NR 547 Final Exam 2025/2026 Test Bank |
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 32-year-old teacher reports 3 weeks of daily depressed
mood, anhedonia, insomnia, weight loss, and passive suicidal
ideation. She had a distinct period 3 years ago of elevated mood
lasting 5 days with increased goal-directed activity but no
impairment. Which diagnosis is most appropriate?
,A. Major Depressive Disorder, single episode
B. Bipolar II Disorder, current episode depressed
C. Cyclothymic Disorder
D. Major Depressive Disorder, recurrent
Correct Answer: A
Rationale: Symptoms meet DSM-5-TR criteria for a major
depressive episode (≥2 weeks). The prior 5-day elevated period
is shorter than hypomania (≥4 days qualifies) but lacked
impairment; however duration of 5 days could be hypomania—
yet it was 3 years earlier and there is no confirmed hypomanic
symptom cluster; with current information best fit is MDD
single episode. If the prior episode actually met hypomanic
criteria, bipolar II would be considered; DSM-5-TR requires clear
hypomanic history. Collateral history and record review needed
to confirm prior hypomania before diagnosing Bipolar II.
Q2. A 45-year-old man presents with episodic abrupt surges of
intense fear, palpitations, chest pain, derealization, and fear of
dying occurring unexpectedly twice in the last month with
persistent worry about more attacks. He avoids leaving home
alone. Best diagnosis?
A. Panic Disorder
B. Specific Phobia (Agoraphobia)
C. Generalized Anxiety Disorder
D. Agoraphobia without history of panic
,Correct Answer: A
Rationale: Recurrent unexpected panic attacks plus at least one
month of persistent worry about additional attacks and
maladaptive change in behavior meets Panic Disorder per DSM-
5-TR. Agoraphobia can co-occur but diagnosis of agoraphobia
alone without panic is incorrect here because the core feature
is recurrent unexpected panic.
Q3. (Select all that apply) A 27-year-old with a 7-year history of
social withdrawal, odd beliefs, constricted affect, and social
anxiety but no sustained frank psychosis. Which diagnoses
should be considered in the differential?
A. Schizotypal Personality Disorder
B. Schizophrenia
C. Schizoaffective Disorder
D. Autism Spectrum Disorder
Correct Answer: A, B, D
Rationale: Schizotypal personality disorder includes long-
standing eccentricity, odd beliefs, and social deficits.
Schizophrenia should be considered if there are ≥6 months
including active-phase psychotic symptoms—must clarify for
frank psychosis. Autism spectrum disorder can present with
lifelong social communication deficits and restricted interests;
differential requires developmental history. Schizoaffective
requires mood episode plus psychosis; absence of prominent
mood symptoms makes C less likely.
, Q4. A 19-year-old college student has persistent inattention
since childhood, academic decline, difficulty organizing tasks,
and often loses items. Symptoms occur across settings (home
and school) and began before age 12. Diagnosis most
consistent?
A. Major Depressive Disorder with concentration difficulties
B. Autism Spectrum Disorder
C. Attention-Deficit/Hyperactivity Disorder, predominantly
inattentive presentation
D. Adjustment Disorder with disturbance of conduct
Correct Answer: C
Rationale: DSM-5-TR ADHD requires onset before age 12,
symptoms across settings, and persistent pattern of inattention.
Depression can cause concentration problems but onset and
cross-setting childhood history favor ADHD. ASD typically
includes social communication deficits and restricted
interests—those are not described.
Q5. A 60-year-old woman presents with 2 months of increasing
forgetfulness, difficulty with instrumental activities of daily
living (managing finances), and MRI showing hippocampal
atrophy. Which diagnosis?
A. Mild neurocognitive disorder (mild NCD)
B. Major neurocognitive disorder (major NCD)
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 32-year-old teacher reports 3 weeks of daily depressed
mood, anhedonia, insomnia, weight loss, and passive suicidal
ideation. She had a distinct period 3 years ago of elevated mood
lasting 5 days with increased goal-directed activity but no
impairment. Which diagnosis is most appropriate?
,A. Major Depressive Disorder, single episode
B. Bipolar II Disorder, current episode depressed
C. Cyclothymic Disorder
D. Major Depressive Disorder, recurrent
Correct Answer: A
Rationale: Symptoms meet DSM-5-TR criteria for a major
depressive episode (≥2 weeks). The prior 5-day elevated period
is shorter than hypomania (≥4 days qualifies) but lacked
impairment; however duration of 5 days could be hypomania—
yet it was 3 years earlier and there is no confirmed hypomanic
symptom cluster; with current information best fit is MDD
single episode. If the prior episode actually met hypomanic
criteria, bipolar II would be considered; DSM-5-TR requires clear
hypomanic history. Collateral history and record review needed
to confirm prior hypomania before diagnosing Bipolar II.
Q2. A 45-year-old man presents with episodic abrupt surges of
intense fear, palpitations, chest pain, derealization, and fear of
dying occurring unexpectedly twice in the last month with
persistent worry about more attacks. He avoids leaving home
alone. Best diagnosis?
A. Panic Disorder
B. Specific Phobia (Agoraphobia)
C. Generalized Anxiety Disorder
D. Agoraphobia without history of panic
,Correct Answer: A
Rationale: Recurrent unexpected panic attacks plus at least one
month of persistent worry about additional attacks and
maladaptive change in behavior meets Panic Disorder per DSM-
5-TR. Agoraphobia can co-occur but diagnosis of agoraphobia
alone without panic is incorrect here because the core feature
is recurrent unexpected panic.
Q3. (Select all that apply) A 27-year-old with a 7-year history of
social withdrawal, odd beliefs, constricted affect, and social
anxiety but no sustained frank psychosis. Which diagnoses
should be considered in the differential?
A. Schizotypal Personality Disorder
B. Schizophrenia
C. Schizoaffective Disorder
D. Autism Spectrum Disorder
Correct Answer: A, B, D
Rationale: Schizotypal personality disorder includes long-
standing eccentricity, odd beliefs, and social deficits.
Schizophrenia should be considered if there are ≥6 months
including active-phase psychotic symptoms—must clarify for
frank psychosis. Autism spectrum disorder can present with
lifelong social communication deficits and restricted interests;
differential requires developmental history. Schizoaffective
requires mood episode plus psychosis; absence of prominent
mood symptoms makes C less likely.
, Q4. A 19-year-old college student has persistent inattention
since childhood, academic decline, difficulty organizing tasks,
and often loses items. Symptoms occur across settings (home
and school) and began before age 12. Diagnosis most
consistent?
A. Major Depressive Disorder with concentration difficulties
B. Autism Spectrum Disorder
C. Attention-Deficit/Hyperactivity Disorder, predominantly
inattentive presentation
D. Adjustment Disorder with disturbance of conduct
Correct Answer: C
Rationale: DSM-5-TR ADHD requires onset before age 12,
symptoms across settings, and persistent pattern of inattention.
Depression can cause concentration problems but onset and
cross-setting childhood history favor ADHD. ASD typically
includes social communication deficits and restricted
interests—those are not described.
Q5. A 60-year-old woman presents with 2 months of increasing
forgetfulness, difficulty with instrumental activities of daily
living (managing finances), and MRI showing hippocampal
atrophy. Which diagnosis?
A. Mild neurocognitive disorder (mild NCD)
B. Major neurocognitive disorder (major NCD)
