NR 547 Final Exam 2025/2026 Study Guide |
Chamberlain PMHNP Differential Diagnosis Test
Bank | 50 Graduate-Level Questions & Answers
for Psychiatric–Mental Health Nursing
Q1. A 28-year-old presents with 3 weeks of pervasive low
mood, anhedonia, insomnia, significant weight loss, feelings of
worthlessness, and passive suicidal ideation. There is no prior
history of hypomanic or manic episodes. Which diagnosis is
most appropriate?
A. Major Depressive Disorder, single episode
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder
D. Adjustment Disorder with Depressed Mood
Correct Answer: A
Rationale: Duration (≥2 weeks) and symptom cluster (depressed
mood, anhedonia, sleep/appetite changes, suicidality) meet
DSM-5-TR criteria for a Major Depressive Episode. Persistent
Depressive Disorder requires ≥2 years of chronic depressive
symptoms. Bipolar II requires a history of hypomanic episodes.
Adjustment disorder requires a psychosocial stressor and
,symptoms onset within 3 months but are not typically this
severe (e.g., suicidal ideation).
Q2. A 35-year-old reports 6 months of fluctuating periods of
mild depressive symptoms and brief hypomanic symptoms that
never meet full criteria for hypomania or major depression but
cause distress. Which is the best fit?
A. Cyclothymic Disorder
B. Bipolar I Disorder
C. Major Depressive Disorder, recurrent
D. Persistent Depressive Disorder
Correct Answer: A
Rationale: Cyclothymic disorder is characterized by ≥2 years (≥1
year in children/adolescents) of numerous periods with
hypomanic-like and depressive symptoms that do not meet full
criteria for hypomanic or major depressive episodes. Bipolar I
requires full manic episodes; Bipolar II requires full hypomanic
and major depressive episodes.
Q3. A patient describes 5 days of elevated mood, increased
energy, decreased need for sleep, pressured speech, and
increased goal-directed activity but no marked impairment and
no psychotic features. What is the correct diagnosis?
A. Manic Episode
B. Hypomanic Episode
,C. Cyclothymic Disorder
D. Substance-Induced Mood Disorder
Correct Answer: B
Rationale: Hypomanic episode per DSM-5-TR: distinct period
lasting at least 4 consecutive days with abnormally elevated or
irritable mood and increased energy, observable change but not
severe enough to cause marked impairment or require
hospitalization and no psychosis. Mania requires ≥1 week or any
duration with hospitalization/psychosis. Substance-induced
would require temporal relation to substance use.
Q4. A 42-year-old with long-standing opioid use develops new-
onset auditory hallucinations and disorganized behavior after a
3-day period without opioids. Which diagnosis is most likely?
A. Schizophreniform Disorder
B. Schizoaffective Disorder
C. Substance/Medication-Induced Psychotic Disorder
D. Brief Psychotic Disorder
Correct Answer: C
Rationale: Temporal relationship to opioid withdrawal and new
psychotic symptoms suggests substance/medication-induced
psychotic disorder. Schizophrenia-spectrum disorders require
symptoms not attributable to substances or a shorter/longer
timeline per DSM-5-TR and persistence beyond expected
intoxication/withdrawal periods.
, Q5. Select all that apply. In differentiating delirium from primary
neurocognitive disorder (major NCD), which features favor
delirium?
A. Acute onset and fluctuating course
B. Disturbance in attention and awareness
C. Progressive, insidious decline over months to years
D. Reversible with treatment of underlying medical cause
Correct Answer: A, B, D
Rationale: Delirium is characterized by acute onset, fluctuating
course, and prominent disturbance in attention/awareness and
is often reversible when the medical cause is treated.
Progressive, insidious decline favors major neurocognitive
disorder rather than delirium.
Q6. A 9-year-old presents with chronic irritability, severe
temper outbursts (3–4 per week) inconsistent with
developmental level, and persistent irritable mood between
outbursts for 12 months across settings. What is the most
appropriate diagnosis?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Pediatric Bipolar Disorder
D. Intermittent Explosive Disorder
Chamberlain PMHNP Differential Diagnosis Test
Bank | 50 Graduate-Level Questions & Answers
for Psychiatric–Mental Health Nursing
Q1. A 28-year-old presents with 3 weeks of pervasive low
mood, anhedonia, insomnia, significant weight loss, feelings of
worthlessness, and passive suicidal ideation. There is no prior
history of hypomanic or manic episodes. Which diagnosis is
most appropriate?
A. Major Depressive Disorder, single episode
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder
D. Adjustment Disorder with Depressed Mood
Correct Answer: A
Rationale: Duration (≥2 weeks) and symptom cluster (depressed
mood, anhedonia, sleep/appetite changes, suicidality) meet
DSM-5-TR criteria for a Major Depressive Episode. Persistent
Depressive Disorder requires ≥2 years of chronic depressive
symptoms. Bipolar II requires a history of hypomanic episodes.
Adjustment disorder requires a psychosocial stressor and
,symptoms onset within 3 months but are not typically this
severe (e.g., suicidal ideation).
Q2. A 35-year-old reports 6 months of fluctuating periods of
mild depressive symptoms and brief hypomanic symptoms that
never meet full criteria for hypomania or major depression but
cause distress. Which is the best fit?
A. Cyclothymic Disorder
B. Bipolar I Disorder
C. Major Depressive Disorder, recurrent
D. Persistent Depressive Disorder
Correct Answer: A
Rationale: Cyclothymic disorder is characterized by ≥2 years (≥1
year in children/adolescents) of numerous periods with
hypomanic-like and depressive symptoms that do not meet full
criteria for hypomanic or major depressive episodes. Bipolar I
requires full manic episodes; Bipolar II requires full hypomanic
and major depressive episodes.
Q3. A patient describes 5 days of elevated mood, increased
energy, decreased need for sleep, pressured speech, and
increased goal-directed activity but no marked impairment and
no psychotic features. What is the correct diagnosis?
A. Manic Episode
B. Hypomanic Episode
,C. Cyclothymic Disorder
D. Substance-Induced Mood Disorder
Correct Answer: B
Rationale: Hypomanic episode per DSM-5-TR: distinct period
lasting at least 4 consecutive days with abnormally elevated or
irritable mood and increased energy, observable change but not
severe enough to cause marked impairment or require
hospitalization and no psychosis. Mania requires ≥1 week or any
duration with hospitalization/psychosis. Substance-induced
would require temporal relation to substance use.
Q4. A 42-year-old with long-standing opioid use develops new-
onset auditory hallucinations and disorganized behavior after a
3-day period without opioids. Which diagnosis is most likely?
A. Schizophreniform Disorder
B. Schizoaffective Disorder
C. Substance/Medication-Induced Psychotic Disorder
D. Brief Psychotic Disorder
Correct Answer: C
Rationale: Temporal relationship to opioid withdrawal and new
psychotic symptoms suggests substance/medication-induced
psychotic disorder. Schizophrenia-spectrum disorders require
symptoms not attributable to substances or a shorter/longer
timeline per DSM-5-TR and persistence beyond expected
intoxication/withdrawal periods.
, Q5. Select all that apply. In differentiating delirium from primary
neurocognitive disorder (major NCD), which features favor
delirium?
A. Acute onset and fluctuating course
B. Disturbance in attention and awareness
C. Progressive, insidious decline over months to years
D. Reversible with treatment of underlying medical cause
Correct Answer: A, B, D
Rationale: Delirium is characterized by acute onset, fluctuating
course, and prominent disturbance in attention/awareness and
is often reversible when the medical cause is treated.
Progressive, insidious decline favors major neurocognitive
disorder rather than delirium.
Q6. A 9-year-old presents with chronic irritability, severe
temper outbursts (3–4 per week) inconsistent with
developmental level, and persistent irritable mood between
outbursts for 12 months across settings. What is the most
appropriate diagnosis?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Pediatric Bipolar Disorder
D. Intermittent Explosive Disorder
