NR 547 Final Exam 2025/2026 |
Chamberlain College of Nursing
Differential Diagnosis PMHNP Practicum
Guide | 50 Q&A with Rationales &
DSM-5-TR Criteria
**Q1.** A 24-year-old graduate student presents with a 3-week
history of pervasive low mood, anhedonia, hypersomnia,
significant weight gain, and a profound sense of leaden
paralysis. She reports that these episodes have occurred like
"clockwork" for the past three autumns, lasting into spring, with
full remission in the summer. What is the most likely specifier
for her Major Depressive Disorder?
A. With melancholic features
B. With seasonal pattern
C. With atypical features
D. With peripartum onset
**Correct Answer: B**
**Rationale:** The hallmark of Major Depressive Disorder,
With seasonal pattern (previously Seasonal Affective Disorder),
,is a temporal relationship where major depressive episodes
occur at a characteristic time of year (e.g., fall/winter) with full
remission at a characteristic time (e.g., spring). The symptoms
described—hypersomnia, weight gain, leaden paralysis—are
classic for "atypical features," but the defining characteristic in
this vignette is the clear, recurrent seasonal pattern overriding
the atypical symptom profile.
**Q2.** A 16-year-old is brought in by his parents for "odd
behavior." For the past 8 months, he has become increasingly
isolative, believing his classmates are plotting to embarrass him.
He reports hearing a voice that comments on his actions in the
third person. His academic performance has declined from As
to Cs. His uncle has schizophrenia. The PMHNP notes mild
poverty of speech and constricted affect. Which diagnosis is
supported at this time?
A. Schizophrenia
B. Delusional Disorder
C. Schizophreniform Disorder
D. Schizotypal Personality Disorder
**Correct Answer: C**
**Rationale:** The patient presents with clear psychotic
symptoms (delusions, hallucinations) and functional decline,
,lasting more than 1 month but less than 6 months, which meets
the duration criteria for Schizophreniform Disorder. The family
history and negative symptoms are supportive but not required.
A diagnosis of Schizophrenia requires symptoms for at least 6
months. Delusional Disorder involves non-bizarre delusions for
1+ month without other prominent psychotic symptoms.
Schizotypal PD is a pervasive pattern, not a discrete psychotic
episode.
**Q3.** (Select All That Apply) A 55-year-old man with a 30-
year history of chronic, severe alcohol use disorder presents
with confusion, ataxia, and ophthalmoplegia (paralysis of eye
muscles). Which of the following are appropriate components
of the immediate management and diagnosis? Select three.
A. Administer intravenous thiamine immediately.
B. Order an urgent MRI brain to assess for mammillary body
lesions.
C. Prescribe a high-potency antipsychotic for presumed
delirium.
D. Start a lorazepam taper for alcohol withdrawal prophylaxis.
E. Assess for confabulation and recent memory impairment.
**Correct Answer: A, B, E**
, **Rationale:** This presentation is classic for Wernicke's
encephalopathy, a medical emergency caused by thiamine
deficiency. Immediate IV thiamine is critical to prevent
progression to irreversible Korsakoff's syndrome (characterized
by confabulation and anterograde amnesia). MRI may show
characteristic mammillary body lesions. Antipsychotics are not
first-line for this metabolic encephalopathy. While withdrawal
prophylaxis is important, the acute neurological symptoms take
precedence and require thiamine repletion *before* glucose
administration to avoid worsening the condition.
**Q4.** A 7-year-old boy's teacher reports he frequently blurts
out answers, has difficulty waiting his turn, and often loses his
pencils. At home, his parents note he is forgetful with chores
and avoids homework that requires sustained mental effort.
However, he can focus for over an hour when building complex
Lego models or playing video games. What is the most
important next step in the diagnostic assessment?
A. Diagnose ADHD, Combined Presentation.
B. Rule out Autism Spectrum Disorder.
C. Assess for the pervasiveness and functional impact of
symptoms across multiple settings.
D. Administer a stimulant trial to confirm the diagnosis.
Chamberlain College of Nursing
Differential Diagnosis PMHNP Practicum
Guide | 50 Q&A with Rationales &
DSM-5-TR Criteria
**Q1.** A 24-year-old graduate student presents with a 3-week
history of pervasive low mood, anhedonia, hypersomnia,
significant weight gain, and a profound sense of leaden
paralysis. She reports that these episodes have occurred like
"clockwork" for the past three autumns, lasting into spring, with
full remission in the summer. What is the most likely specifier
for her Major Depressive Disorder?
A. With melancholic features
B. With seasonal pattern
C. With atypical features
D. With peripartum onset
**Correct Answer: B**
**Rationale:** The hallmark of Major Depressive Disorder,
With seasonal pattern (previously Seasonal Affective Disorder),
,is a temporal relationship where major depressive episodes
occur at a characteristic time of year (e.g., fall/winter) with full
remission at a characteristic time (e.g., spring). The symptoms
described—hypersomnia, weight gain, leaden paralysis—are
classic for "atypical features," but the defining characteristic in
this vignette is the clear, recurrent seasonal pattern overriding
the atypical symptom profile.
**Q2.** A 16-year-old is brought in by his parents for "odd
behavior." For the past 8 months, he has become increasingly
isolative, believing his classmates are plotting to embarrass him.
He reports hearing a voice that comments on his actions in the
third person. His academic performance has declined from As
to Cs. His uncle has schizophrenia. The PMHNP notes mild
poverty of speech and constricted affect. Which diagnosis is
supported at this time?
A. Schizophrenia
B. Delusional Disorder
C. Schizophreniform Disorder
D. Schizotypal Personality Disorder
**Correct Answer: C**
**Rationale:** The patient presents with clear psychotic
symptoms (delusions, hallucinations) and functional decline,
,lasting more than 1 month but less than 6 months, which meets
the duration criteria for Schizophreniform Disorder. The family
history and negative symptoms are supportive but not required.
A diagnosis of Schizophrenia requires symptoms for at least 6
months. Delusional Disorder involves non-bizarre delusions for
1+ month without other prominent psychotic symptoms.
Schizotypal PD is a pervasive pattern, not a discrete psychotic
episode.
**Q3.** (Select All That Apply) A 55-year-old man with a 30-
year history of chronic, severe alcohol use disorder presents
with confusion, ataxia, and ophthalmoplegia (paralysis of eye
muscles). Which of the following are appropriate components
of the immediate management and diagnosis? Select three.
A. Administer intravenous thiamine immediately.
B. Order an urgent MRI brain to assess for mammillary body
lesions.
C. Prescribe a high-potency antipsychotic for presumed
delirium.
D. Start a lorazepam taper for alcohol withdrawal prophylaxis.
E. Assess for confabulation and recent memory impairment.
**Correct Answer: A, B, E**
, **Rationale:** This presentation is classic for Wernicke's
encephalopathy, a medical emergency caused by thiamine
deficiency. Immediate IV thiamine is critical to prevent
progression to irreversible Korsakoff's syndrome (characterized
by confabulation and anterograde amnesia). MRI may show
characteristic mammillary body lesions. Antipsychotics are not
first-line for this metabolic encephalopathy. While withdrawal
prophylaxis is important, the acute neurological symptoms take
precedence and require thiamine repletion *before* glucose
administration to avoid worsening the condition.
**Q4.** A 7-year-old boy's teacher reports he frequently blurts
out answers, has difficulty waiting his turn, and often loses his
pencils. At home, his parents note he is forgetful with chores
and avoids homework that requires sustained mental effort.
However, he can focus for over an hour when building complex
Lego models or playing video games. What is the most
important next step in the diagnostic assessment?
A. Diagnose ADHD, Combined Presentation.
B. Rule out Autism Spectrum Disorder.
C. Assess for the pervasiveness and functional impact of
symptoms across multiple settings.
D. Administer a stimulant trial to confirm the diagnosis.
