NR 547 Final Exam 2025/2026 Test Bank |
Chamberlain PMHNP Differential Diagnosis
Guide | 50 Graduate-Level Questions &
Answers | Psychiatric–Mental Health Exam Prep
Q1. A 28-year-old woman presents with a 10-month history of
depressed mood, anergia, hypersomnia, increased appetite
with 12-pound weight gain, low self-esteem, and hopelessness.
She reports difficulty concentrating at work but denies suicidal
ideation. Episodes occur most of the year with partial
improvement in summer. Prior history notable for one brief
hypomanic episode three years ago. Which diagnosis best fits?
A. Major Depressive Disorder, recurrent, severe without
psychotic features
B. Persistent Depressive Disorder (Dysthymia) with intermittent
major depressive episodes
,C. Bipolar II Disorder, current episode depressed
D. Cyclothymic Disorder
Correct Answer: C
Rationale: The history of a hypomanic episode establishes a
bipolar spectrum diagnosis. The current 10-month depressive
episode with marked functional impairment fits a major
depressive episode; prior hypomania indicates Bipolar II.
Persistent Depressive Disorder requires chronic depressed
mood ≥2 years — not met. Cyclothymia involves chronic
fluctuating hypomanic and depressive symptoms that do not
meet full episode criteria.
Q2. A 45-year-old man presents with recurrent intrusive
memories, nightmares, hypervigilance, and avoidance after
witnessing a workplace explosion 3 weeks ago. He has difficulty
sleeping and irritability. Which diagnosis is most appropriate at
this time?
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder (PTSD)
C. Adjustment Disorder with anxiety
D. Acute anxiety disorder, unspecified
Correct Answer: A
Rationale: Symptoms resembling PTSD that occur within 3 days
to 1 month after trauma and include intrusive memories,
nightmares, avoidance, and hyperarousal meet Acute Stress
,Disorder. PTSD requires duration >1 month. Adjustment
disorder requires stressors that are not traumatic as defined by
DSM-5-TR.
Q3. Select all that apply. A 7-year-old boy has difficulty
sustaining attention, is easily distracted, fidgets in class, and
loses items needed for tasks. Symptoms present for 8 months
across home and school causing academic impairment. What
features support a primary diagnosis of ADHD rather than an
anxiety disorder?
A. Symptom onset before age 12 and cross-situational
impairment
B. Predominantly internalizing worries that increase with
separation
C. Observable hyperactivity (fidgeting) in structured settings
D. Consistent inattentiveness unrelated to specific feared stimuli
Correct Answer: A, C, D
Rationale: ADHD diagnostic support includes onset before 12,
symptoms in ≥2 settings, and observable
hyperactivity/inattention not tied to avoidance of feared
stimuli. Option B describes anxiety features (separation anxiety)
— not supportive of ADHD as primary.
Q4. A 62-year-old woman with progressive memory decline
over 18 months now shows apathy, impaired executive
, function, and impaired episodic memory. MRI shows medial
temporal lobe atrophy. Which is the most likely diagnosis?
A. Mild Neurocognitive Disorder due to Alzheimer’s disease
B. Major Neurocognitive Disorder due to Alzheimer’s disease
C. Major Neurocognitive Disorder due to vascular disease
D. Pseudodementia due to Major Depressive Disorder
Correct Answer: B
Rationale: The progressive decline over 18 months with
functional impairment (impaired ADLs implied by “major”) and
medial temporal lobe atrophy supports Major Neurocognitive
Disorder (dementia) due to Alzheimer’s disease. Mild
neurocognitive disorder implies preserved independence.
Vascular NCD would show stepwise decline and vascular
lesions. Pseudodementia often has prominent depressive
symptoms and inconsistent deficits.
Q5. A 22-year-old college student reports 6 months of excessive
worry about grades, restlessness, muscle tension, and sleep
disturbance. Symptoms are present most days and cause
moderate impairment. Which treatment choice differentiates
generalized anxiety disorder (GAD) from panic disorder?
A. Initiate sertraline and cognitive behavioral therapy (CBT)
focused on worry and problem-solving
B. Prescribe alprazolam PRN for anticipatory anxiety about
exams
Chamberlain PMHNP Differential Diagnosis
Guide | 50 Graduate-Level Questions &
Answers | Psychiatric–Mental Health Exam Prep
Q1. A 28-year-old woman presents with a 10-month history of
depressed mood, anergia, hypersomnia, increased appetite
with 12-pound weight gain, low self-esteem, and hopelessness.
She reports difficulty concentrating at work but denies suicidal
ideation. Episodes occur most of the year with partial
improvement in summer. Prior history notable for one brief
hypomanic episode three years ago. Which diagnosis best fits?
A. Major Depressive Disorder, recurrent, severe without
psychotic features
B. Persistent Depressive Disorder (Dysthymia) with intermittent
major depressive episodes
,C. Bipolar II Disorder, current episode depressed
D. Cyclothymic Disorder
Correct Answer: C
Rationale: The history of a hypomanic episode establishes a
bipolar spectrum diagnosis. The current 10-month depressive
episode with marked functional impairment fits a major
depressive episode; prior hypomania indicates Bipolar II.
Persistent Depressive Disorder requires chronic depressed
mood ≥2 years — not met. Cyclothymia involves chronic
fluctuating hypomanic and depressive symptoms that do not
meet full episode criteria.
Q2. A 45-year-old man presents with recurrent intrusive
memories, nightmares, hypervigilance, and avoidance after
witnessing a workplace explosion 3 weeks ago. He has difficulty
sleeping and irritability. Which diagnosis is most appropriate at
this time?
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder (PTSD)
C. Adjustment Disorder with anxiety
D. Acute anxiety disorder, unspecified
Correct Answer: A
Rationale: Symptoms resembling PTSD that occur within 3 days
to 1 month after trauma and include intrusive memories,
nightmares, avoidance, and hyperarousal meet Acute Stress
,Disorder. PTSD requires duration >1 month. Adjustment
disorder requires stressors that are not traumatic as defined by
DSM-5-TR.
Q3. Select all that apply. A 7-year-old boy has difficulty
sustaining attention, is easily distracted, fidgets in class, and
loses items needed for tasks. Symptoms present for 8 months
across home and school causing academic impairment. What
features support a primary diagnosis of ADHD rather than an
anxiety disorder?
A. Symptom onset before age 12 and cross-situational
impairment
B. Predominantly internalizing worries that increase with
separation
C. Observable hyperactivity (fidgeting) in structured settings
D. Consistent inattentiveness unrelated to specific feared stimuli
Correct Answer: A, C, D
Rationale: ADHD diagnostic support includes onset before 12,
symptoms in ≥2 settings, and observable
hyperactivity/inattention not tied to avoidance of feared
stimuli. Option B describes anxiety features (separation anxiety)
— not supportive of ADHD as primary.
Q4. A 62-year-old woman with progressive memory decline
over 18 months now shows apathy, impaired executive
, function, and impaired episodic memory. MRI shows medial
temporal lobe atrophy. Which is the most likely diagnosis?
A. Mild Neurocognitive Disorder due to Alzheimer’s disease
B. Major Neurocognitive Disorder due to Alzheimer’s disease
C. Major Neurocognitive Disorder due to vascular disease
D. Pseudodementia due to Major Depressive Disorder
Correct Answer: B
Rationale: The progressive decline over 18 months with
functional impairment (impaired ADLs implied by “major”) and
medial temporal lobe atrophy supports Major Neurocognitive
Disorder (dementia) due to Alzheimer’s disease. Mild
neurocognitive disorder implies preserved independence.
Vascular NCD would show stepwise decline and vascular
lesions. Pseudodementia often has prominent depressive
symptoms and inconsistent deficits.
Q5. A 22-year-old college student reports 6 months of excessive
worry about grades, restlessness, muscle tension, and sleep
disturbance. Symptoms are present most days and cause
moderate impairment. Which treatment choice differentiates
generalized anxiety disorder (GAD) from panic disorder?
A. Initiate sertraline and cognitive behavioral therapy (CBT)
focused on worry and problem-solving
B. Prescribe alprazolam PRN for anticipatory anxiety about
exams
