and Step 4 determines the specific primary
mental disorder. ---
2. A 45-year-old patient presents with hallucinations,
delusions, and disorganized speech. The PMHNP should first:
A) Diagnose schizophrenia based on symptom presentation
B) Order a comprehensive metabolic panel and toxicology screen
C) Assess for malingering and factitious disorder
D) Begin antipsychotic medication immediately
Answer C: Assess for malingering and factitious disorder
Rationale: According to the DSM-5-TR hierarchy, ruling out
malingering and factitious disorder is the first step before
,considering other etiologies. Diagnosing schizophrenia is
premature without ruling out other causes. Laboratory testing is
appropriate as Step 2 after ruling out intentional deception.
Medication initiation is clinically inappropriate without a
confirmed diagnosis and proper assessment. ---
3. Which of the following represents the correct sequential
order of the DSM-5-TR differential diagnosis hierarchy?
A) Substance-induced conditions → Medical conditions →
Malingering → Primary disorder
B) Medical conditions → Substance-induced → Malingering →
Primary disorder
C) Malingering/Factitious → Substance/medication-induced →
Medical conditions → Primary disorder
D) Primary disorder → Malingering → Substance-induced →
Medical conditions
Answer C: Malingering/Factitious → Substance/medication-
induced → Medical conditions → Primary disorder
Rationale: The correct hierarchy is: Step 1 - Rule out malingering
and factitious disorder; Step 2 - Rule out substance/medication-
, induced conditions; Step 3 - Rule out medical conditions; Step 4 -
Determine the primary psychiatric disorder. ---
4. What is the primary purpose of the differential diagnosis
process in psychiatric-mental health practice?
A) To confirm the patient's self-reported diagnosis
B) To develop a working list of potential disorders that could
explain the patient's symptoms
C) To rule out all medical causes before considering any mental
health diagnosis
D) To assign a single diagnosis that will guide all future treatment
decisions
Answer B: To develop a working list of potential disorders
that could explain the patient's symptoms
Rationale: The differential diagnosis process involves developing
a working hypothesis or list of potential disorders that could
account for the presenting symptoms. This list is prioritized, and
each potential diagnosis is systematically ruled in or out based on
diagnostic criteria, history, and assessment findings. ---
