NR 547 Final Exam 2025/2026 Test Bank |
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Q&A | Nursing Exam
Prep Guide
Q1. A 24-year-old graduate student presents with a 10-day
history of persistently elevated mood, grandiosity, decreased
need for sleep, and pressured speech. He has maxed out his
credit cards on impulsive purchases. His roommate reports a
similar episode two years ago that resulted in academic
probation, followed by a 6-month period of profound sadness
and anhedonia. What is the most accurate initial diagnosis?
A. Bipolar I Disorder, current episode manic
B. Bipolar II Disorder, current episode hypomanic
C. Cyclothymic Disorder
D. Major Depressive Disorder with mixed features
Correct Answer: A
Rationale: The presence of a full manic episode (lasting 10 days,
causing significant impairment with financial and academic
consequences) and a history of a major depressive episode
meets criteria for Bipolar I Disorder. Bipolar II requires at least
,one hypomanic and one major depressive episode, but no
history of mania. The severity and functional impairment
described rule out hypomania and cyclothymia.
Q2. (Select All That Apply) A 68-year-old woman with a history
of Major Depressive Disorder presents with a 4-month
progression of cognitive deficits. Her daughter notes she gets
lost in her neighborhood, has difficulty with recipes she’s used
for years, and often repeats questions. On exam, she is
apathetic and scores 20/30 on the MoCA, with deficits in recall,
orientation, and executive function. Which of the following are
essential next steps in the differential diagnosis? Select three.
A. Order a brain MRI with coronal hippocampal cuts.
B. Initiate a trial of memantine.
C. Rule out Delirium with a comprehensive metabolic panel,
CBC, and urinalysis.
D. Assess for depressive pseudodementia with a geriatric
depression scale.
E. Prescribe donepezil based on the MoCA score alone.
Correct Answer: A, C, D
Rationale: The presentation suggests Major Neurocognitive
Disorder (likely Alzheimer's). Essential steps include structural
neuroimaging (A) to assess for other etiologies like vascular
disease, ruling out delirium (C) as a reversible cause, and
assessing for the significant overlap of depression and cognitive
decline in the elderly (D). Initiating medication (B, E) is
premature before a thorough diagnostic workup is completed.
,Q3. A 9-year-old boy is brought in for evaluation. His teacher
reports he frequently daydreams, stares into space for 10-15
seconds, and sometimes blinks repetively during these
episodes. He does not fall or lose postural control. These
episodes occur multiple times daily. Academically, he has
recently started struggling with math. What is the most likely
diagnosis?
A. Attention-Deficit/Hyperactivity Disorder, Predominantly
Inattentive Presentation
B. Childhood Absence Epilepsy
C. Autism Spectrum Disorder
D. Typical childhood inattention
Correct Answer: B
Rationale: The hallmark signs of brief staring spells (absence
seizures) with automatisms (eye blinking) and no loss of
posture, occurring multiple times a day with an impact on
learning, are classic for Childhood Absence Epilepsy. ADHD
inattention is more pervasive and not characterized by discrete,
unresponsive staring spells. This requires urgent referral to
neurology.
Q4. A 35-year-old veteran presents with chronic low mood,
irritability, and an exaggerated startle response for the past five
years. He reports persistent avoidance of crowded places and
negative thoughts about himself ("I am a monster"). He denies
flashbacks or intrusive memories of his combat experience but
becomes intensely agitated when hearing fireworks. What is
, the most accurate diagnosis?
A. Posttraumatic Stress Disorder
B. Major Depressive Disorder
C. Generalized Anxiety Disorder
D. Adjustment Disorder
Correct Answer: A
Rationale: This meets DSM-5-TR criteria for PTSD. The
diagnostic criteria no longer require active re-experiencing via
flashbacks; the presence of cue-triggered psychological
distress (fireworks causing agitation) fulfills Criterion B.
Avoidance (Criterion C), negative alterations in cognition/mood
(Criterion D), and hyperarousal (Criterion E) are all clearly
present.
Q5. A 19-year-old female presents with a 1-year history of
recurrent, unexpected panic attacks. She now has persistent
concern about having more attacks and has significantly
changed her behavior, refusing to drive on highways or go to
large lectures. She denies depression, trauma history, or
substance use. What is the primary diagnosis?
A. Panic Disorder
B. Agoraphobia
C. Generalized Anxiety Disorder
D. Panic Disorder with Agoraphobia
Correct Answer: D
Rationale: The criteria for Panic Disorder are met (recurrent
unexpected panic attacks followed by ≥1 month of persistent
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Q&A | Nursing Exam
Prep Guide
Q1. A 24-year-old graduate student presents with a 10-day
history of persistently elevated mood, grandiosity, decreased
need for sleep, and pressured speech. He has maxed out his
credit cards on impulsive purchases. His roommate reports a
similar episode two years ago that resulted in academic
probation, followed by a 6-month period of profound sadness
and anhedonia. What is the most accurate initial diagnosis?
A. Bipolar I Disorder, current episode manic
B. Bipolar II Disorder, current episode hypomanic
C. Cyclothymic Disorder
D. Major Depressive Disorder with mixed features
Correct Answer: A
Rationale: The presence of a full manic episode (lasting 10 days,
causing significant impairment with financial and academic
consequences) and a history of a major depressive episode
meets criteria for Bipolar I Disorder. Bipolar II requires at least
,one hypomanic and one major depressive episode, but no
history of mania. The severity and functional impairment
described rule out hypomania and cyclothymia.
Q2. (Select All That Apply) A 68-year-old woman with a history
of Major Depressive Disorder presents with a 4-month
progression of cognitive deficits. Her daughter notes she gets
lost in her neighborhood, has difficulty with recipes she’s used
for years, and often repeats questions. On exam, she is
apathetic and scores 20/30 on the MoCA, with deficits in recall,
orientation, and executive function. Which of the following are
essential next steps in the differential diagnosis? Select three.
A. Order a brain MRI with coronal hippocampal cuts.
B. Initiate a trial of memantine.
C. Rule out Delirium with a comprehensive metabolic panel,
CBC, and urinalysis.
D. Assess for depressive pseudodementia with a geriatric
depression scale.
E. Prescribe donepezil based on the MoCA score alone.
Correct Answer: A, C, D
Rationale: The presentation suggests Major Neurocognitive
Disorder (likely Alzheimer's). Essential steps include structural
neuroimaging (A) to assess for other etiologies like vascular
disease, ruling out delirium (C) as a reversible cause, and
assessing for the significant overlap of depression and cognitive
decline in the elderly (D). Initiating medication (B, E) is
premature before a thorough diagnostic workup is completed.
,Q3. A 9-year-old boy is brought in for evaluation. His teacher
reports he frequently daydreams, stares into space for 10-15
seconds, and sometimes blinks repetively during these
episodes. He does not fall or lose postural control. These
episodes occur multiple times daily. Academically, he has
recently started struggling with math. What is the most likely
diagnosis?
A. Attention-Deficit/Hyperactivity Disorder, Predominantly
Inattentive Presentation
B. Childhood Absence Epilepsy
C. Autism Spectrum Disorder
D. Typical childhood inattention
Correct Answer: B
Rationale: The hallmark signs of brief staring spells (absence
seizures) with automatisms (eye blinking) and no loss of
posture, occurring multiple times a day with an impact on
learning, are classic for Childhood Absence Epilepsy. ADHD
inattention is more pervasive and not characterized by discrete,
unresponsive staring spells. This requires urgent referral to
neurology.
Q4. A 35-year-old veteran presents with chronic low mood,
irritability, and an exaggerated startle response for the past five
years. He reports persistent avoidance of crowded places and
negative thoughts about himself ("I am a monster"). He denies
flashbacks or intrusive memories of his combat experience but
becomes intensely agitated when hearing fireworks. What is
, the most accurate diagnosis?
A. Posttraumatic Stress Disorder
B. Major Depressive Disorder
C. Generalized Anxiety Disorder
D. Adjustment Disorder
Correct Answer: A
Rationale: This meets DSM-5-TR criteria for PTSD. The
diagnostic criteria no longer require active re-experiencing via
flashbacks; the presence of cue-triggered psychological
distress (fireworks causing agitation) fulfills Criterion B.
Avoidance (Criterion C), negative alterations in cognition/mood
(Criterion D), and hyperarousal (Criterion E) are all clearly
present.
Q5. A 19-year-old female presents with a 1-year history of
recurrent, unexpected panic attacks. She now has persistent
concern about having more attacks and has significantly
changed her behavior, refusing to drive on highways or go to
large lectures. She denies depression, trauma history, or
substance use. What is the primary diagnosis?
A. Panic Disorder
B. Agoraphobia
C. Generalized Anxiety Disorder
D. Panic Disorder with Agoraphobia
Correct Answer: D
Rationale: The criteria for Panic Disorder are met (recurrent
unexpected panic attacks followed by ≥1 month of persistent
