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 28-year-old teacher reports a 10-week history of
pervasive low mood, anhedonia, hypersomnia, increased
appetite, and excessive guilt. Symptoms began after a romantic
breakup but have persisted and are causing occupational
impairment. She reports occasional passive suicidal ideation
without plan. Which diagnosis is most appropriate?
A. Major Depressive Disorder (single episode), severe, with
atypical features
B. Normal bereavement (grief reaction)
C. Persistent Depressive Disorder (Dysthymia)
D. Adjustment Disorder with depressed mood
,Correct Answer: A
Rationale: Duration (~10 weeks) and severity with marked
functional impairment and passive SI exceed expected acute
grief. Atypical features (hypersomnia, hyperphagia,
interpersonal rejection sensitivity/guilt) point to MDD.
Persistent depressive disorder requires ≥2 years duration.
Adjustment disorder is time-limited and less severe.
Q2. A 45-year-old with long-standing alcohol use presents with
2 days of visual hallucinations (seeing animals), tachycardia,
tremor, and diaphoresis after stopping alcohol 48 hours ago.
Which is the most likely primary diagnosis?
A. Alcohol withdrawal delirium (delirium tremens)
B. Alcohol-induced psychotic disorder, with delusions
C. Primary psychotic disorder (schizophrenia)
D. Major neurocognitive disorder with behavioral disturbance
Correct Answer: A
Rationale: Onset within 48–72 hours after cessation, autonomic
hyperactivity, tremor, and visual hallucinations are classic for
alcohol withdrawal delirium. Primary psychosis is less
temporally linked to cessation; neurocognitive disorder less
likely given acute timeline.
Q3. A 16-year-old presents with severe academic decline,
difficulty sustaining attention across settings since early
,childhood, fidgeting, impulsivity, and frequent interrupting.
Symptoms are present at home and school and cause social
impairment. Best diagnosis?
A. ADHD, predominantly inattentive presentation
B. Oppositional defiant disorder
C. Autism spectrum disorder
D. ADHD, combined presentation
Correct Answer: D
Rationale: Symptoms of inattention and hyperactivity-
impulsivity across settings since childhood with impairment fit
ADHD combined type per DSM-5-TR. ODD focuses on defiant
behavior; ASD includes social communication deficits and
restricted interests not described.
Q4. A 32-year-old reports repeated panic attacks with sweating,
palpitations, derealization, and fear of losing control. He avoids
grocery stores because he fears having a panic attack there.
Which diagnosis best captures his presentation?
A. Panic disorder with agoraphobia
B. Generalized anxiety disorder
C. Specific phobia (situational)
D. Social anxiety disorder
Correct Answer: A
Rationale: Recurrent unexpected panic attacks plus avoidance
of situations (grocery stores) due to fear of having panic attacks
, indicates panic disorder with agoraphobia. GAD involves
pervasive worry without discrete panic attacks; social anxiety is
fear of social scrutiny.
Q5. A 70-year-old woman with progressive memory decline
over 1.5 years shows prominent recent memory impairment,
difficulty with instrumental activities, and MRI showing medial
temporal atrophy. Which is most likely?
A. Major neurocognitive disorder (probable Alzheimer’s
disease)
B. Mild neurocognitive disorder due to vascular disease
C. Delirium secondary to urinary tract infection
D. Depression-related pseudodementia
Correct Answer: A
Rationale: Progressive ≥1 year decline with impairment in
ADLs/IADLs and medial temporal atrophy is typical for
Alzheimer’s disease major NCD. Delirium is acute/confusional;
pseudodementia may show rapid onset and mood symptoms;
vascular NCD would have stepwise deficits and imaging
evidence of infarcts.
Q6. A 24-year-old reports hearing voices commenting on her
actions for 6 weeks, disorganized speech, and occupational
impairment. She also had a depressed mood for the last 2
weeks. Which diagnosis fits best?
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 28-year-old teacher reports a 10-week history of
pervasive low mood, anhedonia, hypersomnia, increased
appetite, and excessive guilt. Symptoms began after a romantic
breakup but have persisted and are causing occupational
impairment. She reports occasional passive suicidal ideation
without plan. Which diagnosis is most appropriate?
A. Major Depressive Disorder (single episode), severe, with
atypical features
B. Normal bereavement (grief reaction)
C. Persistent Depressive Disorder (Dysthymia)
D. Adjustment Disorder with depressed mood
,Correct Answer: A
Rationale: Duration (~10 weeks) and severity with marked
functional impairment and passive SI exceed expected acute
grief. Atypical features (hypersomnia, hyperphagia,
interpersonal rejection sensitivity/guilt) point to MDD.
Persistent depressive disorder requires ≥2 years duration.
Adjustment disorder is time-limited and less severe.
Q2. A 45-year-old with long-standing alcohol use presents with
2 days of visual hallucinations (seeing animals), tachycardia,
tremor, and diaphoresis after stopping alcohol 48 hours ago.
Which is the most likely primary diagnosis?
A. Alcohol withdrawal delirium (delirium tremens)
B. Alcohol-induced psychotic disorder, with delusions
C. Primary psychotic disorder (schizophrenia)
D. Major neurocognitive disorder with behavioral disturbance
Correct Answer: A
Rationale: Onset within 48–72 hours after cessation, autonomic
hyperactivity, tremor, and visual hallucinations are classic for
alcohol withdrawal delirium. Primary psychosis is less
temporally linked to cessation; neurocognitive disorder less
likely given acute timeline.
Q3. A 16-year-old presents with severe academic decline,
difficulty sustaining attention across settings since early
,childhood, fidgeting, impulsivity, and frequent interrupting.
Symptoms are present at home and school and cause social
impairment. Best diagnosis?
A. ADHD, predominantly inattentive presentation
B. Oppositional defiant disorder
C. Autism spectrum disorder
D. ADHD, combined presentation
Correct Answer: D
Rationale: Symptoms of inattention and hyperactivity-
impulsivity across settings since childhood with impairment fit
ADHD combined type per DSM-5-TR. ODD focuses on defiant
behavior; ASD includes social communication deficits and
restricted interests not described.
Q4. A 32-year-old reports repeated panic attacks with sweating,
palpitations, derealization, and fear of losing control. He avoids
grocery stores because he fears having a panic attack there.
Which diagnosis best captures his presentation?
A. Panic disorder with agoraphobia
B. Generalized anxiety disorder
C. Specific phobia (situational)
D. Social anxiety disorder
Correct Answer: A
Rationale: Recurrent unexpected panic attacks plus avoidance
of situations (grocery stores) due to fear of having panic attacks
, indicates panic disorder with agoraphobia. GAD involves
pervasive worry without discrete panic attacks; social anxiety is
fear of social scrutiny.
Q5. A 70-year-old woman with progressive memory decline
over 1.5 years shows prominent recent memory impairment,
difficulty with instrumental activities, and MRI showing medial
temporal atrophy. Which is most likely?
A. Major neurocognitive disorder (probable Alzheimer’s
disease)
B. Mild neurocognitive disorder due to vascular disease
C. Delirium secondary to urinary tract infection
D. Depression-related pseudodementia
Correct Answer: A
Rationale: Progressive ≥1 year decline with impairment in
ADLs/IADLs and medial temporal atrophy is typical for
Alzheimer’s disease major NCD. Delirium is acute/confusional;
pseudodementia may show rapid onset and mood symptoms;
vascular NCD would have stepwise deficits and imaging
evidence of infarcts.
Q6. A 24-year-old reports hearing voices commenting on her
actions for 6 weeks, disorganized speech, and occupational
impairment. She also had a depressed mood for the last 2
weeks. Which diagnosis fits best?
