NR 547 Final Exam 2025/2026 Test Bank |
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers Study Guide
Q1. A 28-year-old woman presents with a 3-week history of
pervasive low mood, anhedonia, hypersomnia, increased
appetite, fatigue, and difficulty concentrating. She reports
occasional passive suicidal thoughts but denies prior similar
episodes. No psychotic symptoms or substance use. On mental
status exam she appears slowed but oriented. Which diagnosis
is most consistent with DSM-5-TR criteria?
A. Major Depressive Disorder, single episode, moderate
B. Persistent Depressive Disorder (dysthymia)
C. Adjustment disorder with depressed mood
D. Bipolar II disorder, current depressive episode
Correct Answer: A
Rationale: Symptoms meet duration (≥2 weeks) and symptom
threshold for MDD with significant functional impairment; no
history of hypomania excludes Bipolar II. PDD requires ≥2 years
,of depressed mood. Adjustment disorder requires an
identifiable stressor within 3 months and subthreshold criteria.
Q2. A 45-year-old man presents with episodic intense anxiety,
chest pain, derealization, and fear of dying occurring
unexpectedly over the past 2 months, with concern about
recurrence and behavior change (avoiding exercise). There is no
agoraphobia. Best diagnosis?
A. Specific phobia
B. Panic disorder
C. Generalized anxiety disorder
D. Social anxiety disorder
Correct Answer: B
Rationale: Recurrent unexpected panic attacks with at least 1
month of persistent concern or behavior change meets Panic
Disorder (DSM-5-TR). GAD requires excessive worry for ≥6
months; phobia/social anxiety have specific situational triggers.
Q3. A 7-year-old boy demonstrates persistent inattentive
symptoms across home and school for 18 months: difficulty
sustaining attention, careless mistakes, loses things, but no
hyperactivity. Impairment is moderate. Family history positive
for ADHD. Most appropriate DSM-5-TR diagnosis?
A. ADHD, combined presentation
B. ADHD, predominantly hyperactive-impulsive presentation
,C. ADHD, predominantly inattentive presentation
D. Autism spectrum disorder
Correct Answer: C
Rationale: Symptoms present ≥6 months across settings,
developmentally inappropriate, and cause impairment —
consistent with ADHD inattentive presentation. Combined
requires both inattentive and hyperactive symptoms. ASD
would include social communication deficits and restricted
behaviors, not described.
Q4. Select all that apply. Which features most reliably
distinguish primary insomnia disorder from insomnia secondary
to major depressive disorder?
A. Onset and maintenance of insomnia preceded mood
symptoms
B. Hypersomnia (excessive sleep) predominates
C. Lack of diurnal mood variation associated with sleep
disturbance
D. Prominent anergia, guilt, and pervasive low mood alongside
sleep problems
Correct Answer: A, C
Rationale: If insomnia precedes mood symptoms and occurs
without diurnal mood variation or other depressive features,
primary insomnia is favored. Hypersomnia and pervasive
depressive symptoms suggest insomnia secondary to MDD.
, Q5. A 22-year-old college student reports intrusive memories,
nightmares, hypervigilance, avoidance of reminders, and
exaggerated startle after a sexual assault 2 months ago.
Symptoms cause social withdrawal and grade decline. Best
DSM-5-TR diagnosis?
A. Posttraumatic stress disorder (PTSD)
B. Acute stress disorder
C. Adjustment disorder with anxiety
D. Reactive attachment disorder
Correct Answer: A
Rationale: Symptoms have persisted >1 month and include
intrusion, avoidance, negative alterations in cognition/mood,
and hyperarousal, meeting PTSD. Acute stress disorder is
diagnosed from 3 days to 1 month post-trauma. Adjustment
disorder lacks trauma-specific intrusive symptoms.
Q6. A 66-year-old woman with gradual memory decline over 2
years: impaired episodic memory, word-finding difficulty, and
functional decline in finances; MRI shows hippocampal atrophy.
No fluctuations or visual hallucinations. Most likely diagnosis?
A. Major neurocognitive disorder due to Alzheimer’s disease
B. Major neurocognitive disorder with Lewy bodies
C. Vascular neurocognitive disorder
D. Major neurocognitive disorder due to Parkinson’s disease
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers Study Guide
Q1. A 28-year-old woman presents with a 3-week history of
pervasive low mood, anhedonia, hypersomnia, increased
appetite, fatigue, and difficulty concentrating. She reports
occasional passive suicidal thoughts but denies prior similar
episodes. No psychotic symptoms or substance use. On mental
status exam she appears slowed but oriented. Which diagnosis
is most consistent with DSM-5-TR criteria?
A. Major Depressive Disorder, single episode, moderate
B. Persistent Depressive Disorder (dysthymia)
C. Adjustment disorder with depressed mood
D. Bipolar II disorder, current depressive episode
Correct Answer: A
Rationale: Symptoms meet duration (≥2 weeks) and symptom
threshold for MDD with significant functional impairment; no
history of hypomania excludes Bipolar II. PDD requires ≥2 years
,of depressed mood. Adjustment disorder requires an
identifiable stressor within 3 months and subthreshold criteria.
Q2. A 45-year-old man presents with episodic intense anxiety,
chest pain, derealization, and fear of dying occurring
unexpectedly over the past 2 months, with concern about
recurrence and behavior change (avoiding exercise). There is no
agoraphobia. Best diagnosis?
A. Specific phobia
B. Panic disorder
C. Generalized anxiety disorder
D. Social anxiety disorder
Correct Answer: B
Rationale: Recurrent unexpected panic attacks with at least 1
month of persistent concern or behavior change meets Panic
Disorder (DSM-5-TR). GAD requires excessive worry for ≥6
months; phobia/social anxiety have specific situational triggers.
Q3. A 7-year-old boy demonstrates persistent inattentive
symptoms across home and school for 18 months: difficulty
sustaining attention, careless mistakes, loses things, but no
hyperactivity. Impairment is moderate. Family history positive
for ADHD. Most appropriate DSM-5-TR diagnosis?
A. ADHD, combined presentation
B. ADHD, predominantly hyperactive-impulsive presentation
,C. ADHD, predominantly inattentive presentation
D. Autism spectrum disorder
Correct Answer: C
Rationale: Symptoms present ≥6 months across settings,
developmentally inappropriate, and cause impairment —
consistent with ADHD inattentive presentation. Combined
requires both inattentive and hyperactive symptoms. ASD
would include social communication deficits and restricted
behaviors, not described.
Q4. Select all that apply. Which features most reliably
distinguish primary insomnia disorder from insomnia secondary
to major depressive disorder?
A. Onset and maintenance of insomnia preceded mood
symptoms
B. Hypersomnia (excessive sleep) predominates
C. Lack of diurnal mood variation associated with sleep
disturbance
D. Prominent anergia, guilt, and pervasive low mood alongside
sleep problems
Correct Answer: A, C
Rationale: If insomnia precedes mood symptoms and occurs
without diurnal mood variation or other depressive features,
primary insomnia is favored. Hypersomnia and pervasive
depressive symptoms suggest insomnia secondary to MDD.
, Q5. A 22-year-old college student reports intrusive memories,
nightmares, hypervigilance, avoidance of reminders, and
exaggerated startle after a sexual assault 2 months ago.
Symptoms cause social withdrawal and grade decline. Best
DSM-5-TR diagnosis?
A. Posttraumatic stress disorder (PTSD)
B. Acute stress disorder
C. Adjustment disorder with anxiety
D. Reactive attachment disorder
Correct Answer: A
Rationale: Symptoms have persisted >1 month and include
intrusion, avoidance, negative alterations in cognition/mood,
and hyperarousal, meeting PTSD. Acute stress disorder is
diagnosed from 3 days to 1 month post-trauma. Adjustment
disorder lacks trauma-specific intrusive symptoms.
Q6. A 66-year-old woman with gradual memory decline over 2
years: impaired episodic memory, word-finding difficulty, and
functional decline in finances; MRI shows hippocampal atrophy.
No fluctuations or visual hallucinations. Most likely diagnosis?
A. Major neurocognitive disorder due to Alzheimer’s disease
B. Major neurocognitive disorder with Lewy bodies
C. Vascular neurocognitive disorder
D. Major neurocognitive disorder due to Parkinson’s disease
