NR 547 Final Exam 2025/2026 Latest Guide:
Chamberlain College of Nursing Differential
Diagnosis in Psychiatric-Mental Health Across
Lifespan | 50 Expert Q&A | Test Bank &
PMHNP Practicum Prep
Q1. A 28-year-old female presents with a 3-week history of
persistently elevated mood, grandiosity, decreased need for
sleep, and pressured speech. She has been spending
excessively. Her PHQ-9 score last month during a depressive
episode was 18. Her medical history is significant for
hyperthyroidism, currently managed with methimazole, with
her most recent TSH from 2 weeks ago being 0.8 mIU/L
(normal). What is the most critical next step in diagnostic
assessment?
A. Diagnose Bipolar I Disorder and initiate lithium.
B. Order a urine drug screen and check current thyroid function
tests.
C. Diagnose Substance/Medication-Induced Bipolar and Related
Disorder.
D. Diagnose Cyclothymic Disorder.
,Correct Answer: B
Rationale: While the symptoms meet criteria for a manic
episode, the presence of a known medical condition
(hyperthyroidism) that can induce manic-like symptoms
necessitates ruling out a medical etiology first. A urine drug
screen is also vital to rule out stimulant intoxication. Diagnosis
of a primary bipolar disorder (A) is premature without first
confirming the symptoms are not attributable to
hyperthyroidism, despite a recent normal TSH, as levels can
fluctuate. Option C is a potential outcome but requires
confirmation from the assessment. D is incorrect due to the
severity and acuity of symptoms.
Q2. A 72-year-old man with a history of Major Neurocognitive
Disorder due to Alzheimer's disease presents with new-onset
visual hallucinations of insects on the wall and paranoid
delusions that his home health aide is stealing from him. He has
no prior psychiatric history. His medications include donepezil
and memantine. His cognitive function has declined gradually
over 4 years. What is the most likely diagnosis?
A. Delirium
B. Schizophrenia
C. Major Depressive Disorder with psychotic features
D. Major Neurocognitive Disorder due to Alzheimer's disease,
with behavioral disturbance (psychotic features)
Correct Answer: D
Rationale: In the context of an established Major NCD, the new
,onset of psychotic symptoms is most commonly a behavioral
disturbance specifier of the NCD itself. Delirium (A) is less likely
given the chronic, stable medical context and absence of acute
fluctuating consciousness. Schizophrenia (B) onset is
implausible at this age. MDD with psychotic features (C) is
possible but the presentation lacks prominent affective
symptoms, making the direct association with the NCD more
parsimonious.
Q3. A 16-year-old adolescent is brought in by parents for school
refusal, social withdrawal, and "odd behavior" including staring
at self in mirrors for hours and muttering to himself. Symptoms
began insidiously around age 14. He shows flat affect, makes
poor eye contact, and expresses vague ideas of reference that
his classmates' laughter is "about him." He denies
hallucinations. What is the leading differential diagnosis?
A. Autism Spectrum Disorder
B. Social Anxiety Disorder
C. Schizophreniaform Disorder
D. Schizotypal Personality Disorder
Correct Answer: C
Rationale: The presentation with prodromal symptoms leading
to clear psychotic symptoms (ideas of reference) and negative
symptoms (flat affect, social withdrawal) over a 6-month period
meets criteria for Schizophreniaform Disorder, pending
duration. If symptoms persist beyond 6 months, it would
become Schizophrenia. ASD (A) involves social deficits but not
, typically prominent psychotic features. Social Anxiety (B) does
not explain the odd behavior and ideas of reference.
Schizotypal PD (D) involves pervasive interpersonal deficits and
cognitive distortions, but not clear-cut, persistent psychotic
symptoms; it is also rarely diagnosed in adolescence.
Q4. A 45-year-old woman presents with a 9-month history of
profound fatigue, widespread pain, cognitive complaints ("brain
fog"), and unrefreshing sleep. Extensive medical workup by
rheumatology and neurology, including ANA, ESR, CRP, and MRI
brain, is normal. She is distressed and functionally impaired.
She denies depressed mood or anhedonia as primary
complaints. What diagnosis should be considered?
A. Major Depressive Disorder
B. Somatic Symptom Disorder
C. Illness Anxiety Disorder
D. Generalized Anxiety Disorder
Correct Answer: B
Rationale: This presentation is classic for Somatic Symptom
Disorder, specifically with predominant pain and persistent
course (DSM-5-TR criteria). The key is one or more distressing
somatic symptoms accompanied by excessive thoughts,
feelings, or behaviors related to the symptoms. While MDD (A)
can include somatic symptoms, she denies core mood
symptoms. Illness Anxiety Disorder (C) is preoccupation with
having a serious illness, not necessarily with prominent somatic
Chamberlain College of Nursing Differential
Diagnosis in Psychiatric-Mental Health Across
Lifespan | 50 Expert Q&A | Test Bank &
PMHNP Practicum Prep
Q1. A 28-year-old female presents with a 3-week history of
persistently elevated mood, grandiosity, decreased need for
sleep, and pressured speech. She has been spending
excessively. Her PHQ-9 score last month during a depressive
episode was 18. Her medical history is significant for
hyperthyroidism, currently managed with methimazole, with
her most recent TSH from 2 weeks ago being 0.8 mIU/L
(normal). What is the most critical next step in diagnostic
assessment?
A. Diagnose Bipolar I Disorder and initiate lithium.
B. Order a urine drug screen and check current thyroid function
tests.
C. Diagnose Substance/Medication-Induced Bipolar and Related
Disorder.
D. Diagnose Cyclothymic Disorder.
,Correct Answer: B
Rationale: While the symptoms meet criteria for a manic
episode, the presence of a known medical condition
(hyperthyroidism) that can induce manic-like symptoms
necessitates ruling out a medical etiology first. A urine drug
screen is also vital to rule out stimulant intoxication. Diagnosis
of a primary bipolar disorder (A) is premature without first
confirming the symptoms are not attributable to
hyperthyroidism, despite a recent normal TSH, as levels can
fluctuate. Option C is a potential outcome but requires
confirmation from the assessment. D is incorrect due to the
severity and acuity of symptoms.
Q2. A 72-year-old man with a history of Major Neurocognitive
Disorder due to Alzheimer's disease presents with new-onset
visual hallucinations of insects on the wall and paranoid
delusions that his home health aide is stealing from him. He has
no prior psychiatric history. His medications include donepezil
and memantine. His cognitive function has declined gradually
over 4 years. What is the most likely diagnosis?
A. Delirium
B. Schizophrenia
C. Major Depressive Disorder with psychotic features
D. Major Neurocognitive Disorder due to Alzheimer's disease,
with behavioral disturbance (psychotic features)
Correct Answer: D
Rationale: In the context of an established Major NCD, the new
,onset of psychotic symptoms is most commonly a behavioral
disturbance specifier of the NCD itself. Delirium (A) is less likely
given the chronic, stable medical context and absence of acute
fluctuating consciousness. Schizophrenia (B) onset is
implausible at this age. MDD with psychotic features (C) is
possible but the presentation lacks prominent affective
symptoms, making the direct association with the NCD more
parsimonious.
Q3. A 16-year-old adolescent is brought in by parents for school
refusal, social withdrawal, and "odd behavior" including staring
at self in mirrors for hours and muttering to himself. Symptoms
began insidiously around age 14. He shows flat affect, makes
poor eye contact, and expresses vague ideas of reference that
his classmates' laughter is "about him." He denies
hallucinations. What is the leading differential diagnosis?
A. Autism Spectrum Disorder
B. Social Anxiety Disorder
C. Schizophreniaform Disorder
D. Schizotypal Personality Disorder
Correct Answer: C
Rationale: The presentation with prodromal symptoms leading
to clear psychotic symptoms (ideas of reference) and negative
symptoms (flat affect, social withdrawal) over a 6-month period
meets criteria for Schizophreniaform Disorder, pending
duration. If symptoms persist beyond 6 months, it would
become Schizophrenia. ASD (A) involves social deficits but not
, typically prominent psychotic features. Social Anxiety (B) does
not explain the odd behavior and ideas of reference.
Schizotypal PD (D) involves pervasive interpersonal deficits and
cognitive distortions, but not clear-cut, persistent psychotic
symptoms; it is also rarely diagnosed in adolescence.
Q4. A 45-year-old woman presents with a 9-month history of
profound fatigue, widespread pain, cognitive complaints ("brain
fog"), and unrefreshing sleep. Extensive medical workup by
rheumatology and neurology, including ANA, ESR, CRP, and MRI
brain, is normal. She is distressed and functionally impaired.
She denies depressed mood or anhedonia as primary
complaints. What diagnosis should be considered?
A. Major Depressive Disorder
B. Somatic Symptom Disorder
C. Illness Anxiety Disorder
D. Generalized Anxiety Disorder
Correct Answer: B
Rationale: This presentation is classic for Somatic Symptom
Disorder, specifically with predominant pain and persistent
course (DSM-5-TR criteria). The key is one or more distressing
somatic symptoms accompanied by excessive thoughts,
feelings, or behaviors related to the symptoms. While MDD (A)
can include somatic symptoms, she denies core mood
symptoms. Illness Anxiety Disorder (C) is preoccupation with
having a serious illness, not necessarily with prominent somatic
