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 45-year-old patient reports five weeks of pervasive low
mood, anhedonia, fatigue, insomnia (initial), decreased
concentration, and guilt. There is no history of manic or
hypomanic episodes. Which diagnosis is most appropriate?
A. Persistent depressive disorder (dysthymia)
B. Major depressive disorder, single episode, moderate
C. Adjustment disorder with depressed mood
D. Bipolar II disorder
Correct Answer: B
Rationale: Duration (~5 weeks) and symptom cluster
(anhedonia, marked guilt, concentration impairment, significant
insomnia) meet criteria for a Major Depressive Episode.
Persistent depressive disorder requires ≥2 years of symptoms.
Adjustment disorder requires a psychosocial stressor with less
,severe symptom severity and would resolve within 6 months of
stressor end. Bipolar II needs a history of hypomania, which is
absent. DSM-5-TR diagnostic thresholds and duration guide this
differentiation.
Q2. A 23-year-old presents with recurrent panic attacks,
persistent worry about additional attacks, and avoidance of
places where escape might be difficult for the past 9 months.
Physical exam and labs are normal. Best diagnosis?
A. Specific phobia
B. Panic disorder with agoraphobia
C. Generalized anxiety disorder
D. Social anxiety disorder
Correct Answer: B
Rationale: Recurrent unexpected panic attacks plus ≥1 month of
persistent concern about attacks and avoidance of situations
(agoraphobia) fit Panic Disorder with Agoraphobia. Specific
phobia is circumscribed to a specific object/situation; GAD is
characterized by excessive worry across multiple domains
without recurrent panic attacks as the primary event; Social
anxiety centers on performance/social evaluation.
Q3. A 7-year-old presents with inattentiveness (frequent
careless mistakes), fails to finish homework, and difficulty
sustaining attention in class for 10 months. Symptoms began
before age 12 and occur in both home and school. Parent
reports occasional impulsivity but no hyperactivity. Which is
most accurate?
,A. ADHD, predominantly inattentive presentation
B. ADHD, combined presentation
C. Normal developmental variation
D. Specific learning disorder
Correct Answer: A
Rationale: DSM-5-TR requires ≥6 inattentive symptoms for ≥6
months, onset before 12, and impairment in two settings.
Presence of occasional impulsivity without sufficient
hyperactive/impulsive symptoms supports predominantly
inattentive presentation. Specific learning disorder would be
tied to academic skill deficits on testing, not general attention
across settings.
Q4. A 28-year-old veteran with nightmares, hypervigilance,
avoidance of reminders, and persistent negative alterations in
cognition for 10 months following combat exposure. Differential
diagnosis most consistent with:
A. Acute stress disorder
B. Adjustment disorder
C. Posttraumatic stress disorder (PTSD)
D. Major depressive disorder
Correct Answer: C
Rationale: Symptoms began after exposure to traumatic event
and persist >1 month with intrusion (nightmares), avoidance,
hyperarousal, and negative cognition—consistent with PTSD per
DSM-5-TR. Acute stress disorder is limited to 3 days–1 month
after trauma. Adjustment disorder lacks criteria for exposure to
, trauma and does not include intrusion symptoms like
nightmares.
Q5. A 65-year-old with progressive memory impairment over 2
years, difficulty with instrumental activities, and neuroimaging
showing cortical atrophy. On mental status exam, prominent
visuospatial deficits are present. Most likely diagnosis?
A. Major neurocognitive disorder (Alzheimer’s disease)
B. Vascular neurocognitive disorder
C. Mild neurocognitive disorder
D. Normal age-related cognitive decline
Correct Answer: A
Rationale: Progressive multi-domain cognitive decline impacting
independence over 2 years with cortical atrophy and
visuospatial deficits suggests Major Neurocognitive Disorder
due to Alzheimer’s disease per DSM-5-TR. Vascular NCD
typically shows stepwise decline and imaging evidence of
infarcts. Mild NCD would not cause significant interference with
independence. Normal aging does not produce such functional
impairment.
Q6. A 17-year-old presents with restrictive eating, intense fear
of weight gain despite low BMI, and amenorrhea. Which
diagnosis applies?
A. Anorexia nervosa, restricting type
B. Bulimia nervosa
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 45-year-old patient reports five weeks of pervasive low
mood, anhedonia, fatigue, insomnia (initial), decreased
concentration, and guilt. There is no history of manic or
hypomanic episodes. Which diagnosis is most appropriate?
A. Persistent depressive disorder (dysthymia)
B. Major depressive disorder, single episode, moderate
C. Adjustment disorder with depressed mood
D. Bipolar II disorder
Correct Answer: B
Rationale: Duration (~5 weeks) and symptom cluster
(anhedonia, marked guilt, concentration impairment, significant
insomnia) meet criteria for a Major Depressive Episode.
Persistent depressive disorder requires ≥2 years of symptoms.
Adjustment disorder requires a psychosocial stressor with less
,severe symptom severity and would resolve within 6 months of
stressor end. Bipolar II needs a history of hypomania, which is
absent. DSM-5-TR diagnostic thresholds and duration guide this
differentiation.
Q2. A 23-year-old presents with recurrent panic attacks,
persistent worry about additional attacks, and avoidance of
places where escape might be difficult for the past 9 months.
Physical exam and labs are normal. Best diagnosis?
A. Specific phobia
B. Panic disorder with agoraphobia
C. Generalized anxiety disorder
D. Social anxiety disorder
Correct Answer: B
Rationale: Recurrent unexpected panic attacks plus ≥1 month of
persistent concern about attacks and avoidance of situations
(agoraphobia) fit Panic Disorder with Agoraphobia. Specific
phobia is circumscribed to a specific object/situation; GAD is
characterized by excessive worry across multiple domains
without recurrent panic attacks as the primary event; Social
anxiety centers on performance/social evaluation.
Q3. A 7-year-old presents with inattentiveness (frequent
careless mistakes), fails to finish homework, and difficulty
sustaining attention in class for 10 months. Symptoms began
before age 12 and occur in both home and school. Parent
reports occasional impulsivity but no hyperactivity. Which is
most accurate?
,A. ADHD, predominantly inattentive presentation
B. ADHD, combined presentation
C. Normal developmental variation
D. Specific learning disorder
Correct Answer: A
Rationale: DSM-5-TR requires ≥6 inattentive symptoms for ≥6
months, onset before 12, and impairment in two settings.
Presence of occasional impulsivity without sufficient
hyperactive/impulsive symptoms supports predominantly
inattentive presentation. Specific learning disorder would be
tied to academic skill deficits on testing, not general attention
across settings.
Q4. A 28-year-old veteran with nightmares, hypervigilance,
avoidance of reminders, and persistent negative alterations in
cognition for 10 months following combat exposure. Differential
diagnosis most consistent with:
A. Acute stress disorder
B. Adjustment disorder
C. Posttraumatic stress disorder (PTSD)
D. Major depressive disorder
Correct Answer: C
Rationale: Symptoms began after exposure to traumatic event
and persist >1 month with intrusion (nightmares), avoidance,
hyperarousal, and negative cognition—consistent with PTSD per
DSM-5-TR. Acute stress disorder is limited to 3 days–1 month
after trauma. Adjustment disorder lacks criteria for exposure to
, trauma and does not include intrusion symptoms like
nightmares.
Q5. A 65-year-old with progressive memory impairment over 2
years, difficulty with instrumental activities, and neuroimaging
showing cortical atrophy. On mental status exam, prominent
visuospatial deficits are present. Most likely diagnosis?
A. Major neurocognitive disorder (Alzheimer’s disease)
B. Vascular neurocognitive disorder
C. Mild neurocognitive disorder
D. Normal age-related cognitive decline
Correct Answer: A
Rationale: Progressive multi-domain cognitive decline impacting
independence over 2 years with cortical atrophy and
visuospatial deficits suggests Major Neurocognitive Disorder
due to Alzheimer’s disease per DSM-5-TR. Vascular NCD
typically shows stepwise decline and imaging evidence of
infarcts. Mild NCD would not cause significant interference with
independence. Normal aging does not produce such functional
impairment.
Q6. A 17-year-old presents with restrictive eating, intense fear
of weight gain despite low BMI, and amenorrhea. Which
diagnosis applies?
A. Anorexia nervosa, restricting type
B. Bulimia nervosa
